Tumor regression grading of gastrointestinal cancers after neoadjuvant therapy.

Langer, Rupert; Becker, Karen (2018). Tumor regression grading of gastrointestinal cancers after neoadjuvant therapy. Virchows Archiv, 472(2), pp. 175-186. Springer 10.1007/s00428-017-2232-x

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Neoadjuvant therapy has been successfully introduced in the treatment of locally advanced gastrointestinal malignancies, particularly esophageal, gastric, and rectal cancers. The effects of preoperative chemo- or radiochemotherapy can be determined by histopathological investigation of the resection specimen following this treatment. Frequent histological findings after neoadjuvant therapy include various amounts of residual tumor, inflammation, resorptive changes with infiltrates of foamy histiocytes, foreign body reactions, and scarry fibrosis. Several tumor regression grading (TRG) systems, which aim to categorize the amount of regressive changes after cytotoxic treatment in primary tumor sites, have been proposed for gastroesophageal and rectal carcinomas. These systems primarily refer to the amount of therapy-induced fibrosis in relation to the residual tumor (e.g., the Mandard, Dworak, or AJCC systems) or the estimated percentage of residual tumor in relation to the previous tumor site (e.g., the Becker, Rödel, or Rectal Cancer Regression Grading systems). TRGs provide valuable prognostic information, as in most cases, complete or subtotal tumor regression after neoadjuvant treatment is associated with better patient outcomes. This review describes the typical histopathological findings after neoadjuvant treatment, discusses the most commonly used TRG systems for gastroesophageal and rectal carcinomas, addresses the limitations and critical issues of tumor regression grading in these tumors, and describes the clinical impact of TRG.

Item Type:

Journal Article (Review Article)


04 Faculty of Medicine > Service Sector > Institute of Pathology
04 Faculty of Medicine > Service Sector > Institute of Pathology > Clinical Pathology

UniBE Contributor:

Langer, Rupert


500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health








Rupert Langer

Date Deposited:

16 Nov 2017 14:04

Last Modified:

23 Oct 2019 09:29

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Esophageal cancer Gastric cancer Histopathology Neoadjuvant therapy Rectal cancer Tumor regression grading





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