Preoperative adjuvant radiation with chemotherapy for rectal cancer: Its impact on stage of disease and the role of endorectal ultrasound
- 37 Downloads
Background: Preoperative adjuvant radiation combined with chemotherapy is a recent development in the management of patients with rectal cancer invading perirectal tissue and regional lymph nodes. This study was performed to assess the impact of preoperative adjuvant therapy in patients judged by endorectal ultrasound to have extramural invasion of rectal cancer and/or regional lymph node involvement on tumor regression in bowel wall and lymph nodes. The predictive value of ultrasound in staging wall penetration and lymph node involvement after preoperative adjuvant therapy was also assessed.
Methods: Patients (n=43) were selected by ultrasound to have preoperative irradiation (4,500–5,040 cGy over 5–6 weeks). In 30 patients this was combined with 5-fluorouracil, 370 mg/m2, for 5 days in the first and last weeks of irradiation. Pretreatment ultrasound was compared with pathologic findings in the resected specimen in all patients. Twenty-one were assessed by ultrasound after adjuvant therapy and findings compared with histology.
Results: Downstaging was seen in 23 (53%) patients with wall invasion and in 23 (72%) of 32 patients with lymph node involvement. Overall, downstaging was achieved in 30 (70%). Positive predictive values of ultrasound after irradiation were 72% and 56% for wall penetration and lymph node status, respectively. Negative predictive values of ultrasound after irradiation were 100% and 82%, respectively.
Conclusion: In the majority of patients with rectal cancer invading perirectal tissues or lymph nodes, lesions may be downstaged by preoperative adjuvant therapy. Endorectal ultrasound after adjuvant therapy for rectal cancer is of a lesser predictive value chiefly because of overstaging.
Key WordsRectal cancer Stage Preoperative adjuvant radiation Preoperative adjuvant chemotherapy Endorectal ultrasound
Unable to display preview. Download preview PDF.
- 3.Pilipshen SJ, Heilweil M, Quan SHQ, et al. Patterns of pelvic recurrence following definitive resection of rectal cancer.Cancer 1983;53:1354.Google Scholar
- 4.Rich T, Gunderson LL, Lew R, et al. Patterns of recurrence of rectal cancer after potentially curative surgery.Cancer 1984;52:1317.Google Scholar
- 7.Malcolum AW, Perencevich NP, Olson RM, et al. Analysis of recurrence patterns following curative resection for carcinoma of the colon and rectum.Surg Gynecol Obstet 1981;131:152.Google Scholar
- 13.Rich TA. Local therapy—radiation therapy. In: Cohen AM, Winawer SJ, Friedman MA, Gunderson LL, eds.Cancer of the colon, rectum, and anus. New York: McGraw-Hill, 1955:553–9.Google Scholar