P-0275 - Clinical significance of tumour regression grade in locally-advanced rectal cancer treated with preoperative chemoradiotherapy

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Anti-Cancer Agents & Biologic Therapy
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Alba Hernandez
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors A. Hernandez1, J. Hernando2, A. Anton3, S. Rosero-Cuesta David2, V. Alonso-Orduña1, E. Polo2, M. Ponce Jose2, C. Hörndler2, A. Monzon2, L. Sarria2
  • 1Hospital MIguel Servet, Zaragoza/ES
  • 2Hospital Miguel Servet, Zaragoza/ES
  • 3Hospital Universitario Miguel Servet, Zaragoza/ES



Neoadjuvant chemoradiotherapy applied to the locally advanced rectal cancer reduces local recurrence and improves survival. We assessed the influence of tumor regression grade (TRG) on survival in locally-advanced rectal cancer patients treated with fluoropyrimidine-based chemoradiotherapy followed by surgical resection.


86 patients treated at our hospital between January 2007 and December 2009 were analyzed. Patients received preoperative chemoradiotherapy consisting of Capecitabine 825 mg/m2 bid from Monday to Friday every week with concurrent pelvic radiation of 50.4 Gy, followed by radical surgery (total mesorectal excision) at 6-8 weeks. The TRG was determined by the amount of fibrosis in the tumor and was divided into 5 grades: TRG4 no viable tumor cells, TRG3 more than 50% tumor regression (dominant fibrosis outgrowing the tumor mass), TRG2 dominant tumor mass with obvious fibrosis in 26-50% of the tumor mass, TRG1 dominant tumor mass with obvious fibrosis in ≤25% of the tumor mass and TRG0 fibrosis was completely absent. We analyzed the role of TRG as a prognostic factor.


Median follow-up was 51 months. Frequency of TRG: Total Regression TRG4 (14%), Good Regression TRG3 (55,8%), Moderate Regression TRG2 (22,1%), Minor Regression TRG1 (7%) and No Regression TRG0 (1,2%). 5-year disease-free survival for all the group was 71%. 5-year disease-free survival: TRG4 90%, TRG3-TRG2 82% and TRG1-TRG0 43,5%(p = 0,001). 5-year overall survival for all the Group was 74%. 5-year overall survival: TRG4 80%, TRG3-TRG2 84% and TRG0-1 62% (p= 0,015)


Higher TRG after preoperative chemoradiotherapy for rectal cancer closely correlates with better overall and disease-free survival. The TRG is considered to be a significant prognostic factor.