The Potential of Restaging in the Prediction of Pathologic Response After Preoperative Chemoradiotherapy for Rectal Cancer

Maretto, Isacco; Pomerri, Fabio; Mescoli, Claudia; Enrico, B.; Burzi, S; Rugge, Massimo; Muzzio, Pier Carlo; Nitti, Donato

doi:10.1245/s10434-006-9269-4

Cited by 125 publications

(70 citation statements)

References 40 publications

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“…Even patients with no residual tumor by endoscopic biopsies after CRT are found to have residual tumor present in resected specimens in a large percentage of cases, especially if pretreatment staging showed transmural involvement and mesorectal lymphadenopathy. Over the past few years, the use of neoadjuvant chemoradiation in locally advanced rectal cancer has led some authors to suggest that distal resection margins of 1–2 cm may suffice [30,31,32]. In a recent retrospective study, whole-mount pathologic analysis was used to characterize distal and circumferential resection margins and microscopic patterns of residual disease following rectal cancer treated with preoperative chemoradiation.…”

Section: Discussionmentioning

confidence: 99%

Distal Margins in Radical Resections for Rectal Cancer after Chemoradiation Therapy: How Short Is Long Enough?

2010

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Background: The purpose of our study was to assess the impact of distal margin length on outcome in patients with rectal cancer treated with neoadjuvant chemoradiation therapy (CRT) followed by radical resection. Methods: Fifty-three consecutive patients were evaluated. The selection criteria included: adenocarcinoma of the mid- or distal rectum, locally advanced stage, absence of distant metastases, and preoperative CRT followed by proctectomy with total mesorectal excision. The operations included low anterior resection in 33 patients (62%) and abdominoperineal resection in 20 (38%). The outcome measures were: tumor regression, complete pathologic response, length of distal resection margins, status of radial margins and recurrence rate. Results: Forty-eight patients (91%) had tumor regression, and 11 (21%) had a complete pathologic response. Distal resection margins were tumor-free in all patients, ranging in length from 0.1 to 7.4 cm (mean = 2.2). Follow-up (mean = 48.8 months) was current in 50 of 53 patients (94%). There was no locoregional recurrence. Conclusions: Distal resection margins shorter than 1–2 cm appear to be equivalent to longer margins in patients who undergo CRT followed by proctectomy with total mesorectal excision. These findings may lead to greater utilization of sphincter-saving procedures in rectal cancer.

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Section: Discussionmentioning

confidence: 99%

Distal Margins in Radical Resections for Rectal Cancer after Chemoradiation Therapy: How Short Is Long Enough?

2010

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“…Although MRI is considered the most accurate tool for primary tumour staging in rectal cancer [5][6][7], this modality has intrinsic limitations in the differentiation of residual viable tumour from surrounding fibrosis after neoadjuvant CRT of rectal cancer [8][9][10]. With the introduction of higher field-strength MR scanners and the parallel imaging technique for rectal MRI, diffusionweighted imaging (DWI) has been shown to have several potential benefits for the assessment of tumour localisation and staging [11,12].…”

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confidence: 99%

Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison withT₂weighted and PET/CT imaging

Song¹,

Kim²,

Lee³

et al. 2012

BJR

111

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“…As endorectal ultrasound is known to be unreliable in defining the local stage after pelvic radiotherapy, because it is incapable of distinguishing between post-radiotherapy fibrosis and residual tumor [9]. Patients who underwent a neoadjuvant treatment were excluded.…”

Section: Methodsmentioning

confidence: 99%

Limits of Endorectal Ultrasound in Tailoring Treatment of Patients with Rectal Cancer

et al. 2015

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Background: Endorectal ultrasound (ERUS) is considered reliable in staging rectal cancer, but recently some critics have questioned its accuracy. The aim of this study was to evaluate how often an ERUS-based decision leads to an appropriate treatment. Methods: Two hundred and twenty patients with rectal cancer staged with ERUS who underwent a surgical resection or a local excision without neoadjuvant therapy from 1997 to 2012 were included. According to ERUS, patients were divided into three groups of indication: (a) local excision (Tis-1 N0), (b) direct surgery (T2 N0), (c) preoperative chemoradiation (T3-4 or N+). Accuracy was explored by the correlation established with the final pathology. Results: Accuracy for T and N staging was 65 and 64%, respectively. Indication to local excision and to chemoradiation was correct in 97 and 88% of patients staged by ERUS. Accuracy of indication to direct surgery was poor (37%), and 21% of patients were overtreated in this group. Conclusions: ERUS seems not able to fulfill all the needs of ideal tailored therapeutic strategies. T2 diagnosis needs to be confirmed by an excisional biopsy before a final decision is made because overstaging of early tumors may occur in a not-so-negligible proportion of patients.

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The Potential of Restaging in the Prediction of Pathologic Response After Preoperative Chemoradiotherapy for Rectal Cancer

Abstract: Current rectal cancer staging modalities after chemoradiotherapy allow good prediction of node-negative cases, although none of them is able to predict the pathologic complete response on the rectal wall.

Cited by 125 publications

References 40 publications

Distal Margins in Radical Resections for Rectal Cancer after Chemoradiation Therapy: How Short Is Long Enough?

Distal Margins in Radical Resections for Rectal Cancer after Chemoradiation Therapy: How Short Is Long Enough?

Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison withT₂weighted and PET/CT imaging

Limits of Endorectal Ultrasound in Tailoring Treatment of Patients with Rectal Cancer

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The Potential of Restaging in the Prediction of Pathologic Response After Preoperative Chemoradiotherapy for Rectal Cancer

Abstract: Current rectal cancer staging modalities after chemoradiotherapy allow good prediction of node-negative cases, although none of them is able to predict the pathologic complete response on the rectal wall.

Cited by 125 publications

References 40 publications

Distal Margins in Radical Resections for Rectal Cancer after Chemoradiation Therapy: How Short Is Long Enough?

Distal Margins in Radical Resections for Rectal Cancer after Chemoradiation Therapy: How Short Is Long Enough?

Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison withT2weighted and PET/CT imaging

Limits of Endorectal Ultrasound in Tailoring Treatment of Patients with Rectal Cancer

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Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison withT₂weighted and PET/CT imaging