How much literature is there on the use of this scoring system to assess the tumour's response to the neoadjuvant stage of therapy?
There is a lot of literature available regarding Mandard TRG in esophageal cancer.
We use it to classify our patients who recieved neoadjuvant treatment followed by surgery. However we only found the complete responders (TRG 1) to be distinctive for overall survival. So far we have not enough patients to find a significant difference in OS for all other subgroups (TRG 2 - 5). Thus sofar we only make a distinction between complete responders and not-complete responders.
Originally it was designed for response to chemoradiotherapy althugh it is also used for neo-adjuvant chemotherapy. The cut-offs for defining responders remain unclear (some say Mandard 1-3, others Mandard 1-2).
What is clear is that Mandard is not a perfect system of classifying response. It often does not correlate with radiological response, a patients description of response (e.g dysphagia clearly improved during chemotherapy) and only considers response in the primary tumour. Perhaps lymph node response is as important or more important ?
In addition, regression in the primary tumour may not be the only important factor. Pathological regression in lymph nodes also associated with a survival benefit in a recent series we have published
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