Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2013

01-01-2013 | Colorectal Cancer

Is Restaging with Chest and Abdominal CT Scan after Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer Necessary?

Authors: Ninos Ayez, MD, Wijnand J. Alberda, MD, Jacobus W. A. Burger, MD, PhD, Alexander M. M. Eggermont, MD, PhD, Joost J. M. E. Nuyttens, MD, PhD, Roy S. Dwarkasing, MD, François E. J. A. Willemssen, MD, Cornelis Verhoef, MD, PhD

Published in: Annals of Surgical Oncology | Issue 1/2013

Login to get access

Abstract

Background

There is no evidence regarding restaging of patients with locally advanced rectal cancer after a long course of neoadjuvant radiotherapy with or without chemotherapy. This study evaluated the value of restaging with chest and abdominal computed tomographic (CT) scan after radiotherapy.

Methods

Between January 2000 and December 2010, all newly diagnosed patients in our tertiary referral hospital, who underwent a long course of radiotherapy for locally advanced rectal cancer, were analyzed. Patients were only included if they had chest and abdominal imaging before and after radiotherapy treatment.

Results

A total of 153 patients who met the inclusion criteria and were treated with curative intent were included. A change in treatment strategy due to new findings on the CT scan after radiotherapy was observed in 18 (12 %) of 153 patients. Twelve patients (8 %) were spared rectal surgery due to progressive metastatic disease.

