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- Title
What Is the Utility of Restaging Imaging for Patients With Clinical Stage II/III Rectal Cancer After Completion of Neoadjuvant Chemoradiation and Prior to Proctectomy?
- Authors
Hendrick, Leah E.; Buckner, Jacob D.; Guerrero, Whitney M.; Shibata, David; Hinkle, Nathan M.; Monroe, Justin J.; Glazer, Evan S.; Deneve, Jeremiah L.; Dickson, Paxton V.
- Abstract
<bold>Background: </bold>In the United States, patients with clinical stage II or III rectal cancer typically receive neoadjuvant chemoradiation therapy (chemo/XRT) over a 5-6 week period followed by a 6-10 week break prior to proctectomy. In the current study, we evaluate the utilization of restaging studies performed and detection of disease progression during this window.<bold>Methods: </bold>A retrospective review of patients with clinical stage II/III rectal cancer was performed. Medical records were analyzed to collect clinicopathologic data and the performance and results of preoperative, early postoperative, and first surveillance CT and/or PET/CT in patients completing long course neoadjuvant chemo/XRT and undergoing proctectomy.<bold>Results: </bold>Between 2005 and 2017, 176 patients with clinical stage II or III rectal adenocarcinoma completed neoadjuvant chemo/XRT and underwent proctectomy. Preoperative restaging with CT CAP and/or CT/PET was performed in 72 (40.9%) patients with no detection of disease progression. Of the 104 patients without preoperative restaging, 1 had intraoperative detection of liver metastases and 31 had early postoperative reimaging (within 30 days of proctectomy) of which 2 had detection of new pulmonary metastases. Among 72 patients with no preoperative or early postoperative reimaging, first surveillance imaging was available in 47 and detected new metastases in 8 (17%).<bold>Discussion: </bold>In patients with clinical stage II/III rectal cancer who undergo long course neoadjuvant chemo/XRT, perioperative reimaging with CT CAP and/or PET/CT detects new metastases in a small percentage of patients. A multi-institutional, prospective analysis using standardized staging protocols is warranted to better determine the value of preoperative restaging in these patients.
- Subjects
UNITED States; NEOADJUVANT chemotherapy; CHEMORADIOTHERAPY; RECTAL cancer; DIAGNOSTIC imaging; LIVER metastasis; ABDOMINOPERINEAL resection; DISEASE progression; ADENOCARCINOMA; RECTUM tumors; RETROSPECTIVE studies; TUMOR classification; COMBINED modality therapy; COMPUTED tomography
- Publication
American Surgeon, 2021, Vol 87, Issue 2, p242
- ISSN
0003-1348
- Publication type
journal article
- DOI
10.1177/0003134820950298