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Preoperative staging of irradiated rectal cancers using digital rectal examination, computed tomography, endorectal ultrasound, and magnetic resonance imaging does not accurately predict T0,N0 pathology

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Diseases of the Colon & Rectum

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.

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References

  1. Berard P, Papillon J. Role of preoperative irradiation for anal preservation in cancer of the low rectum. World J Surg 1992;16:502–9.

    PubMed  Google Scholar 

  2. Dahl O, Horn A, Morild I,et al. Low-dose preoperative radiation postpones recurrences in operable rectal cancer: results of a randomized multicenter trial in western Norway. Cancer 1990;66:2286–94.

    PubMed  Google Scholar 

  3. Gerard A, Buyse M, Nordlinger B,et al. Preoperative radiotherapy as adjuvant treatment in rectal cancer: final results of a randomized study of the European Organization for Research and Treatment of Cancer. Ann Surg 1988;208:606–14.

    PubMed  Google Scholar 

  4. Higgins GA, Humphrey EW, Dwight RW,et al. Preoperative radiation and surgery for cancer of the rectum: Veterans Administration Surgical Oncology Trial II. Cancer 1986;58:352–9.

    PubMed  Google Scholar 

  5. Kodner IJ, Shemesh EI, Fry RD,et al. Preoperative irradiation for rectal cancer: improved local control and long-term survival. Ann Surg 1989;209:194–9.

    PubMed  Google Scholar 

  6. Krook JE, Moertel CG, Gunderson LL,et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 1991;324:709–15.

    PubMed  Google Scholar 

  7. Chari RS, Tyler DS, Anscher MS,et al. Preoperative radiation and chemotherapy in the treatment of adeno-carcinoma of the rectum. Ann Surg 1995;221:778–87.

    PubMed  Google Scholar 

  8. Meterissian S, Skibber J, Rich T,et al. Patterns of residual disease after preoperative chemoradiation in ultrasound T3 rectal carcinoma. Ann Surg Oncol 1994;1:111–6.

    PubMed  Google Scholar 

  9. Minsky BD, Cohen AM, Kemeny N,et al. Enhancement of radiation-induced downstaging of rectal cancer by fluorouracil and high-dose leucovorin chemotherapy. J Clin Oncol 1992;10:79–84.

    PubMed  Google Scholar 

  10. Minsky BD, Cohen AM, Enker W,et al. Preoperative 5-fluorouracil, low-dose leucovorin, and concurrent radiation therapy for rectal cancer. Cancer 1994;73:273–80.

    Google Scholar 

  11. Minsky BD, Cohen AM, Kemeny N,et al. Combined modality therapy of rectal cancer: decreased acute toxicity with the preoperative approach. J Clin Oncol 1992;10:1218–24.

    PubMed  Google Scholar 

  12. Williamson PR, Hellinger MD, Larach SW, Ferrara A. Endorectal ultrasound of T3 and T4 rectal cancers after preoperative chemoradiation. Dis Colon Rectum 1996;39:45–9.

    PubMed  Google Scholar 

  13. Anderson BO, Hann LE, Enker WE, Dershaw DD, Guillen JG, Cohen AM. Transrectal ultrasonography and operative selection for early carcinoma of the rectum. J Am Coll Surg 1994;179:513–7.

    PubMed  Google Scholar 

  14. Fleshman JW, Myerson RJ, Fry RD, Kodner IJ. Accuracy of transrectal ultrasound in predicting pathologic stage of rectal cancer before and after preoperative radiation therapy. Dis Colon Rectum 1992;35:823–9.

    PubMed  Google Scholar 

  15. Napoleon B, Pujol B, Berger F, Valette PJ, Gerard JP, Souquet JC. Accuracy of endosonography in the staging of rectal cancer treated by radiotherapy. Br J Surg 1991;78:785–8.

    PubMed  Google Scholar 

  16. Watanabe M, Sugimura K, Kuroda S, Okizuka H, Ishida T. CT assessment of post irradiation changes in the rectum and perirectal region. Clin Imaging 1995;19:182–7.

    PubMed  Google Scholar 

  17. Astler VB, Coller FA. The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 1954;139:846–52.

    PubMed  Google Scholar 

  18. Meade PG, Blatchford GJ, Thorson AG, Christenson MA, Ternent CA. Preoperative chemoradiation downstages locally advanced ultrasound-staged rectal cancer. Am J Surg 1995;170:609–13.

    PubMed  Google Scholar 

  19. Beynon J, Mortenson NJ, Foy DM, Channer JL, Virjee J, Goddard P. Preoperative assessment of local invasion in rectal cancer: digital examination, endoluminal sonog-raphy or computed tomography? Br J Surg 1986;73:1015–7.

    PubMed  Google Scholar 

  20. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum 1985;28:42–6.

    PubMed  Google Scholar 

  21. Kramann B, Hildebrandt U. Computed tomography versus endosonography in the staging of rectal carcinoma: a comparative study. Int J Colorectal Dis 1986;1:216–8.

    PubMed  Google Scholar 

  22. Rifkin MD, Wechsler RJ. A comparison of computed tomography and endorectal ultrasound in staging rectal cancer. Int J Colorectal Dis 1986;1:219–23.

    PubMed  Google Scholar 

  23. Durdey P, Williams NS. Preoperative evaluation of patients with low rectal carcinoma. World J Surg 1992;16:430–6.

    PubMed  Google Scholar 

  24. Herzog U, von Flue M, Tondelli P, Schuppisser JP. How accurate is endorectal ultrasound in the preoperative staging of rectal cancer? Dis Colon Rectum 1993;36:127–34.

    PubMed  Google Scholar 

  25. Katsura Y, Yamada K, Ishizawa T, Yoshinaka H, Shimazu H. Endorectal ultrasonography for the assessment of wall invasion and lymph node metastasis in rectal cancer. Dis Colon Rectum 1992;35:362–8.

    PubMed  Google Scholar 

  26. Solomon MJ, McLeod R. Endoluminal transrectal ultrasonography: ccuracy, reliability, and validity. Dis Colon Rectum 1993;36:200–5.

    PubMed  Google Scholar 

  27. Starck M, Bohe M, Fork FT, Lindström C, Sjöberg S. Endoluminal ultrasound and low-field magnetic resonance imaging are superior to clinical examination in the preoperative staging of rectal cancer. Eur J Surg 1995;161:841–5.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Thomas Jefferson University, 1100 Walnut Street, Suite 702, 19107, Philadelphia, Pennsylvania

    H. Kahn M.D., A. Alexander M.D., J. Rakinic M.D., D. Nagle M.D. &  R. Fry M.D.

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  1. H. Kahn M.D.
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  2. A. Alexander M.D.
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  3. J. Rakinic M.D.
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  4. D. Nagle M.D.
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  5. R. Fry M.D.
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Read at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9 to 14, 1996.

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Kahn, H., Alexander, A., Rakinic, J. et al. Preoperative staging of irradiated rectal cancers using digital rectal examination, computed tomography, endorectal ultrasound, and magnetic resonance imaging does not accurately predict T0,N0 pathology. Dis Colon Rectum 40, 140–144 (1997). https://doi.org/10.1007/BF02054977

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  • DOI: https://doi.org/10.1007/BF02054977

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