Overstaging: A Challenge in Rectal Cancer Treatment

Scheele, J.; Schmidt, Stefan A.; Tenzer, Sandra; Henne‐Bruns, Doris; Kornmann, Marko

doi:10.1159/000488652

Cited by 18 publications

(21 citation statements)

References 34 publications

(45 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, unfortunately none of the trials included in the current analysis provided sufficiently detailed information in their reports to perform this subgroup analysis. Nevertheless, this subgroup analysis would have been of particular importance because of the frequent problem of clinical overstaging in rectal cancer, which may result in unnecessary, ineffective, and even harmful overtreatment (53).…”

Section: Reviewmentioning

confidence: 99%

Addition of Platinum Derivatives to Fluoropyrimidine-Based Neoadjuvant Chemoradiotherapy for Stage II/III Rectal Cancer: Systematic Review and Meta-Analysis

Hüttner¹,

Probst²,

Kalkum³

et al. 2019

JNCI: Journal of the National Cancer Institute

View full text Add to dashboard Cite

Background Current guidelines recommend neoadjuvant therapy for patients with stage II or III rectal cancer. The addition of platinum derivatives to fluoropyrimidine-based chemoradiotherapy has been frequently investigated, but their role in this setting remains controversial. Methods PubMed, Cochrane Library, and Web of Science were systematically searched for randomized trials comparing chemoradiotherapy with or without platinum agents in stage II or III rectal cancer. Main outcome parameters were overall and disease-free survival, additional outcomes included pathological complete response, isolated local recurrence, distant recurrence, toxicity, and perioperative morbidity. Time-to-event data were pooled as hazard ratios (HRs) by the inverse variance method and binary outcomes as odds ratios (ORs) by the Peto method with their respective 95% confidence interval (CI). All statistical tests were two-sided. Results Ten randomized controlled trials with data on 5599 patients were included in the meta-analysis. Platinum derivatives did not statistically significantly improve overall survival (HR = 0.93, 95% CI = 0.82 to 1.05, P = .23), disease-free survival (HR = 0.91, 95% CI = 0.83 to 1.01, P = .07), or local recurrence (OR = 0.83, 95% CI = 0.66 to 1.05, P = .12). However, it led to a statistically significant increase of pathological complete response (OR = 1.31, 95% CI = 1.10 to 1.55, P = .002) and a statistically significant reduction of distant recurrence (OR = 0.78, 95% CI = 0.66 to 0.92, P = .004). Benefits were accompanied by higher rates of grade 3 or 4 toxicities. Conclusions Intensified neoadjuvant chemoradiotherapy with the addition of platinum derivatives cannot be recommended routinely because it did not improve overall or disease-free survival and was associated with increased toxicity. It needs to be elucidated whether the benefits in distant recurrence and pathological complete response may be advantageous for selected high-risk patients.

show abstract

Section: Reviewmentioning

confidence: 99%

Addition of Platinum Derivatives to Fluoropyrimidine-Based Neoadjuvant Chemoradiotherapy for Stage II/III Rectal Cancer: Systematic Review and Meta-Analysis

Hüttner¹,

Probst²,

Kalkum³

et al. 2019

JNCI: Journal of the National Cancer Institute

View full text Add to dashboard Cite

show abstract

“…Despite the recent technical improvements, all imaging modalities are still at risk of staging failure, with an overstaging rate reported up to 30% [ 22 , 23 , 24 ]. Numerous studies have reported on MRI and ERUS diagnostic performance for rectal cancer staging, but there are considerable differences in methodologic analysis, results and accuracy measures among them, particularly for T3 staging [ 4 , 22 , 24 , 25 , 26 , 27 ]. Moreover, none of the studies have been performed using three different imaging modalities in comparison and focused on a single stage of the disease.…”

Section: Introductionmentioning

confidence: 99%

Endorectal Ultrasound and Magnetic Resonance Imaging for Rectal Cancer Staging: A Modern Multimodality Approach

