Restaging locally advanced rectal cancer by different imaging modalities after preoperative chemoradiation: a comparative study

Radiation Oncology

Baruch Brenner²  Aaron Sulkes²  Eyal Fenig²  Nir Wasserberg²  Ofer Purim²  Rachel Levy-Drummer¹  Yulia Kundel²  Ram Dickman² 

[1] Faculty of Life Sciences, Bar Ilan University, Ramat Gan 52900, Israel;Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel

关键词: Restaging;    Preoperative chemoradiation;    Locally advanced rectal cancer;    Endorectal ultrasonography;    Computed tomography;   

Others  :  829624
DOI  :  10.1186/1748-717X-8-278

 received in 2013-03-20, accepted in 2013-11-17,  发布年份 2013

【 摘 要 】

Background

To compare the accuracy of different imaging modalities, alone and in combination in predicting findings at surgery after preoperative chemoradiation for locally advanced rectal cancer.

Methods

Following chemoradiation, tumors were reclassified on the basis of findings on pelvic computed tomography (CT) (94 patients), endorectal ultrasonography (EUS) (138 patients) alone or by both CT and EUS (80 patients). The ability of the imaging modalities, to predict the pathologic T status, N status, and TNM stage at surgery was evaluated and compared.

Results

Mean age of the patients was 64.5 years (range 28–88 years); 55% were male. CT and EUS combined had a positive predictive value of 20% for pathologic pT1 stage, 29% for pT1, 29% for pT2, and 58% for pT3. Predictive values for the operative TNM stage were 50% for stage I, 45% for stage II, and 31% for stage III. These values did not exceed those for each modality alone.

Conclusion

The performance of preoperative CT and EUS in predicting the T and TNM stage of rectal cancer at surgery is poor. Neither modality alone nor the two combined is sufficiently accurate to serve as the basis for decisions regarding treatment modification.

