This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Maretto, I. Articles by Nitti, D. Search for Related Content PubMed PubMed Citation Articles by Maretto, I. Articles by Nitti, D.

The Potential of Restaging in the Prediction of Pathologic Response After Preoperative Chemoradiotherapy for Rectal Cancer

¹ Department of Oncological and Surgical Sciences, Clinica Chirurgica II, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy
² Department of Diagnostic Sciences and Special Therapies, Radiology Unit, Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
³ Department of Diagnostic Sciences and Special Therapies, Pathology Unit, Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Padua, Via Gabelli, 61, 35128, Padua, Italy

Correspondence: Address correspondence and reprint requests to: Salvatore Pucciarelli, MD, E-mail: puc{at}unipd.it

Background: We performed this study to prospectively evaluate the postchemoradiotherapy performance of transrectal ultrasonography (TRUS), pelvic computed tomography (CT) scan and magnetic resonance imaging (MRI), and endoscopic biopsies for predicting the pathologic complete response of rectal cancer patients.

Methods: Four weeks after completion of preoperative chemoradiotherapy, 46 consecutive patients with mid to low rectal cancer were prospectively evaluated by proctoscopy, TRUS, and pelvic CT scan and MRI. On the basis of T and N status, patients were classified as T0 or T1–4 and N-negative or N-positive. For each staging modality used, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Findings were compared with the pathologic tumor-node-metastasis stage.

Results: On histopathologic analysis, 12 patients had pT0 and 34 had pT1–4 lesions; out of 45 assessable patients, 9 were N-positive. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting T status (T0 vs. T 1) were 77%, 33%, 74%, 36%, and 64%, respectively, for TRUS; 100%, 0%, 74%, not assessable, and 74% for CT; and 100%, 0%, 77%, not assessable, and 77% for MRI. The corresponding figures in predicting N status (N-negative vs. N-positive) were, respectively, 37%, 67%, 21%, 81%, and 61% for TRUS; 78%, 58%, 32%, 91%, and 62% for CT; and 33%, 74%, 25%, 81%, and 65% for MRI.

Conclusions: Current rectal cancer staging modalities after chemoradiotherapy allow good prediction of node-negative cases, although none of them is able to predict the pathologic complete response on the rectal wall.

Key Words: Rectal cancer • Staging • CT scan • MRI • TRUS

This article has been cited by other articles:

				T. Borschitz, D. Wachtlin, M. Mohler, H. Schmidberger, and T. Junginger Neoadjuvant Chemoradiation and Local Excision for T2-3 Rectal Cancer Ann. Surg. Oncol., March 1, 2008; 15(3): 712 - 720. [Abstract] [Full Text] [PDF]