Article

Annals of Surgical Oncology

, Volume 14, Issue 2, pp 455-461

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

  • Isacco MarettoAffiliated withDepartment of Oncological and Surgical Sciences, Clinica Chirurgica II, University of Padua
  • , Fabio PomerriAffiliated withDepartment of Diagnostic Sciences and Special Therapies, Radiology Unit, Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Padua
  • , Salvatore PucciarelliAffiliated withDepartment of Oncological and Surgical Sciences, Clinica Chirurgica II, University of Padua Email author 
  • , Claudia MescoliAffiliated withDepartment of Diagnostic Sciences and Special Therapies, Pathology Unit, Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Padua
  • , Enrico BellucoAffiliated withDepartment of Oncological and Surgical Sciences, Clinica Chirurgica II, University of Padua
  • , Simona BurziAffiliated withDepartment of Diagnostic Sciences and Special Therapies, Radiology Unit, Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Padua
  • , Massimo RuggeAffiliated withDepartment of Diagnostic Sciences and Special Therapies, Pathology Unit, Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Padua
  • , Pier Carlo MuzzioAffiliated withDepartment of Diagnostic Sciences and Special Therapies, Radiology Unit, Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Padua
  • , Donato NittiAffiliated withDepartment of Oncological and Surgical Sciences, Clinica Chirurgica II, University of Padua

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Abstract

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.

Keywords

Rectal cancer Staging CT scan MRI TRUS