Investigation of The Relationship Between Neoadjuvant Chemoradiotherapy Response and Prognostic Parameters In Rectal Adenocarcinomas

Öz

In rectal carcinomas, the rate of pelvic recurrence is quite high with surgery and adjuvant chemoradiotherapy (CRT). Therefore, neoadjuvant chemoradiotherapy (CRT) is used increasingly in rectal cancers. In our study, we aimed to reveal the CRT response in rectal cancers and to determine which clinical-morphological prognostic parameters are effective in predicting the treatment response. Forty-six patients with rectal cancer diagnosed between 2016-2019 and treated with neoadjuvant CRT were included in the study. The cases were re-examined by two pathologists for prognostic parameters and tumor regression grade (TRG). Modified Ryan Scoring system was used to evaluate TRG. Data showing Microsatellite instability (MSI) status with some parameters such as tumor diameter and distant metastasis before treatment were obtained by searching patient files on the computer. Nineteen of the 46 cases were female and 27 were male. Forty-four of the cases are classical adenocarcinoma and 2 of them are mucinous adenocarcinoma. According to TRG, which was used to evaluate the treatment response, 1 (2.2%) of the cases showed complete response (Score 0); 8 (17.4%) showed near-complete response (Score 1); 18 (39.1%) showed partial response (Score 2) and 19 (41.3%) showed no response or poor response (Score 3). A statistically significant relationship was found among prognostic parameters only between tumor grade and treatment response (p = 0.021). Response to treatment after CRT is in the inverse ratio to the pathological grade of the tumor. The treatment response is better in low grade tumors. In patients with rectal cancer and treated with neoadjuvant CRT, survival is determined not by the pre-treatment clinical staging, but rather by the pathological staging, which includes TRG after treatment. Tumor response to CRT is also effective in planning adjuvant chemotherapy in patients with rectal cancer.

Anahtar Kelimeler

• Rectal carcinoma, tumor regression grade, chemoradiotherapy, prognostic parameters

Rektal Adenokarsinomlarda Neoadjuvan Kemoradyoterapi Cevabı ile Prognostik Parametreler Arasındaki İlişkinin Araştırılması

Öz

Rektal karsinomlarda cerrahi ve sonrasında (adjuvan) kemoradyoterapi ile pelvik nüks oranı oldukça yüksektir. Bu nedenle neoadjuvan kemoradyoterapi (KRT), rektal kanserlerde giderek daha fazla kullanılan bir tedavi protokolüdür. Çalışmamızda rektal kanserlerde tedavi cevabını ortaya koymayı ve hangi klinik-morfolojik prognostik parametrelerin tedavi cevabını tahmin etmede etkili olduğunu belirlemeyi amaçladık. 2016-2019 yılları arasında tanı almış ve neoadjuvan KRT tedavisi görmüş 46 rektal kanserli hasta çalışmaya dahil edildi. Vakalar prognostik parametreler ve tümör regresyon derecesi (TRD) açısından iki patolog tarafından tekrar değerlendirildi. TRD’yi değerlendirmek için Modifiye Ryan Skorlama sistemi kullanıldı. Tedavi öncesi tümör çapı ve uzak metastaz gibi bazı parametrelerle Mikrosatellit instabilite (MSİ) durumunu gösteren veriler, bilgisayarda hasta dosyaları araştırılarak elde edildi. Çalışmaya dahil edilen 46 olgunun 19’u kadın 27’si erkektir. Olguların 44 tanesi klasik adenokarsinom, 2 tanesi müsinöz adenokarsinomdur. Tedavi sonrası yanıtı değerlendirmek için kullanılan TRD’ye göre, olguların 1’i (%2,2) tam yanıt (Skor 0), 8’i (%17,4) tama yakın yanıt (Skor 1), 18’i (%39,1) kısmi yanıt (Skor 2) ve 19’u (%41,3) ise yanıt yok ya da kötü yanıt (Skor 3) göstermiştir. Prognostik parametrelerden yalnızca tümör derecesi ile tedavi cevabı arasında istatiksel olarak anlamlı bir ilişki saptanmıştır (p = 0,021). KRT sonrası tedavi cevabı patolojik tümör derecesi ile ters orantılıdır. Düşük dereceli tümörlerde tedavi cevabı daha iyidir. KRT alan rektal kanserli hastalarda sağ kalım, tedavi öncesi klinik evre tarafından değil, daha çok tedavi sonrası TRD’yi de içeren patolojik evre tarafından belirlenmektedir. Rektal kanserli hastalarda KRT’ye tümör yanıtı adjuvan kemoterapi planlanmasında da etkili olmaktadır.

Anahtar Kelimeler

• Rektal karsinom
• tümör regresyon derecesi
• kemoradyoterapi
• prognostik parametreler

Kaynakça

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