nach oben

Erschienen in:

01.02.2007

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

verfasst von: Isacco Maretto, MD, Fabio Pomerri, MD, Salvatore Pucciarelli, MD, Claudia Mescoli, MD, Enrico Belluco, MD, Simona Burzi, MD, Massimo Rugge, MD, Pier Carlo Muzzio, MD, Donato Nitti, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 2/2007

Einloggen, um Zugang zu erhalten

Abstract

Background

We performed this study to prospectively evaluate the postchemoradiotherapy performance of transrectal ultrasonography (TRUS), pelvic computed tomography (CT) scan and magnetic resonance imaging (MRI), and endoscopic biopsies for predicting the pathologic complete response of rectal cancer patients.

Methods

Four weeks after completion of preoperative chemoradiotherapy, 46 consecutive patients with mid to low rectal cancer were prospectively evaluated by proctoscopy, TRUS, and pelvic CT scan and MRI. On the basis of T and N status, patients were classified as T0 or T1–4 and N-negative or N-positive. For each staging modality used, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Findings were compared with the pathologic tumor-node-metastasis stage.

Results

On histopathologic analysis, 12 patients had pT0 and 34 had pT1–4 lesions; out of 45 assessable patients, 9 were N-positive. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting T status (T0 vs. T ≥1) were 77%, 33%, 74%, 36%, and 64%, respectively, for TRUS; 100%, 0%, 74%, not assessable, and 74% for CT; and 100%, 0%, 77%, not assessable, and 77% for MRI. The corresponding figures in predicting N status (N-negative vs. N-positive) were, respectively, 37%, 67%, 21%, 81%, and 61% for TRUS; 78%, 58%, 32%, 91%, and 62% for CT; and 33%, 74%, 25%, 81%, and 65% for MRI.

Conclusions

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.

Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638–46PubMedCrossRef

Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351:1731–40PubMedCrossRef

Kim NK, Kim MJ, Yun SH, Sohn SK, Min JS. Comparative study of transrectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer. Dis Colon Rectum 1999; 42:770–5PubMedCrossRef

Herbst F. Pelvic radiological imaging: a surgeon’s perspective. Eur J Radiol 2003; 47:135–41PubMedCrossRef

Bipat S, Glas AS, Slors FJM, Zwinderman AH, Bossuyt PMM, Stoker J. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 2004; 232:773–83PubMedCrossRef

Kahn H, Alexander A, Rakinic J, Rakinic J, Nagle D, Fry R. Preoperative staging of irradiated rectal cancers using digital rectal examination, computed tomography, endorectal ultrasound, and magnetic resonance imaging does not accurately predict T0, N0 pathology. Dis Colon Rectum 1997; 40:140–4PubMedCrossRef

Rau B, Hunerbein M, Barth C, et al. Accuracy of endorectal ultrasound after preoperative radiochemotherapy in locally advanced rectal cancer. Surg Endosc 1999; 13:980–4PubMedCrossRef

Denecke T, Rau B, Hoffmann KT, et al. 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; 15:1658–66PubMedCrossRef

Stipa F, Chessin DB, Shia J, et al. A pathologic complete response of rectal cancer to preoperative combined-modality therapy results in improved oncological outcome compared with those who achieved no downstaging on the basis of preoperative endorectal ultrasonography. Ann Surg Oncol 2006; 13:1047–53PubMedCrossRef

10.

Theodoropoulos G, Wise WE, Padmanabhan A, et al. T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum 2002; 45:895–903PubMedCrossRef

11.

Chan AKP, Wong A, Jenken D, Heine J, Buie D, Johnson D. Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys 2005; 61:665–77PubMed

12.

Bedrosian I, Rodriguez-Bigas MA, Feig B, et al. Predicting the node-negative mesorectum after preoperative chemoradiation for locally advanced rectal carcinoma. J Gastrointest Surg 2004; 8:56–62PubMedCrossRef

13.

Stipa F, Zernecke A, Moore HG, et al. Residual mesorectal lymph node involvement following neoadjuvant combined-modality therapy: rationale for radical resection? Ann Surg Oncol 2004; 11:187–91PubMedCrossRef

14.

Read TE, Andujar JE, Caushaj PF, et al. Neoadjuvant therapy for rectal cancer: histologic response of the primary tumor predicts nodal status. Dis Colon Rectum 2004; 47:825–31PubMedCrossRef

15.

Pucciarelli S, Capirci C, Emanuele U, et al. Relationship between pathologic T-stage and nodal metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer. Ann Surg Oncol 2005; 12:111–6PubMedCrossRef

16.

Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 2004; 240:711–7PubMed

17.

Kim CJ, Yeatman TJ, Coppola D, et al. Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg 2001; 234:352–8PubMedCrossRef

18.

Schell SR, Zlotecki RA, Mendenhall WM, Marsh RW, Vauthey JN, Copeland EM III. Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy. J Am Coll Surg 2002; 194:584–90PubMedCrossRef

19.

Bonnen M, Crane C, Vauthey JN, et al. Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients. Int J Radiat Oncol Biol Phys 2004; 60:1098–105PubMedCrossRef

20.

Pucciarelli S, Friso ML, Toppan P, et al. Preoperative combined radiotherapy and chemotherapy for middle and lower rectal cancer: preliminary results. Ann Surg Oncol 2000; 7:38–44PubMedCrossRef

21.

Pucciarelli S, Toppan P, Friso ML, et al. Complete pathologic response following preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome. Dis Colon Rectum 2004; 47:1798–807PubMedCrossRef

22.

