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Pathological grading of regression following neoadjuvant chemoradiation therapy: the clinical need is now
  1. Tom P MacGregor,
  2. Tim S Maughan,
  3. Ricky A Sharma
  1. Oncology Department, Old Road Research Campus Building, Oxford, United Kingdom, OX3 7DQ
  1. Correspondence to Dr Ricky A Sharma, Cancer Research UK-Medical Research Council Gray Institute for Radiation Oncology and Biology, Oncology Department, Old Road Research Campus Building, OX3 7DQ, UK; ricky.sharma{at}


Neoadjuvant chemoradiotherapy for locally advanced rectal cancer has been shown to decrease rates of local recurrence and more than double the rate of sphincter-preserving surgery. There is now compelling evidence that pathological complete response is an independent predictor of likelihood of local recurrence, distal metastases, disease-free and overall survival in locally advanced rectal cancer following neoadjuvant chemoradiotherapy. Pathological regression grading can therefore guide clinical decisions about salvage surgical strategies, adjuvant therapy and long-term surveillance. No universally recognised regression grading system currently exists for pathologists presented with resected tumour specimens following neoadjuvant chemoradiotherapy. The purpose of this review is to highlight the relevance of accurate tumour regression grading in achieving optimal clinical care for patients with rectal cancer.

  • Rectal neoplasms
  • chemoradiotherapy
  • neoadjuvant therapy
  • tumour regression grade
  • cancer
  • rectal cancer

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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