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Japanese Journal of Clinical Oncology 2004 34(12):740-746; doi:10.1093/jjco/hyh140
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© 2004 Foundation for Promotion of Cancer Research

Predictive Factors of Tumor Shrinkage and Histological Regression in Patients who Received Preoperative Radiotherapy for Rectal Cancer

Toshiyuki Suzuki1, Sotaro Sadahiro1, Maki Fukasawa1, Kenji Ishikawa1, Akemi Kamijo1, Seiei Yasuda1, Hiroyasu Makuuchi1, Yukio Ohizumi2 and Chieko Murayama2

Departments of 1 Surgery and 2 Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan

For reprints and all correspondence: Toshiyuki Suzuki, Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, 259-1193, Japan. E-mail: tsuzuki{at}is.icc.u-tokai.ac.jp

Received April 15, 2004; accepted October 15, 2004

Objective: In order to determine the reliable predictors of response to radiotherapy for rectal cancer, we assessed apoptosis, p53 and p21 in biopsy specimens collected before treatment, and investigated the relationships to the histological effect of irradiation and the degree of tumor shrinkage.

Methods: Ninety-three patients with advanced rectal adenocarcinoma were treated with preoperative irradiation of 20 Gy in 10 fractions in combination with intraoperative electron beam irradiation of 15 Gy. We evaluated tumor grade, pathological tumor regression, biological markers associated with apoptosis and proliferation [apoptotic index (AI), p53, p21 and Ki67], and the degree of tumor shrinkage.

Results: Considering positivity of p21 and of apoptosis and negativity of p53 as favorable factors in tumor shrinkage, we compared the degree of shrinkage among the patients using the number of favorable factors as the score. The degree of shrinkage was 41.5 ± 8.5% in patients with three favorable factors, 31.4 ± 9.7% in patients with two favorable factors and 26.5 ± 11.2% in patients with one favorable factor. However, there was no significant difference in the proportion of marked regression according to the number of favorable factors.

Conclusions: Histological examination of apoptosis, p21 and p53 in biopsy specimens and scoring were considered to be useful predictive methods for assessing the efficacy of radiotherapy for rectal cancer.

Key Words: rectal cancer • p53 • p21 • apoptosis • radiation sensitivity


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