【 授权许可】

   
2013 Dickman et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Sauer R, Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R, German Rectal Cancer Study Group: Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004, 351:1731-1740.
• [2]Grann A, Feng C, Wong D, Saltz L, Paty PP, Guillem JG, Cohen AM, Minsky BD: Preoperative combined modality therapy for clinically resectable uT3 rectal adenocarcinoma. Int J Radiat Oncol Biol Phys 2001, 49:987-995.
• [3]Janjan NA, Khoo VS, Abbruzzese J, Pazdur R, Dubrow R, Cleary KR, Allen PK, Lynch PM, Glober G, Wolff R, Rich TA, Skibber J: Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: The M.D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys 1999, 44:1027-1038.
• [4]Medich D, McGinty J, Parda D, Karlovits S, Davis C, Caushaj P, Lembersky B: Preoperative chemoradiotherapy and radical surgery for locally advanced distal rectal adenocarcinoma: Pathologic findings and clinical implications. Dis Colon Rectum 2001, 44:1123-1128.
• [5]Garcia-Aguilar J, Hernandez de Anda E, Sirivongs P, Lee SH, Madoff RD, Rothenberger DA: A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum 2003, 46:298-304.
• [6]Denecke T, Rau B, Hoffmann KT, Hildebrandt B, Ruf J, Gutberlet M, Hünerbein M, Felix R, Wust P, Amthauer H: Comparison of CT, MRI and FDG-PET in response prediction of patients with locally advanced rectal cancer after multimodal preoperative therapy: is there a benefit in using functional imaging? Eur Radiol 2005, 15:1658-1666.
• [7]Fleshman JW, Myerson RJ, Fry RD, Kodner IJ: Accuracy of transrectal ultrasound in predicting pathologic stage of rectal cancer before and after preoperative radiation therapy. Dis Colon Rectum 1992, 35:823-829.
• [8]Vanagunas A, Lin DE, Stryker SJ: Accuracy of endoscopic ultrasound for restaging rectal cancer following neoadjuvant chemoradiation therapy. Am J Gastroenterol 2004, 99:109-112.
• [9]Rau B, Hünerbein M, Barth C, Wust P, Haensch W, Riess H, Felix R, Schlag PM: Accuracy of endorectal ultrasound after preoperative radiochemotherapy in locally advanced rectal cancer. Surg Endosc 1999, 13:980-984.
• [10]Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J: Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging – a meta-analysis. Radiology 2004, 232:773-783.
• [11]Gagliardi G, Bayar S, Smith R, Salem RR: Preoperative staging of rectal cancer using magnetic resonance imaging with external phase-arrayed coils. Arch Surg 2002, 137:447-451.
• [12]Calvo FA, Domper M, Matute R, Martínez-Lázaro R, Arranz JA, Desco M, Alvarez E, Carreras JL: 18 F-FDG positron emission tomography staging and restaging in rectal cancer treated with preoperative chemoradiation. Int J Radiat Oncol Biol Phys 2004, 58:528-535.
• [13]Guillem JG, Puig-La Calle J Jr, Akhurst T, Tickoo S, Ruo L, Minsky BD, Gollub MJ, Klimstra DS, Mazumdar M, Paty PB, Macapinlac H, Yeung H, Saltz L, Finn RD, Erdi Y, Humm J, Cohen AM, Larson S: Prospective assessment of primary rectal cancer response to preoperative radiation and chemotherapy using 18-fluorodeoxyglucose positron emission tomography. Dis Colon Rectum 2000, 43:18-24.
• [14]Pomerri F, Pucciarelli S, Maretto I, Zandonà M, Del Bianco P, Amadio L, Rugge M, Nitti D, Muzzio PC: Prospective assessment of imaging after preoperative chemoradiotherapy for rectal cancer. Surgery 2011, 149:56-64.
• [15]Lai DT, Fulham M, Stephen MS, Chu KM, Solomon M, Thompson JF, Sheldon DM, Storey DW: The role of whole-body positron emission tomography with [18 F]fluorodeoxy-glucose in identifying operable colorectal cancer metastases to the liver. Arch Surg 1996, 131:703-707.
• [16]Guillem JG, Díaz-González JA, Minsky BD, Valentini V, Jeong SY, Rodriguez-Bigas MA, Coco C, Leon R, Hernandez-Lizoain JL, Aristu JJ, Riedel ER, Nitti D, Wong WD, Pucciarelli S: cT3N0 rectal cancer: potential overtreatment with preoperative chemoradiotherapy is warranted. J Clin Oncol 2008, 26:368-373.
• [17]Maldjian C, Smith R, Kilger A, Schnall M, Ginsberg G, Kochman M: Endorectal surface coil MR imaging as a staging technique for rectal carcinoma: a comparison study to rectal endosonography. Abdom Imaging 2000, 25:75-80.
• [18]Dworak O: Number and size of lymph nodes and node metastases in rectal carcinomas. Surg Endosc 1989, 3:96-99.
• [19]Beets-Tan RG, Beets GL: Rectal cancer: how accurate can imagings predict the T stage and the circumferential resection margin? Int J Colorectal Dis 2003, 18:385-391.
• [20]Beets-Tan RG, Beets GL, Borstlap AC, Oei TK, Teune TM, von Meyenfeldt MF, van Engelshoven JM: Preoperative assessment of local tumor extent in advanced rectal cancer: CT or high-resolution MRI? Abdom Imaging 2000, 25:533-541.
• [21]Kundel Y, Brenner R, Purim O, Peled N, Idelevich E, Fenig E, Sulkes A, Brenner B: Is local excision after complete pathological response to neoadjuvant chemoradiation for rectal cancer an acceptable treatment option? Dis Colon Rectum 2010, 53:1624-1631.
• [22]Tulchinsky H, Shmueli E, Figer A, Klausner JM, Rabau M: An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol 2008, 15:2661-2667.
• [23]Abdel-Nabi H, Doerr RJ, Lamonica DM, Cronin VR, Galantowicz PJ, Carbone GM, Spaulding MB: Staging of primary colorectal carcinomas with fluorine-18fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings. Radiology 1998, 206:755-760.
• [24]Flamen P, Stroobants S, Van Cutsem M, Dupont P, Bormans G, De Vadder N, Penninckx F, Van Hoe L, Mortelmans L: Additional value of whole-body positron emission tomography with fluorine-18–2-fluoro-deoxy-D-glucose in recurrent colorectal cancer. J Clin Oncol 1999, 17:894-901.
• [25]Cascini GL, Avallone A, Delrio P, Guida C, Tatangelo F, Marone P, Aloj L, De Martinis F, Comella P, Parisi V, Lastoria S: 18 F-FDG PET is an early predictor of pathologic tumor response to preoperative radiochemotherapy in locally advanced rectal cancer. J Nucl Med 2006, 47:1241-1248.
• [26]van der Paardt MP, Zagers MB, Beets-Tan RG, Stoker J, Bipat S: Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic mr imaging: a systematic review and meta-analysis. Radiology 2013, 269:101-112.
• [27]Uçar A, Obuz F, Sökmen S, Terzi C, Sağol O, Sarıoğlu S, Füzün M: Efficacy of high resolution magnetic resonance imaging in preoperative local staging of rectal cancer. Mol Imaging Radionucl Ther 2013, 22:42-48.