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Tumour regression after radiotherapy for rectal cancer - Results from the randomised Stockholm III trial
Karolinska Inst, Dept Mol Med & Surg, Solna, Sweden;Karolinska Univ Hosp, Dept Colorectal Canc, Stockholm, Sweden;Karolinska Univ Hosp, Karolinska Inst, Dept Mol Med & Surg, S-17176 Stockholm, Sweden.
Skane Univ Hosp, Dept Pathol & Cytol, Div Pathol Lund, Lund, Sweden;Dept Clin Sci, Div Oncol & Pathol, Barngatan 2B, SE-22185 Lund, Sweden.
Karolinska Inst, Dept Mol Med & Surg, Solna, Sweden;Karolinska Univ Hosp, Dept Colorectal Canc, Stockholm, Sweden;Karolinska Univ Hosp, Karolinska Inst, Dept Mol Med & Surg, S-17176 Stockholm, Sweden.
Karolinska Inst, Dept Mol Med & Surg, Solna, Sweden;Norrtalje Sjukhus, Dept Surg, Norrtalje, Sweden;TioHundra AB, Kirurgmottagningen, Box 905, S-76129 Norrtalje, Sweden.
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2019 (English)In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 135, p. 178-186Article in journal (Refereed) Published
Abstract [en]

Background and purpose: Neoadjuvant radiotherapy (RT) in rectal cancer induces tumour regression with a possible complete response (pCR). The optimal fractionation and timing to surgery is not established. The Stockholm III trial randomly assigned 840 patients to 5 x 5 Gy surgery within one week (SRT), 5 x 5 Gy with surgery after 4-8 weeks, and 2 Gy x 25 with surgery after 4-8 weeks (LRT-delay). The aim of this substudy was to assess tumour regression and correlation to survival. Material and methods: All available microscopy slides were assessed by one pathologist, blinded to treatment, regarding tumour regression, graded according to the Dworak system (TRG), TNM-stage and other standard histopathology characteristics. Patients' data were collected from the Swedish ColoRectal Cancer Registry. Outcomes were TRG, pCR-rates, overall survival (OS) and time to recurrence (TTR). Results: 318, 285 and 94 patients were included in the SRT, SRT-delay and LRT-delay groups. Median follow up was 5.7 years. There were significantly lower tumour stages after SRT-delay. pCR was seen in 1 (0.3%), 29 (10.4%) and 2 (2.2%) patients in SRT, SRT-delay and LRT-delay, respectively. The pCR and Dworak grade 4 were associated with superior survival. pCR vs no-pCR Hazard Ratio (95% Confidence Interval) OS: 0.51 (0.26-0.99) p = 0.046, TTR: 0.27 (0.09-0.86) p = 0.027. Conclusion: SRT-delay induces pCR in about 10% of the patients and is in this aspect superior to 25 x 2 Gy. A complete tumour response, TRG 4 using the Dworak system, or a pCR, is associated with superior OS and TTR.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD , 2019. Vol. 135, p. 178-186
Keywords [en]
Cancer, Colorectal cancer, Radiotherapy, Neoadjuvant treatment, Neoadjuvant radiotherapy, Rectal cancer
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-385962DOI: 10.1016/j.radonc.2019.03.016ISI: 000468409200024PubMedID: 31015165OAI: oai:DiVA.org:uu-385962DiVA, id: diva2:1327140
Funder
Swedish Research CouncilThe Cancer Society in StockholmStockholm County CouncilSwedish Cancer SocietyThe Karolinska Institutet's Research FoundationAvailable from: 2019-06-19 Created: 2019-06-19 Last updated: 2019-06-19Bibliographically approved

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