H Kahn1, A Alexander, J Rakinic, D Nagle, R Fry. 1. Division of Colon and Rectal Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Abstract
PURPOSE: The postradiation preoperative staging results of 25 patients with rectal cancer who were found to have Stage T0,N0 lesions after surgery were examined. Our aim was to assess the ability of preoperative staging following radiation therapy to predict the absence of disease. METHODS: From 1983 to 1994, 25 patients treated with preoperative radiation therapy for biopsy-proven rectal cancer were found to have no pathologic evidence of disease in the resected specimen (T0,N0). The preoperative postradiation disease staging results of these patients were compared with the postoperative pathologic findings. Each patient received 4,500 to 5,580 cGy during a five-week to six-week period, and four patients had preoperative chemotherapy. Surgical resection was performed six to eight weeks after completion of radiation therapy. All 25 patients were staged by digital rectal examination before surgery. In addition, 13 patients were assessed using computed tomography, 6 by endorectal ultrasound, and 1 by magnetic resonance imaging. RESULTS: Most irradiated lesions were overstaged by radiologic assessment and physical examination. No technique could reliably distinguish between postradiation fibrosis and residual cancer. The negative predictive value for digital rectal examination was 24 percent. Computed tomography accurately staged 23 percent of lesions, and endorectal ultrasound predicted 17 percent of lesions correctly. The single patient evaluated by magnetic resonance imaging was overstaged and thought to have a T2 lesion. CONCLUSIONS: Our ability to assess local eradication of rectal cancer following radiation therapy remains poor. Conventional imaging and clinical examination techniques are unable to safely predict which patients do not require surgical excision following curative radiation therapy for rectal cancer.
PURPOSE: The postradiation preoperative staging results of 25 patients with rectal cancer who were found to have Stage T0,N0 lesions after surgery were examined. Our aim was to assess the ability of preoperative staging following radiation therapy to predict the absence of disease. METHODS: From 1983 to 1994, 25 patients treated with preoperative radiation therapy for biopsy-proven rectal cancer were found to have no pathologic evidence of disease in the resected specimen (T0,N0). The preoperative postradiation disease staging results of these patients were compared with the postoperative pathologic findings. Each patient received 4,500 to 5,580 cGy during a five-week to six-week period, and four patients had preoperative chemotherapy. Surgical resection was performed six to eight weeks after completion of radiation therapy. All 25 patients were staged by digital rectal examination before surgery. In addition, 13 patients were assessed using computed tomography, 6 by endorectal ultrasound, and 1 by magnetic resonance imaging. RESULTS: Most irradiated lesions were overstaged by radiologic assessment and physical examination. No technique could reliably distinguish between postradiation fibrosis and residual cancer. The negative predictive value for digital rectal examination was 24 percent. Computed tomography accurately staged 23 percent of lesions, and endorectal ultrasound predicted 17 percent of lesions correctly. The single patient evaluated by magnetic resonance imaging was overstaged and thought to have a T2 lesion. CONCLUSIONS: Our ability to assess local eradication of rectal cancer following radiation therapy remains poor. Conventional imaging and clinical examination techniques are unable to safely predict which patients do not require surgical excision following curative radiation therapy for rectal cancer.
Authors: Jong Wan Kim; Hyun Chul Kim; Ji Won Park; Sung Chan Park; Dae Kyung Sohn; Hyo Seong Choi; Dae Yong Kim; Hee Jin Chang; Ji Yeon Baek; Sun Young Kim; Seok Ki Kim; Jae Hwan Oh Journal: Int J Colorectal Dis Date: 2013-02-13 Impact factor: 2.571
Authors: Joan Manel Gasent Blesa; Javier Garde Noguera; Juan Bautista Laforga Canales; Vicent Giner Bosch; Antonio Alberola; Miguel Soler Tortosa; Miguel Peris Godoy; Jose Luis Sanchez; Mariano Provencio Pulla; Vicente Alberola Candel Journal: J Gastrointest Cancer Date: 2012-12
Authors: Sthela M Murad-Regadas; Francisco Sergio P Regadas; Lusmar V Rodrigues; Rosilma G L Barreto; Francisco Coracy C Monteiro; Beethoven B Landim; Erico C Holanda Journal: Surg Endosc Date: 2008-09-24 Impact factor: 4.584