Neoadjuvant chemoradiotherapy for rectal cancer: how important is tumour regression?

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Neoadjuvant chemoradiotherapy (CRT) improves resectability of locally advanced rectal cancer, and decreases the risk of local recurrence.1 However, the degree of tumour regression varies considerably between individuals. Approximately 20% of patients achieve a pathological complete response (pCR), yet a similar proportion experience little to no tumour regression, with remaining patients classed as partial or intermediate responders.4
Although it is now widely accepted that pCR is associated with improved long‐term prognosis,8 the significance of attaining a partial response is still debated. Several studies have shown improved disease‐free survival (DFS) in partial compared to poor responders,5 but others have suggested no survival benefit for anything less than a pCR or near pCR.11 A recent meta‐analysis of 11 studies reporting on tumour regression following neoadjuvant CRT demonstrated a 50% improvement in DFS in partial versus poor responders.13 However, the authors state that further studies are required to provide more detailed and precise estimates on the survival of such patients. To the best of our knowledge, none of the studies published to date have included patients with distant metastases at the time of primary surgery. The value of tumour regression in the context of metastatic disease therefore remains unknown.
Here we present data from 205 consecutive patients with stage II–IV rectal adenocarcinoma, treated with neoadjuvant CRT and surgical resection at a single centre. The aim was to assess the prognostic value of tumour regression.
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