Nitin Singhal1, Karthik Vallam1, Reena Engineer1, Vikas Ostwal1, Supreeta Arya1, Avanish Saklani1. 1. 1 Specialist Registrar Oncosurgery, 2 Department of Radiation Oncology, 3 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India ; 4 Department of Radiodiagnosis, 5 Departmemt of GI Surgery, Tata Memorial Centre, Mumbai, India.
Abstract
BACKGROUND: Neoadjuvant chemoradiation is the standard of care for locally advanced rectal cancer. However, there is no clarity regarding the necessity for restaging scans to rule out systemic progression of disease post chemoradiation with existing literature being divided on the need for the same. METHODS: Data from a prospectively maintained database was retrospectively analysed. All locally advanced rectal cancers (node positive/T4/T3 with threatened or involved CRM) were included. Biopsy proof of adenocarcinoma and CT scan of abdomen and chest were mandatory. Grade of tumor and response to CTRT on restaging magnetic resonance imaging (MRI) were documented. RESULTS: Out of 119 patients subjected to CTRT, 72 underwent definitive total mesorectal excision while 13 patients progressed locoregionally on restaging MR pelvis and 15 other patients progressed systemically while the rest defaulted. Patients with poorly differentiated (PD) cancers were compared to those with well/moderately differentiated (WMD) tumors. PD tumors had a significantly higher rate of local progression (32.1% vs. 5.6% %, P=0.0011) and systemic progression (35.7% vs. 6.9%, P=0.0008) as compared to WMD tumors. Only one-third (9/28) of PD patients underwent TME while the rest progressed. CONCLUSIONS: Selecting poorly differentiated tumors alone for restaging CECT abdomen and thorax will be a cost effective strategy as the rate of progression is very high. Also patients with PD tumors need to be consulted about the high probability of progression of disease.
BACKGROUND: Neoadjuvant chemoradiation is the standard of care for locally advanced rectal cancer. However, there is no clarity regarding the necessity for restaging scans to rule out systemic progression of disease post chemoradiation with existing literature being divided on the need for the same. METHODS: Data from a prospectively maintained database was retrospectively analysed. All locally advanced rectal cancers (node positive/T4/T3 with threatened or involved CRM) were included. Biopsy proof of adenocarcinoma and CT scan of abdomen and chest were mandatory. Grade of tumor and response to CTRT on restaging magnetic resonance imaging (MRI) were documented. RESULTS: Out of 119 patients subjected to CTRT, 72 underwent definitive total mesorectal excision while 13 patients progressed locoregionally on restaging MR pelvis and 15 other patients progressed systemically while the rest defaulted. Patients with poorly differentiated (PD) cancers were compared to those with well/moderately differentiated (WMD) tumors. PD tumors had a significantly higher rate of local progression (32.1% vs. 5.6% %, P=0.0011) and systemic progression (35.7% vs. 6.9%, P=0.0008) as compared to WMD tumors. Only one-third (9/28) of PDpatients underwent TME while the rest progressed. CONCLUSIONS: Selecting poorly differentiated tumors alone for restaging CECT abdomen and thorax will be a cost effective strategy as the rate of progression is very high. Also patients with PD tumors need to be consulted about the high probability of progression of disease.
Authors: C Bisschop; J J J Tjalma; G A P Hospers; D Van Geldere; J W B de Groot; E M Wiegman; M Van't Veer-Ten Kate; M G Havenith; J Vecht; J C Beukema; G Kats-Ugurlu; S V K Mahesh; B van Etten; K Havenga; J G M Burgerhof; D J A de Groot; W H de Vos Tot Nederveen Cappel Journal: Ann Surg Oncol Date: 2014-08-26 Impact factor: 5.344
Authors: Jennifer S Davids; Karim Alavi; J Andres Cervera-Servin; Christine S Choi; Paul R Sturrock; W Brian Sweeney; Justin A Maykel Journal: Int J Surg Date: 2014-11-04 Impact factor: 6.071
Authors: Ann M Hanly; Elizabeth M Ryan; Ailín C Rogers; Deborah A McNamara; Robert D Madoff; Desmond C Winter Journal: Ann Surg Date: 2014-04 Impact factor: 12.969
Authors: C C Compton; L P Fielding; L J Burgart; B Conley; H S Cooper; S R Hamilton; M E Hammond; D E Henson; R V Hutter; R B Nagle; M L Nielsen; D J Sargent; C R Taylor; M Welton; C Willett Journal: Arch Pathol Lab Med Date: 2000-07 Impact factor: 5.534
Authors: Gina Brown; Catherine J Richards; Michael W Bourne; Robert G Newcombe; Andrew G Radcliffe; Nicholas S Dallimore; Geraint T Williams Journal: Radiology Date: 2003-05 Impact factor: 11.105
Authors: Jacques Ferlay; Isabelle Soerjomataram; Rajesh Dikshit; Sultan Eser; Colin Mathers; Marise Rebelo; Donald Maxwell Parkin; David Forman; Freddie Bray Journal: Int J Cancer Date: 2014-10-09 Impact factor: 7.396