Jennifer S Davids1, Karim Alavi2, J Andres Cervera-Servin3, Christine S Choi4, Paul R Sturrock5, W Brian Sweeney6, Justin A Maykel7. 1. University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: Jennifer.Davids@umassmemorial.org. 2. University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: Karim.Alavi@umassmemorial.org. 3. University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: Andres.CerveraServin@swedish.org. 4. University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: Christine.Choi@umassmemorial.org. 5. University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: Paul.Sturrock3@umassmemorial.org. 6. University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: W.Brian.Sweeney@umassmemorial.org. 7. University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: Justin.Maykel@umassmemorial.org.
Abstract
INTRODUCTION: Pre-operative restaging CT scans are often performed routinely following neoadjuvant chemoradiotherapy for locally advanced rectal cancer. There is a paucity of data on the utility of this common practice. We sought to determine how often restaging CTs identified disease progression or regression that altered management. METHODS: We performed a single-institution retrospective study. From 2007 to 2011, 182 patients had newly-diagnosed, non-metastatic rectal adenocarcinoma, of which 96 were surgical candidates with clinical stage II/III disease. Ninety-one of these patients (95%) completed neoadjuvant chemoradiation. RESULTS: Eighty-three out of 91 patients (91%) had restaging CTs. Four patients (5%) had new lesions suspicious for distant metastasis (2 lung, 2 liver) on restaging CT scan reports (1 of these was present on initial staging CT but not reported). All 4 patients had node-positive disease. In no case did restaging CT result in a change in surgical management. DISCUSSION: Because of the financial costs and established risks of intravenous contrast and cumulative radiation exposure, it may be advisable to take a more selective approach to preoperative imaging. Larger, prospective studies may enable identification of an at-risk cohort who would benefit most from restaging CT. CONCLUSION: Routine restaging CT scans are low yield in the management of locally advanced rectal cancer.
INTRODUCTION: Pre-operative restaging CT scans are often performed routinely following neoadjuvant chemoradiotherapy for locally advanced rectal cancer. There is a paucity of data on the utility of this common practice. We sought to determine how often restaging CTs identified disease progression or regression that altered management. METHODS: We performed a single-institution retrospective study. From 2007 to 2011, 182 patients had newly-diagnosed, non-metastatic rectal adenocarcinoma, of which 96 were surgical candidates with clinical stage II/III disease. Ninety-one of these patients (95%) completed neoadjuvant chemoradiation. RESULTS: Eighty-three out of 91 patients (91%) had restaging CTs. Four patients (5%) had new lesions suspicious for distant metastasis (2 lung, 2 liver) on restaging CT scan reports (1 of these was present on initial staging CT but not reported). All 4 patients had node-positive disease. In no case did restaging CT result in a change in surgical management. DISCUSSION: Because of the financial costs and established risks of intravenous contrast and cumulative radiation exposure, it may be advisable to take a more selective approach to preoperative imaging. Larger, prospective studies may enable identification of an at-risk cohort who would benefit most from restaging CT. CONCLUSION: Routine restaging CT scans are low yield in the management of locally advanced rectal cancer.
Authors: Hyo Jung Park; Jong Keon Jang; Seong Ho Park; In Ja Park; Jong Hoon Kim; Seunghee Baek; Yong Sang Hong Journal: JAMA Oncol Date: 2018-02-01 Impact factor: 31.777