Conclusions

Restaging with a chest and abdominal CT scan after radiotherapy for locally advanced rectal cancer is advisable because additional findings may alter the treatment strategy.
Literature
1.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.PubMedCrossRef
2.
Bengmark S, Hafstrom L. The natural history of primary and secondary malignant tumors of the liver. I. The prognosis for patients with hepatic metastases from colonic and rectal carcinoma by laparotomy. Cancer. 1969;23:198–202.PubMedCrossRef
3.
Poultsides GA, Schulick RD, Pawlik TM. Hepatic resection for colorectal metastases: the impact of surgical margin status on outcome. HPB (Oxford). 2010;12:43–9.CrossRef
4.
Tan KK, Lopes Gde L Jr, Sim R. How uncommon are isolated lung metastases in colorectal cancer? A review from database of 754 patients over 4 years. J Gastrointest Surg. 2009;13:642–8.PubMedCrossRef
5.
Choi DJ, Kwak JM, Kim J, Woo SU, Kim SH. Preoperative chest computerized tomography in patients with locally advanced mid or lower rectal cancer: its role in staging and impact on treatment strategy. J Surg Oncol. 2010;102:588–92.PubMedCrossRef
6.
Mitry E, Fields AL, Bleiberg H, et al. Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials. J Clin Oncol. 2008;26(30):4906–11.PubMedCrossRef
7.
Tjandra JJ, Kilkenny JW, Buie WD, Hyman N, Simmang C, Anthony T, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum. 2005;48:411–23.PubMedCrossRef
8.
9.
10.
van der Pool AE, de Wilt JH, Lalmahomed ZS, Eggermont AM, Ijzermans JN, Verhoef C. Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases. Br J Surg. 2010;97:383–90.PubMedCrossRef
11.
Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.PubMedCrossRef
12.
de Bruin AF, Nuyttens JJ, Ferenschild FT, Planting AS, Verhoef C, de Wilt JH. Preoperative chemoradiation with capecitabine in locally advanced rectal cancer. Neth J Med. 2008;66:71–6.PubMed
13.
Ferenschild FT, Vermaas M, Nuyttens JJ, Marinelli AW, Wiggers T, van der Sijp JR, et al. Value of intraoperative radiotherapy in locally advanced rectal cancer. Dis Colon Rectum. 2006;49:1257–65.PubMedCrossRef
14.
Verhoef C, van der Pool AE, Nuyttens JJ, Planting AS, Eggermont AM, de Wilt JH. The “liver-first approach” for patients with locally advanced rectal cancer and synchronous liver metastases. Dis Colon Rectum. 2009;52:23–30.PubMedCrossRef
15.
Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.PubMedCrossRef
16.
Makela J, Haukipuro K, Laitinen S, Kairaluoma MI. Palliative operations for colorectal cancer. Dis Colon Rectum. 1990;33:846–50.PubMedCrossRef
17.
Stillwell AP, Buettner PG, Ho YH. Meta-analysis of survival of patients with stage IV colorectal cancer managed with surgical resection versus chemotherapy alone. World J Surg. 2010;34:797–807.PubMedCrossRef
18.
Law WL, Chan WF, Lee YM, Chu KW. Non-curative surgery for colorectal cancer: critical appraisal of outcomes. Int J Colorectal Dis. 2004;19:197–202.PubMedCrossRef
19.
Rosen SA, Buell JF, Yoshida A, Kazsuba S, Hurst R, Michelassi F, et al. Initial presentation with stage IV colorectal cancer: how aggressive should we be? Arch Surg. 2000;135:530–4.PubMedCrossRef
20.
Beets-Tan RG, Beets GL. Local staging of rectal cancer: a review of imaging. J Magn Reson Imaging. 2011;33:1012–9.PubMedCrossRef
21.
Calvo FA, Domper M, Matute R, Martinez-Lazaro R. 18F-FDG positron emission tomography staging and restaging in rectal cancer treated with preoperative chemoradiation. Int J Radiat Oncol Biol Phys. 2004;58:528–35.PubMedCrossRef
22.
Guillem JG, Puig-La Calle J Jr, Akhurst T, Tickoo S, Ruo L, Minsky BD, et al. 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.PubMedCrossRef
23.
Chen CC, Lee RC, Lin JK, Wang LW, Yang SH. How accurate is magnetic resonance imaging in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy? Dis Colon Rectum. 2005;48:722–8.PubMedCrossRef
24.
Barbaro B, Vitale R, Leccisotti L, Vecchio FM, Santoro L, Valentini V, et al. Restaging locally advanced rectal cancer with MR imaging after chemoradiation therapy. Radiographics. 2010;30:699–716.PubMedCrossRef
25.
Dresen RC, Beets GL, Rutten HJ, Engelen SM, Lahaye MJ, Vliegen RF, et al. Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy. Part I. Are we able to predict tumor confined to the rectal wall? Radiology. 2009;252:71–80.PubMedCrossRef
26.
Valls C, Andia E, Sanchez A, Fabregat J, Pozuelo O, Quintero JC, et al. Hepatic metastases from colorectal cancer: preoperative detection and assessment of resectability with helical CT. Radiology. 2001;218:55–60.PubMed
27.
Bipat S, van Leeuwen MS, Ijzermans JN, Comans EF, Plan- ting AS, Bossuyt PM, et al. Evidence-based guideline on management of colorectal liver metastases in the Netherlands. Neth J Med. 2007;65:5–14.PubMed
28.
Kinkel K, Lu Y, Both M, Warren RS, Thoeni RF. Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology. 2002;224:748–56.PubMedCrossRef
29.
Parnaby C, Bailey W, Balasingam A, Beckert L, Eglinton T, Fife J, et al. Pulmonary staging in colorectal cancer: a review. Colorectal Dis. 2012;14:660–70.PubMedCrossRef
30.
Grossmann I, Avenarius JK, Mastboom WJ, Klaase JM, Avenarius JK, de Hingh IH, et al. Preoperative staging with chest CT in patients with colorectal carcinoma: not as a routine procedure. Ann Surg Oncol. 2010;17:2045–50.PubMedCrossRef
31.
Pavoor RS, Shukla PJ, Milsom JW. The importance of preoperative staging with chest CT scan in patients with colorectal cancer. Ann Surg Oncol. 2011;18(Suppl 3):S224–5.PubMedCrossRef
Metadata
Title
Is Restaging with Chest and Abdominal CT Scan after Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer Necessary?
Authors
Ninos Ayez, MD
Wijnand J. Alberda, MD
Jacobus W. A. Burger, MD, PhD
Alexander M. M. Eggermont, MD, PhD
Joost J. M. E. Nuyttens, MD, PhD
Roy S. Dwarkasing, MD
François E. J. A. Willemssen, MD
Cornelis Verhoef, MD, PhD
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 1/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2537-6

Other articles of this Issue 1/2013

Annals of Surgical Oncology 1/2013 Go to the issue

Gastrointestinal Oncology

Guidelines for Extended Lymphadenectomy in Gastric Cancer: A Prospective Comparative Study

Gastrointestinal Oncology

Prognostic Relevance of Number and Ratio of Metastatic Lymph Nodes in Resected Pancreatic, Ampullary, and Distal Bile Duct Carcinomas

Endocrine Tumors

BRAF V600E Mutation Independently Predicts Central Compartment Lymph Node Metastasis in Patients with Papillary Thyroid Cancer

Health Policy

Surgeon-Level Variation in Patients’ Appraisals of Their Breast Cancer Treatment Experiences

Translational Research and Biomarkers

WWOX Protein Expression Varies Among RCC Histotypes and Downregulation of WWOX Protein Correlates with Less-Favorable Prognosis in Clear RCC

Breast Oncology

A Comparison of Clinical and Pathologic Assessments for the Prediction of Occult Nipple Involvement in Nipple-Sparing Mastectomies