Pathological Response Assessment following Long Course Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Single Institutional Cohort Study
Introduction: Neoadjuvant chemoradiation and Total Mesorectal Excision (TME) have shown pathological complete response (pCR) rates of 15-27%. The pCR is a significant predictor of survival. The Mandard Tumour Regression Grading (TRG) system is used to report pathological response. Aim: To evaluate...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2025-08-01
|
| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2025&month=August&volume=19&issue=8&page=XC15-XC18&id=21355 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849240607624527872 |
|---|---|
| author | Maria Baby Jomon Raphael B Rajkrishna Mathew Varghese Febin Antony |
| author_facet | Maria Baby Jomon Raphael B Rajkrishna Mathew Varghese Febin Antony |
| author_sort | Maria Baby |
| collection | DOAJ |
| description | Introduction: Neoadjuvant chemoradiation and Total Mesorectal Excision (TME) have shown pathological complete response (pCR) rates of 15-27%. The pCR is a significant predictor of survival. The Mandard Tumour Regression Grading (TRG) system is used to report pathological response.
Aim: To evaluate the pathological response in patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation and to investigate Disease-Free Survival (DFS).
Materials and Methods: This single-centre cohort ambispective study was conducted from January 2019 to July 2023 at the Amala Institute of Medical Sciences, Thrissur, Kerala, India. It included patients aged 18-75 years with T3, T4, any NM0, and any T, N1, N2M0 rectal cancer, with an Eastern Cooperative Oncology Group (ECOG) performance status of 1-2. Patients who did not undergo surgery or chemotherapy at our centre, those who refused surgery, and those planned for Total Neoadjuvant Therapy (TNT) or short-course radiation therapy were excluded. Thirty-nine patients meeting the criteria were included in the study. All patients underwent neoadjuvant chemoradiation using Intensity Modulated Radiation Therapy (IMRT) to a dose of 50.4 Gy in 28 fractions over five and a half weeks, combined with concurrent chemotherapy using Capecitabine 825 mg/m² twice daily. All operable patients subsequently underwent TME, followed by adjuvant chemotherapy. Pathological response was assessed using Mandard TRG.
Results: Thirty-nine patients were enrolled. The most common tumour location was found to be between 6-10 cm from the anal verge (22, 56.41%). The most frequent radiological T stage was T3, constituting 26 patients (66.67%), and 16 patients (41.03%) presented with N2 disease. TRG 1 was observed in seven patients (17.95%), TRG 2 in six patients (15.38%), TRG 3 in 21 patients (53.85%), TRG 4 in four patients (10.26%), and TRG 5 in one patient (2.56%). The median follow-up time was 24 months (range: 3-60 months). The two-year DFS was 86%.
Conclusion: Neoadjuvant chemoradiation in locally advanced rectal cancer demonstrated meaningful pathological tumour regression and encouraging DFS outcomes. |
| format | Article |
| id | doaj-art-79eb85247c814b17b58dd79d058abfc2 |
| institution | Kabale University |
| issn | 2249-782X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj-art-79eb85247c814b17b58dd79d058abfc22025-08-20T04:00:32ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X2025-08-01198XC15XC1810.7860/JCDR/2025/78942.21355Pathological Response Assessment following Long Course Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Single Institutional Cohort StudyMaria Baby0Jomon Raphael1B Rajkrishna2Mathew Varghese3Febin Antony4Junior Resident, Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India.Professor, Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India.Associate Professor, Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India.Associate Professor, Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India.Assistant Professor, Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India.Introduction: Neoadjuvant chemoradiation and Total Mesorectal Excision (TME) have shown pathological complete response (pCR) rates of 15-27%. The pCR is a significant predictor of survival. The Mandard Tumour Regression Grading (TRG) system is used to report pathological response. Aim: To evaluate the pathological response in patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation and to investigate Disease-Free Survival (DFS). Materials and Methods: This single-centre cohort ambispective study was conducted from January 2019 to July 2023 at the Amala Institute of Medical Sciences, Thrissur, Kerala, India. It included patients aged 18-75 years with T3, T4, any NM0, and any T, N1, N2M0 rectal cancer, with an Eastern Cooperative Oncology Group (ECOG) performance status of 1-2. Patients who did not undergo surgery or chemotherapy at our centre, those who refused surgery, and those planned for Total Neoadjuvant Therapy (TNT) or short-course radiation therapy were excluded. Thirty-nine patients meeting the criteria were included in the study. All patients underwent neoadjuvant chemoradiation using Intensity Modulated Radiation Therapy (IMRT) to a dose of 50.4 Gy in 28 fractions over five and a half weeks, combined with concurrent chemotherapy using Capecitabine 825 mg/m² twice daily. All operable patients subsequently underwent TME, followed by adjuvant chemotherapy. Pathological response was assessed using Mandard TRG. Results: Thirty-nine patients were enrolled. The most common tumour location was found to be between 6-10 cm from the anal verge (22, 56.41%). The most frequent radiological T stage was T3, constituting 26 patients (66.67%), and 16 patients (41.03%) presented with N2 disease. TRG 1 was observed in seven patients (17.95%), TRG 2 in six patients (15.38%), TRG 3 in 21 patients (53.85%), TRG 4 in four patients (10.26%), and TRG 5 in one patient (2.56%). The median follow-up time was 24 months (range: 3-60 months). The two-year DFS was 86%. Conclusion: Neoadjuvant chemoradiation in locally advanced rectal cancer demonstrated meaningful pathological tumour regression and encouraging DFS outcomes.https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2025&month=August&volume=19&issue=8&page=XC15-XC18&id=21355disease-free survivaltotal mesorectal excisiontumour regression grading |
| spellingShingle | Maria Baby Jomon Raphael B Rajkrishna Mathew Varghese Febin Antony Pathological Response Assessment following Long Course Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Single Institutional Cohort Study Journal of Clinical and Diagnostic Research disease-free survival total mesorectal excision tumour regression grading |
| title | Pathological Response Assessment following Long Course Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Single Institutional Cohort Study |
| title_full | Pathological Response Assessment following Long Course Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Single Institutional Cohort Study |
| title_fullStr | Pathological Response Assessment following Long Course Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Single Institutional Cohort Study |
| title_full_unstemmed | Pathological Response Assessment following Long Course Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Single Institutional Cohort Study |
| title_short | Pathological Response Assessment following Long Course Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Single Institutional Cohort Study |
| title_sort | pathological response assessment following long course neoadjuvant chemoradiation in locally advanced rectal cancer a single institutional cohort study |
| topic | disease-free survival total mesorectal excision tumour regression grading |
| url | https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2025&month=August&volume=19&issue=8&page=XC15-XC18&id=21355 |
| work_keys_str_mv | AT mariababy pathologicalresponseassessmentfollowinglongcourseneoadjuvantchemoradiationinlocallyadvancedrectalcancerasingleinstitutionalcohortstudy AT jomonraphael pathologicalresponseassessmentfollowinglongcourseneoadjuvantchemoradiationinlocallyadvancedrectalcancerasingleinstitutionalcohortstudy AT brajkrishna pathologicalresponseassessmentfollowinglongcourseneoadjuvantchemoradiationinlocallyadvancedrectalcancerasingleinstitutionalcohortstudy AT mathewvarghese pathologicalresponseassessmentfollowinglongcourseneoadjuvantchemoradiationinlocallyadvancedrectalcancerasingleinstitutionalcohortstudy AT febinantony pathologicalresponseassessmentfollowinglongcourseneoadjuvantchemoradiationinlocallyadvancedrectalcancerasingleinstitutionalcohortstudy |