Cancer Res Treat.  2016 Apr;48(2):561-566. 10.4143/crt.2015.114.

Multimodal Assessments Are Needed for Restaging after Neoadjunvant Chemoradiation Therapy in Rectal Cancer Patients

• Kye BH
• Kim HJ
• Kim G
• Kim JG
• Cho HM

• KMID: 2454333
• DOI: http://doi.org/10.4143/crt.2015.114

Abstract

PURPOSE
Restaging after neoadjuvant treatment is done for planning the surgical approach and, increasingly, to determine whether additional therapy or resection can be avoided for selected patients.
MATERIALS AND METHODS
Local restaging after neoadjuvant chemoradiation therapy (nCRT) was performed in 270 patients with locally advanced (cT3or4 or N+) rectal cancer. Abdomen and pelvic computed tomography (APCT) was used in all 270 patients, transrectal ultrasound (TRUS) in 121 patients, and rectal magnetic resonance imaging (MRI) in 65 patients. Findings according to imaging modalities were correlated with pathologic stage using Cohen's kappa (κ) to test agreement and intra-class correlation coefficient α to test reliability.
RESULTS
Accuracy for prediction of ypT stage according to three imaging modalities was 45.2% (κ=0.136, α=0.380) in APCT, 49.2% (κ=0.259, α=0.514) in rectal MRI, and 57.9% (κ=0.266, α=0.520) in TRUS. Accuracy for prediction of ypN stage was 66.0% (κ=0.274, α=0.441) in APCT, 71.8% (κ=0.401, α=0.549) in rectal MRI, and 66.1% (κ=0.147, α=0.272) in TRUS. Of 270 patients, 37 (13.7%) were diagnosed as pathologic complete responder after nCRT. Rectal MRI for restaging did not predict complete response. On the other hand, TRUS did predict three complete responders (κ=0.238, α=0.401).
CONCLUSION
APCT, rectal MRI, and TRUS are unreliable in restaging rectal cancer after nCRT. We think that multimodal assessment with rectal MRI and TRUS may be the best option for local restaging of locally advanced rectal cancer after nCRT.

Keyword

Rectal neoplasms; Neoadjuvant therapy; Neoplasm staging

MeSH Terms

Abdomen
Hand
Humans
Magnetic Resonance Imaging
Neoadjuvant Therapy
Neoplasm Staging
Rectal Neoplasms*
Ultrasonography

Figure

• 

  Fig. 1. A clinical complete response of the primary lesion after neoadjuvant chemoradiation therapy (nCRT) was defined when the primary lesion after nCRT was homogenous hypoechoic, reduced in size, had an intact whole rectal wall structure (B), especially hyper-echoic submucosal line, which was destructed before nCRT (A), and did not infiltrate to perirectal tissue.

Reference

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