Objective: To determine the correlation between tumour response to preoperative RCTX and lymph node status, an established parameter of clinical outcome.
Method: After IRB approval, 86 consecutive rectal cancer patients who received preoperative RCTX were identified. Fifty seven were males. Mean age 62 years. Preoperative staging by ultrasound was available in 60 patients. Radiotherapy consisted of (40-60 g) and chemotherapy of 5-FU infusion (1500 mg/m(2) week), assessed using Dworak's system.
Results: Tumour response according to Tumor regression grade (TRG) were: TRG 0: 8 (9.3%); TRG 1: 15 (17.4%); TRG 2: 14 (16.2%); TRG 3: 31 (36%); TRG 4: 18 (20%). Eighteen patients had tumour stage 0 (20.9%); while 8 (9.2%), 28 (32.1%), 30 (34.5%) and three had tumours stages 1, 2, 3 and 4 respectively. Evaluation of nodal status revealed no involvement in 65 patients (N0), and positive nodes in 21 (14 N1, 7 N2). Response to RCTX was significantly associated with node stage, hence individuals without node involvement (N0) had 66% of positive tumour response (TRG 4), while individuals with node metastasis had less response to RCTX (TRG 0, 1 and 2) 35% N1 and 14% for N2 (P = 0.007). Node status was independently associated to poor response to preoperative RCTX, even after adjusting for tumour stage, age and gender (OR 0.02, 95% CI 0.0009-0.67).
Conclusion: Tumour shrinkage by preoperative RCTX appears to correlate with lymph node metastasis suggesting that neoadjuvant RCTX may have a positive impact in overall patient survival.