Abstract
To ascertain the approach and degree of consensus of pathologists in the handling and regression grading of colorectal cancer resection specimens treated with neoadjuvant chemoradiation, a ten-part questionnaire was circulated to 18 gastrointestinal pathologists in eight countries. The questions were specific and addressed pertinent issues related to colorectal cancer with neoadjuvant chemoradiation. There is a lack of consensus on how to handle the specimen, number of sections taken, correlation with pre- and post-operative radiological imaging, and especially, regression grading schema employed. Consensus in the form of guidelines is required so that the pathological assessment of these specimens will provide clinically relevant information for patient management, irrespective of location.
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Gerard A, Buyse M, Nordlinger B et al (1998) Preoperative radiotherapy as adjuvant treatment in rectal cancer: final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC). Ann Surg 208:606–614
Janjan NA, Khoo VS, Abbruzzese J et al (1999) Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M.D. Anderson Center experience. Int J Radiat Oncol Biol Phys 44:1027–1038
Camma C, Giunta M, Fiorica F et al (2000) Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. JAMA 284:1008–1015
Kaminsky-Forrett MC, Conroy T, Luporsi E et al (1998) Prognostic implications of downstaging following preoperative radiation therapy for operable T3–T4 rectal cancer. Int J Radiat Oncol Biol Phys 42:935–941
Mohiuddin M, Hayne M, Regine WF et al (2000) Prognostic significance of postchemoradiation stage following preoperative chemotherapy and radiation for advanced/recurrent rectal cancers. Int J Radiat Oncol Biol Phys 48:1075–1080
Medich D, McGinty J, Parda D et al (2001) Preoperative chemoradiotherapy and radical surgery for locally advanced distal rectal adenocarcinoma. Dis Colon Rectum 44:1123–1128
Mandard AM, Dalibard F, Mandard JC et al (1994) Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma: clinicopathologic correlations. Cancer 73:2680–2686
Dworak O, Keilholz L, Hoffmann A (1997) Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis 12:19–23
Bateman AC, Jaynes E, Bateman AR (2009) Rectal cancer staging post neoadjuvant therapy—how should the changes be assessed? Histopathology 54:713–721
Pucciarelli S, Toppan P, Friso ML et al (2004) Complete pathologic response following preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome. Dis Colon Rectum 47:1798–1807
Bouzourene H, Bosman FT, Seelentag W, Matter M, Coucke P (2002) Importance of tumour regression assessment in predicting the outcome in patients with locally advanced rectal carcinoma who are treated with preoperative radiotherapy. Cancer 94:1121–1130
Wheeler JMD, Dodds E, Warren BF et al (2004) Preoperative chemoradiotherapy and total mesorectal excision surgery for locally advanced rectal cancer: correlation with rectal cancer regression grade. Dis Colon Rectum 47:2025–2031
Vecchio FM, Valentini V, Minsky BD et al (2005) The relationship of pathologic tumour regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys 62:752–760
Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740
O’Neill BDP, Brown G, Heald RJ et al (2007) Non-operative treatment after neoadjuvant chemoradiotherapy for rectal cancer. Lancet Oncol 8:625–633
Rodel C, Martus P, Papadoupolos T et al (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23:8688–8696
Nagtegaal ID, Klein E, Kranenbarg J et al (2000) Pathology data in the central databases of multicenter randomized trials need to be based on pathology reports and controlled by trained quality managers. J Clin Oncol 18:1771–1779
Nagtegaal ID, Marijnen CAM, Kranenbarg EK et al (2002) Short-term preoperative radiotherapy interferes with the determination of pathological parameters in rectal cancer. J Pathol 197:20–27
Glynne-Jones R, Anyamene N (2006) Just how useful an endpoint is complete pathological response after neoadjuvant chemoradiation in rectal cancer? Int J Radiat Oncol Biol Phys 66:319–320
Valentini V, Aristei C, Glimelius B et al (2009) Multidisciplinary rectal cancer management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2). Radiother Oncol 92:148–163
Williams GT, Quirke P, Shepherd NA (2007) Royal College of Pathologists’ Dataset for Colorectal Cancer, 2nd revision. http://www.rcpath.org/resources/pdf/G049-ColorectalDataset-Sep07.pdf
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Chetty, R., Gill, P., Govender, D. et al. A multi-centre pathologist survey on pathological processing and regression grading of colorectal cancer resection specimens treated by neoadjuvant chemoradiation. Virchows Arch 460, 151–155 (2012). https://doi.org/10.1007/s00428-012-1193-3
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DOI: https://doi.org/10.1007/s00428-012-1193-3