Reginelli

Clemente

Sangiovanni

et al. 2021

JCM

View full text Add to dashboard Cite

Preoperative staging represents a crucial point for the management, type of surgery, and candidacy for neoadjuvant therapy in patient with rectal cancer. The most recent clinical guidelines in oncology recommend an accurate preoperative evaluation in order to address early and advanced tumors to different therapeutic options. In particular, potential pitfalls may occur in the assessment of T3 tumors, which represents the most common stage at diagnosis. The depth of tumor invasion is known to be an important prognostic factor in rectal carcinoma; as a consequence, the T3 imaging classification has a substantial importance for treatment strategy and patient survival. However, the differentiation between tumor invasion of perirectal fat and mesorectal desmoplastic reactions remains a main goal for radiologists. Magnetic resonance imaging (MRI) is actually considered as the best imaging modality for rectal cancer staging. Although the endorectal ultrasound (ERUS) is the preferred staging method for early tumors, it could also be useful in identifying perirectal fat invasion. Moreover, the addiction of diffusion weighted imaging (DWI) improves the diagnostic performance of MRI in rectal cancer staging by adding functional information about rectal tumor and adjacent mesorectal tissues. This study investigated the diagnostic performance of conventional MRI alone, in combination with the DWI technique and ERUS in order to assess the best diagnostic imaging combination for rectal cancer staging.

show abstract

“…Although analyzing overstaging was not the aim of the analysis, Table 2 shows it does occur. Although the numbers are small, due to the neoadjuvant therapies that hamper analyses on overstaging, it is a problem discussed in literature 38,39 . Overstaging can lead to unnecessary neoadjuvant treatment that might not offer a benefit, but does do harm.…”

Section: Discussionmentioning

confidence: 99%

“…Although the numbers are small, due to the neoadjuvant therapies that hamper analyses on overstaging, it is a problem discussed in literature. 38,39 Overstaging can lead to unnecessary neoadjuvant treatment that might not offer a benefit, but does do harm. Short-course radiotherapy is associated with more frequent fecal incontinence, sexual problems, and delayed wound healing.…”

Section: Multivariable Analysis Revealed That For Patients With (Y)pn1mentioning

confidence: 99%

Effect of understaging on local recurrence of rectal cancer

Giesen

Borstlap

Bemelman

et al. 2020

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background and Objectives: Magnetic resonance imaging of the pelvis has a limited accuracy to detect positive lymph nodes but does dictate neoadjuvant treatment in rectal cancer. This study aimed to investigate preoperative lymph node understaging and its effects on postoperative local recurrence rate. Methods: Patients were selected from a retrospective cross-sectional snapshot study. Patients with emergency surgery, cM1 disease, or unknown cN-or (y)pN category were excluded. Clinical and pathologic N-categories were compared and the impact on local recurrence was determined by multivariable analysis. Results: Out of 1548 included patients, 233 had preoperatively underestimated lymph node staging based on (y)pN category. Out of the 695 patients staged cN0, 168 (24%) had positive lymph nodes at pathology, and out of the 594 patients staged cN1, 65 (11%) were (y)pN2. Overall 3-year local recurrence rate was 5%. Clinical N-category was not associated with local recurrence when corrected for pT-category, neoadjuvant therapy, and resection margin, neither in patients with (y)pN1 (hazard ratio [HR]: 1.67 (95% confidence interval [CI]: 0.68-4.12) P = .263) nor (y)pN2-category (HR: 1.91 95% CI: [0.75-4.84], P = .175). Conclusion: Preoperative understaging of nodal status in rectal cancer is not uncommon. No significant effect on local recurrence or overall survival rates were found in the present study.

show abstract

Overstaging: A Challenge in Rectal Cancer Treatment

Cited by 18 publications

References 34 publications

Addition of Platinum Derivatives to Fluoropyrimidine-Based Neoadjuvant Chemoradiotherapy for Stage II/III Rectal Cancer: Systematic Review and Meta-Analysis

Addition of Platinum Derivatives to Fluoropyrimidine-Based Neoadjuvant Chemoradiotherapy for Stage II/III Rectal Cancer: Systematic Review and Meta-Analysis

Endorectal Ultrasound and Magnetic Resonance Imaging for Rectal Cancer Staging: A Modern Multimodality Approach

Effect of understaging on local recurrence of rectal cancer

Contact Info

Product

Resources

About