AIM: A pilot study was undertaken to determine the accuracy of computed tomography (CT) staging in identifying patients with high-risk colon cancers who would be considered as candidates for a neoadjuvant therapy trial (FOxTROT) and those at low risk (T1/T2) who would be excluded. METHOD: Participating radiologists from 19 centres attended workshops for standardization of image interpretation according to previously defined prognostic criteria: good prognosis tumours, including, T1/T2; intermediate prognosis, T3 < 5 mm tumour invasion beyond the muscularis propria (MP); and poor prognosis tumours, including T3 with tumour extension ≥ 5 mm beyond the MP or T4. The CT findings were compared with histopathology as the reference standard. RESULTS: Of 94 patients with radiological and pathological data, 71% were categorized by CT as having a poor prognosis. The sensitivity and specificity of CT in identifying these tumours were 87% (95% CI, 74-94) and 49% (95% CI, 33-65). Sensitivity and specificity for tumour infiltration beyond the MP (T3/T4 vs T1/T2) were 95% (95% CI, 87-98) and 50% (95% CI, 22-77), respectively. Including all CT-staged T3 and T4 patients in the trial would have increased the proportion eligible for entry to 89% (n = 84) without affecting the false-positive rate of 7%. Some 20% of T3/T4 patients would have been ineligible for FOxTROT because of synchronous metastases. CONCLUSION: In a multicentre setting, CT scanning identified high-risk (T3/4) colon cancers with minimal overstaging of T1/T2 tumours, thus establishing the feasibility of radiologically guided neoadjuvant chemotherapy.
AIM: A pilot study was undertaken to determine the accuracy of computed tomography (CT) staging in identifying patients with high-risk colon cancers who would be considered as candidates for a neoadjuvant therapy trial (FOxTROT) and those at low risk (T1/T2) who would be excluded. METHOD: Participating radiologists from 19 centres attended workshops for standardization of image interpretation according to previously defined prognostic criteria: good prognosis tumours, including, T1/T2; intermediate prognosis, T3 < 5 mm tumour invasion beyond the muscularis propria (MP); and poor prognosis tumours, including T3 with tumour extension ≥ 5 mm beyond the MP or T4. The CT findings were compared with histopathology as the reference standard. RESULTS: Of 94 patients with radiological and pathological data, 71% were categorized by CT as having a poor prognosis. The sensitivity and specificity of CT in identifying these tumours were 87% (95% CI, 74-94) and 49% (95% CI, 33-65). Sensitivity and specificity for tumour infiltration beyond the MP (T3/T4 vs T1/T2) were 95% (95% CI, 87-98) and 50% (95% CI, 22-77), respectively. Including all CT-staged T3 and T4 patients in the trial would have increased the proportion eligible for entry to 89% (n = 84) without affecting the false-positive rate of 7%. Some 20% of T3/T4 patients would have been ineligible for FOxTROT because of synchronous metastases. CONCLUSION: In a multicentre setting, CT scanning identified high-risk (T3/4) colon cancers with minimal overstaging of T1/T2 tumours, thus establishing the feasibility of radiologically guided neoadjuvant chemotherapy.
Authors: Audrey H Choi; Rebecca A Nelson; Hans F Schoellhammer; Won Cho; Michelle Ko; Amanda Arrington; Christopher R Oxner; Marwan Fakih; Jimmie Wong; Stephen M Sentovich; Julio Garcia-Aguilar; Joseph Kim Journal: World J Gastrointest Surg Date: 2015-07-27
Authors: A Venara; C Ridereau-Zins; L Toque; E Cesbron; S Michalak; E Lermite; C Aube; A Hamy Journal: Int J Colorectal Dis Date: 2015-02-27 Impact factor: 2.571
Authors: Ahmed N Dehal; Amanda N Graff-Baker; Brooke Vuong; Daniel Nelson; Shu-Ching Chang; David Y Lee; Melanie Goldfarb; Anton J Bilchik Journal: J Gastrointest Surg Date: 2018-05-22 Impact factor: 3.452
Authors: M L Malmstrøm; I Gögenur; L B Riis; H Hassan; T W Klausen; T Perner; A Săftoiu; P Vilmann Journal: Int J Colorectal Dis Date: 2017-04-21 Impact factor: 2.571
Authors: M L Malmstrøm; S Brisling; T W Klausen; A Săftoiu; T Perner; P Vilmann; I Gögenur Journal: Int J Colorectal Dis Date: 2017-11-07 Impact factor: 2.571