Clinical relevance of positron emission tomography/computed tomography‐positive inguinal nodes in rectal cancer after neoadjuvant chemoradiation

Perez, Rodrigo Oliva; Habr‐Gama, Angelita; Julião, Guilherme Pagin São; Proscurshim, Igor; Ono, Carla Rachel; Lynn, Patricio B.; Aguilar, Patrícia Bailão; Nahas, Sérgio Carlos; Gama-Rodrigues, Joaquim; Buchpiguel, Carlos Alberto

doi:10.1111/codi.12159

Cited by 11 publications

(13 citation statements)

References 17 publications

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“…After RCT, inguinal lymph nodes were seen in a few patients as reported before [ 31 ], These findings could be found either unilaterally or bilaterally. Most interestingly, the same inguinal lymph nodes could be seen in F-18 FDG and F-18 FLT PET/CT in 3 patients.…”

Section: Discussionsupporting

confidence: 71%

Assessment of response to neoadjuvant radiochemotherapy with F-18 FLT and F-18 FDG PET/CT in patients with rectal cancer

et al. 2014

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ObjectiveThe comparison of 2-deoxy-2-[18F]fluoro-d-glucose (F-18 FDG) and 3′-deoxy-3′-[18F]fluorothymidine (F-18 FLT) imaging in patients with rectal cancer before and after neoadjuvant radiochemotherapy (RCT) in relation to histopathology and immunohistochemistry obtained from surgery.Methods20 consecutive patients (15 m, 5 f), mean age of 65 ± 10 years were included into this prospective study with a mean follow-up of 4.1 ± 0.8 years.ResultsAmong histopathological responders (n = 8 out of 20), posttreatment F-18 FLT and F-18 FDG scans were negative in 75 % (n = 6) and 38 % (n = 3), respectively. The mean response index (RI) was 61.0 % ± 14.0 % for F-18 FLT and 58.7 % ± 14.6 % for F-18 FDG imaging. Peritumoral lymphocytic infiltration (CD3 positive cells) was significantly related to posttreatment SUVmax in F-18 FDG but not F-18 FLT studies.ConclusionA significant decrease of SUVmax in F-18 FDG and F-18 FLT studies could be seen after RCT. Negative posttreatment F-18 FLT studies identified more histopathological responders.

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Section: Discussionsupporting

confidence: 71%

Assessment of response to neoadjuvant radiochemotherapy with F-18 FLT and F-18 FDG PET/CT in patients with rectal cancer

et al. 2014

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“…Furthermore, identification of the disease characteristics linked to an increased risk of developing IGN recurrence in addition to ACI will assist in decisions regarding elective IGN irradiation in the minority of patients who will benefit from this treatment despite the potential for complications. Research in rectal cancer has included the sentinel node procedure [ 21 ], serial acquisition of 18 F-deoxyfluoroglucose positron emission tomography-CT [ 22 ], and the study of histological tumor features at the distal front invading the dentate line [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Is elective inguinal radiotherapy necessary for locally advanced rectal adenocarcinoma invading anal canal?

et al. 2014

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BackgroundWe investigated whether routine elective irradiation of a clinically negative inguinal node (IGN) is necessary for patients with locally advanced distal rectal cancer and anal canal invasion (ACI).MethodsWe reviewed retrospectively 1,246 patients with locally advanced rectal adenocarcinoma managed using preoperative or postoperative chemoradiotherapy and radical surgery between 2001 and 2011. The patients’ IGN was clinically negative at presentation and IGN irradiation was not performed. ACI was defined as the lower edge of the tumor being within 3 cm of the anal verge. Patients were divided into two groups, those with ACI (n = 189, 15.2%) and without ACI (n = 1,057, 84.8%).ResultsThe follow-up period was a median of 66 months (range, 3–142 months). Among the 1,246 patients, 10 developed IGN recurrence; 7 with ACI and 3 without ACI. The actuarial IGN recurrence rate at 5 years was 0.7%; 3.5% and 0.2% in patients with and without ACI, respectively (p < 0.001). Isolated IGN recurrence occurred in three patients, all of whom had ACI tumors. These three patients received curative intent local treatments, and one was alive with no evidence of disease 10 years after IGN recurrence. Salvage treatments in the other two patients controlled successfully the IGN recurrence for >5 years, but they developed second malignancy or pelvic and distant recurrences. Seven patients with non-isolated IGN recurrence died of disease at 5–22 months after IGN recurrence.ConclusionThe low IGN recurrence rate even with ACI and the feasibility of salvage of isolated IGN recurrence indicated that routine elective IGN irradiation is not necessary for rectal cancer with ACI.

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“…Overall, PET-CT findings compared with clinical and pathologic findings and resulted in a sensitivity of 93%, specificity of 53%, a negative predictive value of 73%, a positive predictive value of 87%, and an overall accuracy of 85% for the detection of persistent residual cancer (i.e. an incomplete response) 41. They concluded that the combination of clinical and PET-CT findings provide a safe and appropriate selection of patients who may attain a cCR after neoadjuvant chemotherapy.…”

Section: Pet-ctmentioning

confidence: 99%

“…This can be potentially expanded to predicting tumor response following CRT. In 2013, Perez and colleagues reported their results of a prospective randomized trial in which PET-CT is used to evaluate the inguinal nodes in patients who received neoadjuvant chemoradiation therapy for low rectal cancer 41. Patients were assessed for tumor response at 12 weeks after the completion of CRT by a single colorectal surgeon who used clinical and endoscopic approaches identical to those used at the initial assessment.…”

Section: Pet-ctmentioning

confidence: 99%

Future Directions for Monitoring Treatment Response in Colorectal Cancer

Walker¹,

Zwintscher²,

Johnson³

et al. 2014

J. Cancer

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Treatment of advanced colon and rectal cancer has significantly evolved with the introduction of neoadjuvant chemoradiation therapy so much that, along with more effective chemotherapy regimens, surgery has been considered unnecessary among some institutions for select patients. The tumor response to these treatments has also improved and ultimately has been shown to have a direct effect on prognosis. Yet, the best way to monitor that response, whether clinically, radiologically, or with laboratory findings, remains controversial. The authors' aim is to briefly review the options available and, more importantly, examine emerging and future options to assist in monitoring treatment response in cases of locally advanced rectal cancer and metastatic colon cancer.

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Clinical relevance of positron emission tomography/computed tomography‐positive inguinal nodes in rectal cancer after neoadjuvant chemoradiation

Cited by 11 publications

References 17 publications

Assessment of response to neoadjuvant radiochemotherapy with F-18 FLT and F-18 FDG PET/CT in patients with rectal cancer

Assessment of response to neoadjuvant radiochemotherapy with F-18 FLT and F-18 FDG PET/CT in patients with rectal cancer

Is elective inguinal radiotherapy necessary for locally advanced rectal adenocarcinoma invading anal canal?

Future Directions for Monitoring Treatment Response in Colorectal Cancer

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