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Tumour regression a...
Tumour regression after radiotherapy for rectal cancer - Results from the randomised Stockholm III trial
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- Erlandsson, Johan (author)
- Karolinska Institutet
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- Lorinc, Ester (author)
- Skane Univ Hosp, Dept Pathol & Cytol, Div Pathol Lund, Lund, Sweden;Dept Clin Sci, Div Oncol & Pathol, Barngatan 2B, SE-22185 Lund, Sweden
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- Ahlberga, Madelene (author)
- 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
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- Pettersson, David (author)
- 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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- Holm, Torbjorn (author)
- Karolinska Institutet
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- Glimelius, Bengt (author)
- Uppsala universitet,Experimentell och klinisk onkologi
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- Martling, Anna (author)
- Karolinska Institutet
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(creator_code:org_t)
- ELSEVIER IRELAND LTD, 2019
- 2019
- English.
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In: Radiotherapy and Oncology. - : ELSEVIER IRELAND LTD. - 0167-8140 .- 1879-0887. ; 135, s. 178-186
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Subject headings
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
Keyword
- Cancer
- Colorectal cancer
- Radiotherapy
- Neoadjuvant treatment
- Neoadjuvant radiotherapy
- Rectal cancer
Publication and Content Type
- ref (subject category)
- art (subject category)
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