gms | German Medical Science

27th German Cancer Congress Berlin 2006

German Cancer Society (Frankfurt/M.)

22. - 26.03.2006, Berlin

Downstaging, sphincter preservation and tumour regression grading in patients with rectal cancer treated with preoperative radiochemotherapy–first results of interdisciplinary treatment in Wiesbaden

Meeting Abstract

  • corresponding author presenting/speaker R. Mücke - Department of Radiotherapy, St.-Josefs-Hospital Wiesbaden, Deutschland
  • A. Fisseler-Eckhoff - Institute of Pathology and Cytology, HSK Wiesbaden
  • G. Lochhas - Department of Radiotherapy, St.-Josefs-Hospital Wiesbaden
  • D. Lorenz - Department of Surgery, HSK Wiesbaden
  • M. Houf - Department of Coloproctology, St.-Josefs-Hospital Wiesbaden
  • K.H. Link - Department of Surgery, Asklepios Paulinen Hospital Wiesbaden
  • F.J. Prott - Department of Radiotherapy, St.-Josefs-Hospital Wiesbaden

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPO605

The electronic version of this article is the complete one and can be found online at:

Published: March 20, 2006

© 2006 Mücke et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: Retrospective analysis of tumour downstaging, sphincter preservation and tumour regression grading (TRG) after preoperative simultaneous radiochemotherapy in patients with rectal cancer.

Methods: From 2000 to March 2005 preoperative radiochemotherapy was performed on 50 patients with UICC-stage II (n=13), III (n=32) and IV (n=5) rectal carcinoma. Pre-treatment stages were determined as T3 in 39 and T4 in 10 patients using endorectal ultrasound and magnetic resonance imaging. One patient with a regional lymphonodal recurrence was treated. The pelvis was irradiated with daily fractions of 1.8 Gy, 5 times a week to a total dose of 50.4 Gy. Chemotherapy was performed on day 1-5 and 29-33 of radiotherapy with continuous infusion of 5-fluorouracil (5-FU) (1000 mg/m2/d). TRG following radiochemotherapy was determined by the amount of viable tumour versus the amount of fibrosis, ranging from no evidence of any treatment effect (grade 0) to a complete response with no viable tumour identified (grade 4). The five point TRG was categorized as poor regression (TRG 0+1), intermediate regression (TRG 2+3), and complete regression (TRG 4).

Results: All 50 patients with a median age of 61.5 years (range 32-84) completed therapy, assessment of TRG was available in 46 patients. Downstaging of at least one T-category was found in 23/49 patients (46.9%) (p=0.0001, Wilcoxon-test). A complete pathological regression was found in 5 patients (10.9%), intermediate regression in 36 Patients (78.2%), and poor regression in 5 patients (10.9%). A R0-resection was achieved in 45 patients (90%). Sphincter preservation was achieved in 41.6% of patients with tumours located at or below 6 cm from the anal verge.

Conclusion: Downstaging, sphincter preservation rate in tumours of the distal rectum and distribution of TRG are comparable to results ofother studys. This schedule is feasible and highly effective in the treatment of patients with rectal cancer.