Enker WE, Thaler TH, Cranon LM, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 1995; 181:335–46PubMed

23.

Greene FL, Page DL, Fleming ID, et al. American Joint Committee on Cancer (AJCC). AJCC Cancer Staging Manual. 6th ed. New York: Springer-Verlag, 2002:121–3

24.

Blomqvist L, Holm T, Nyren S, Svanström R, Ulvskog Y, Iselius L. MR imaging and computed tomography in patients with rectal tumours clinically judged as locally advanced. Clin Radiol 2002; 57:211–8PubMedCrossRef

25.

Chiesura-Corona M, Muzzio PC, Giust G, Zuliani M, Pucciarelli S, Toppan P. Rectal cancer: CT local staging with histopathologic correlation. Abdom Imaging 2001; 26:134–8PubMedCrossRef

26.

Harewood GC, Wiersema MJ, Nelson H, et al. A prospective, blinded assessment of the impact of preoperative staging on the management of rectal cancer. Gastroenterology 2002; 123:24–32PubMedCrossRef

27.

Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 1986;2:996–9PubMedCrossRef

28.

Vanagunas A, Lin DE, Stryker SJ. Accuracy of endoscopic ultrasound for restaging rectal cancer following neoadjuvant chemoradiation therapy. Am J Gastroenterol 2004; 99:109–12PubMedCrossRef

29.

Barbaro B, Schulsinger A, Valentini V, Marano P, Rotman M. The accuracy of transrectal ultrasound in predicting pathological stage of low-lying rectal cancer after preoperative chemoradiation therapy. Int J Radiat Oncol Biol Phys 1999;43:1043–7PubMedCrossRef

30.

Chen CC, Lee RC, Lin JK, Wang LW, Yang SH. How accurate is magnetic resonance in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy? Dis Colon Rectum 2005; 48:722–8PubMedCrossRef

31.

Hoffmann KT, Rau B, Wust P, et al. Restaging of locally advanced carcinoma of the rectum with MR imaging after preoperative radiochemotherapy plus regional hyperthermia. Strahlenther Onkol 2002; 178:386–92PubMedCrossRef

32.

Liersch T, Langer C, Jakob C, et al. Preoperative diagnostic procedures in locally advanced rectal carcinoma (> or = T3 or N+). What does endoluminal ultrasound achieve at staging and restaging (after neoadjuvant radiochemotherapy) in contrast to computed tomography? Chirurg 2003; 74:224–34PubMedCrossRef

33.

Kim MJ, Lim JS, Oh YT, et al. Preoperative MRI of rectal cancer with and without rectal water filling: an intraindividual comparison. Am J Roentgenol 2004; 182:1469–76

34.

Blomqvist L, Machado M, Rubio C, et al. Rectal tumor staging: MR imaging using pelvic phased-array and endorectal coils vs endoscopic ultrasonography. Eur Radiol 2000; 10:653–60PubMedCrossRef

35.

Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg 2003; 90:355–64PubMedCrossRef

36.

Koh DM, Brown G, Temple L, et al. Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings—initial observations. Radiology 2004; 231:91–9PubMedCrossRef

37.

Knaebel HP, Koch M, Feise T, Benner A, Kienle P. Diagnostic of rectal cancer: endorectal ultrasound. Recent Results Cancer Res 2005; 165:46–57PubMedCrossRef

38.

Brown G, Richards CJ, Bourne MW, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 2003; 227:371–7PubMedCrossRef

39.

Catalano MF, Sivak MV Jr, Rice T, Gragg LA, Van Dam J. Endosonographic features predictive of lymph node metastasis. Gastrointest Endosc 1994; 40:442–6PubMedCrossRef

40.

Kotanagy H, Fukuoka T, Shibata Y, et al. The size of regional lymph nodes does not correlate with the presence or absence of metastases in lymph nodes in rectal cancer. J Surg Oncol 1993; 54:252–4CrossRef

41.

Ratto C, Ricci R, Rossi C, Morelli U, Vecchio FM, Doglietto GB. Mesorectal microfoci adversely affect the prognosis of patients with rectal cancer. Dis Colon Rectum 2002; 45:733–42PubMedCrossRef

Titel: The Potential of Restaging in the Prediction of Pathologic Response After Preoperative Chemoradiotherapy for Rectal Cancer
verfasst von: Isacco Maretto, MD
Fabio Pomerri, MD
Salvatore Pucciarelli, MD
Claudia Mescoli, MD
Enrico Belluco, MD
Simona Burzi, MD
Massimo Rugge, MD
Pier Carlo Muzzio, MD
Donato Nitti, MD
Publikationsdatum: 01.02.2007
Verlag: Springer-Verlag
Erschienen in: Annals of Surgical Oncology / Ausgabe 2/2007
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-006-9269-4

Neu im Fachgebiet Chirurgie

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Was nützt die Kraniektomie bei schwerer tiefer Hirnblutung?

17.05.2024 Hirnblutung Nachrichten

Eine Studie zum Nutzen der druckentlastenden Kraniektomie nach schwerer tiefer supratentorieller Hirnblutung deutet einen Nutzen der Operation an. Für überlebende Patienten ist das dennoch nur eine bedingt gute Nachricht.

Klinikreform soll zehntausende Menschenleben retten

15.05.2024 Klinik aktuell Nachrichten

Gesundheitsminister Lauterbach hat die vom Bundeskabinett beschlossene Klinikreform verteidigt. Kritik an den Plänen kommt vom Marburger Bund. Und in den Ländern wird über den Gang zum Vermittlungsausschuss spekuliert.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

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