title: Prognostic importance of Mandard tumour regression grade following pre-operative chemo/radiotherapy for locally advanced rectal cancer.
abstract: OBJECTIVE
  To assess the prognostic value of the Mandard tumour regression score (TRG) following pre-operative chemo/radiotherapy in patients with locally advanced rectal cancer.
  
  
  METHODS
  The study involved 158 patients with locally advanced rectal cancer treated with pre-operative long course chemo/radiotherapy at Nottingham University Hospital between April 2001 and December 2008. Patients were treated with radiotherapy to a dose of 50 Gy in 25 fractions over 5 weeks with or without concurrent capecitabine chemotherapy at a dose of 1650 mg/m(2)/day. Surgery was normally performed after an interval of 6-10 weeks. The response to pre-operative treatment was carefully graded by a single pathologist using the five point Mandard score. The median follow-up was 40 months (range 3-90 months).
  
  
  RESULTS
  Of the 158 patients 14% were TRG1, 41% were TRG2, 31% were TRG3, 13% were TRG4 and 1% were TRG5. The groups were combined into TRG1, TRG2 and TRG3-5 to simplify further analysis. The Mandard score was clearly related to both disease-free (p < 0.001) and overall survival (p = 0.012). On multivariate analysis perineural invasion, nodal status, TRG and circumferential resection margin status were the most powerful predictors of disease-free survival.
  
  
  CONCLUSIONS
  The Mandard tumour regression score is an independent prognostic factor and predicts for long-term outcome following pre-operative chemo/radiotherapy in rectal cancer.
authors.affiliation: Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Castle Road, Cottingham, Hull HU16 5JQ, UK. Amandeep.Dhadda@hey.nhs.uk
authors.forename: A S
authors.initials: AS
authors.lastname: Dhadda
authors.forename: P
authors.initials: P
authors.lastname: Dickinson
authors.forename: A M
authors.initials: AM
authors.lastname: Zaitoun
authors.forename: N
authors.initials: N
authors.lastname: Gandhi
authors.forename: E M
authors.initials: EM
authors.lastname: Bessell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D004358:Drug Therapy / Q000379:methods; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000379:methods; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome