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Restaging Patients with Rectal Cancer Following Neoadjuvant Chemoradiation: A Systematic Review

  • Leah E. Hendrick
  • Renee L. Levesque
  • Nathan M. Hinkle
  • Justin J. Monroe
  • Evan S. Glazer
  • Jeremiah L. Deneve
  • Danny Yakoub
  • David Shibata
  • Paxton V. DicksonEmail author
Scientific Review

Abstract

Background

In the USA, most patients with clinical stage II/III rectal cancer receive neoadjuvant chemoradiation (chemo/XRT) over 5–6 weeks followed by a 6–10-week break before proctectomy. As chemotherapy is delivered at radio-sensitizing doses, there is essentially a 3-month window during which potential systemic disease is untreated. Evidence regarding the utility of restaging patients prior to proctectomy is limited.

Methods

PubMed, Scopus, Web of Science, and the Cochrane Library were searched for studies evaluating the utility of restaging patients with rectal cancer after completion of long-course chemo/XRT, and reporting associated changes in management. Studies that were non-English, included <50 patients, or examining the diagnostic accuracy of imaging modalities were excluded. Study quality was evaluated using the modified Newcastle Ottawa Scale.

Results

Eight studies were identified including a total of 1251 patients restaged between completion of chemo/XRT and proctectomy. All studies were retrospective. Restaging identified new metastatic disease in 72 (6.0%) patients, with 4 studies reporting specific sites: liver (n = 28), lung (n = 8), adrenal (n = 1), bone (n = 1), and multiple sites (n = 7). Overall progression (distant or local) was detected in 88 (7.0%) patients and resulted in a change in management in 77 (87.5%) of these patients. Tumor-related prognostic characteristics were inconsistently reported among studies, precluding meta-analysis.

Conclusions

Although restaging between completion of neoadjuvant chemo/XRT and proctectomy detects disease progression in only a small percentage of patients, findings alter the treatment plan in the vast majority of these patients. Multi-institutional collaboration with analysis of well-defined prognostic variables may better identify patients most likely to benefit from restaging.

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest.

References

  1. 1.
    Benson AB, 3rd et al (2018) Rectal cancer, version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 16(7):874–901CrossRefGoogle Scholar
  2. 2.
    Monson JR et al (2013) Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum 56(5):535–550CrossRefGoogle Scholar
  3. 3.
    Shamseer L et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 350:g7647CrossRefGoogle Scholar
  4. 4.
    Wells GA et al (2011) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. Available: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
  5. 5.
    Bazerbachi F et al (2018) Systematic review of acute pancreatitis associated with interferon-alpha or pegylated interferon-alpha: possible or definitive causation? Pancreatology 18(7):691–699CrossRefGoogle Scholar
  6. 6.
    Bazerbachi F et al (2017) Systematic review of mixed cryoglobulinemia associated with hepatitis E virus infection: association or causation? Gastroenterol Rep (Oxf) 5(3):178–184CrossRefGoogle Scholar
  7. 7.
    Ayez N et al (2013) Is restaging with chest and abdominal CT scan after neoadjuvant chemoradiotherapy for locally advanced rectal cancer necessary? Ann Surg Oncol 20(1):155–160CrossRefGoogle Scholar
  8. 8.
    Jaffe TA et al (2013) Is follow-up CT imaging of the chest and abdomen necessary after preoperative neoadjuvant therapy in rectal cancer patients without evidence of metastatic disease at diagnosis? Colorectal Dis 15(11):e654–e658CrossRefGoogle Scholar
  9. 9.
    Davids JS et al (2014) Routine preoperative restaging CTs after neoadjuvant chemoradiation for locally advanced rectal cancer are low yield: a retrospective case study. Int J Surg 12(12):1295–1299CrossRefGoogle Scholar
  10. 10.
    Hanly AM et al (2014) Multicenter evaluation of rectal cancer reImaging post neoadjuvant (MERRION) therapy. Ann Surg 259(4):723–727CrossRefGoogle Scholar
  11. 11.
    Bisschop C et al (2015) Consequence of restaging after neoadjuvant treatment for locally advanced rectal cancer. Ann Surg Oncol 22(2):552–556CrossRefGoogle Scholar
  12. 12.
    McBrearty A et al (2016) Re-staging following long-course chemoradiotherapy for rectal cancer: does it influence management? Ulster Med J 85(3):178–181PubMedPubMedCentralGoogle Scholar
  13. 13.
    Schneider DA et al (2016) Relative value of restaging MRI, CT, and FDG-PET scan after preoperative chemoradiation for rectal cancer. Dis Colon Rectum 59(3):179–186CrossRefGoogle Scholar
  14. 14.
    Park HJ et al (2018) Restaging abdominopelvic computed tomography before surgery after preoperative chemoradiotherapy in patients with locally advanced rectal cancer. JAMA Oncol 4(2):259–262CrossRefGoogle Scholar
  15. 15.
    Bhoday J et al (2016) Magnetic resonance tumor regression grade and residual mucosal abnormality as predictors for pathological complete response in rectal cancer postneoadjuvant chemoradiotherapy. Dis Colon Rectum 59(10):925–933CrossRefGoogle Scholar
  16. 16.
    Beets-Tan RGH et al (2018) Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 28(4):1465–1475CrossRefGoogle Scholar
  17. 17.
    Cercek A et al (2018) Adoption of total neoadjuvant therapy for locally advanced rectal cancer. JAMA Oncol 4(6):e180071CrossRefGoogle Scholar
  18. 18.
    Qiu M et al (2015) Pattern of distant metastases in colorectal cancer: a SEER based study. Oncotarget 6(36):38658–38666CrossRefGoogle Scholar
  19. 19.
    Singhal N et al (2016) Restaging after neoadjuvant chemoradiation in rectal cancers: is histology the key in patient selection? J Gastrointest Oncol 7(3):360–364CrossRefGoogle Scholar
  20. 20.
    Song JH et al (2016) Significance of histologic tumor grade in rectal cancer treated with preoperative chemoradiotherapy followed by curative surgery: a multi-institutional retrospective study. Radiother Oncol 118(2):387–392CrossRefGoogle Scholar
  21. 21.
    Saito G et al (2018) Relations of changes in serum carcinoembryonic antigen levels before and after neoadjuvant chemoradiotherapy and after surgery to histologic response and outcomes in patients with locally advanced rectal cancer. Oncology 94(3):167–175CrossRefGoogle Scholar
  22. 22.
    Garcia-Aguilar J et al (2011) Identification of a biomarker profile associated with resistance to neoadjuvant chemoradiation therapy in rectal cancer. Ann Surg 254(3):486–192; discussion 492–493CrossRefGoogle Scholar
  23. 23.
    Chow OS et al (2016) KRAS and combined KRAS/TP53 mutations in locally advanced rectal cancer are independently associated with decreased response to neoadjuvant therapy. Ann Surg Oncol 23(8):2548–2555CrossRefGoogle Scholar
  24. 24.
    Chand M et al (2015) The prognostic significance of postchemoradiotherapy high-resolution MRI and histopathology detected extramural venous invasion in rectal cancer. Ann Surg 261(3):473–479CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Leah E. Hendrick
    • 1
  • Renee L. Levesque
    • 1
  • Nathan M. Hinkle
    • 1
  • Justin J. Monroe
    • 1
  • Evan S. Glazer
    • 1
  • Jeremiah L. Deneve
    • 1
  • Danny Yakoub
    • 1
  • David Shibata
    • 1
  • Paxton V. Dickson
    • 1
    Email author
  1. 1.Division of Surgical Oncology, Department of SurgeryUniversity of Tennessee Health Science CenterMemphisUSA

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