Criteria for three-dimensional anorectal ultrasound assessment of response to chemoradiotherapy in rectal cancer patients

Murad-Regadas, Sthela M.; Regadas, Francisco Sérgio Pinheiro; Rodrigues, Lusmar Veras; Crispin, Francisco Jean; Kenmoti, Viviane Tiemi; Fernandes, Graziela Olívia da Silva; Buchen, Guilherme; Monteiro, Francisco Coracy Carneiro

doi:10.1111/j.1463-1318.2010.02471.x

Cited by 10 publications

(5 citation statements)

References 37 publications

(105 reference statements)

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“…owing to tumour shrinkage [13]. Schiessel et al pathological complete response 8% to 30% [14]. In our study, 89.6% underwent neoadjuvant radiotherapy, long-course radiotherapy (74.4%), short-course radiotherapy 15.2%, neoadjuvant chemotherapy, 28.7%), adjuvant chemotherapy in 70.1%, pathologic complete response (11%).…”

Section: Discussionsupporting

confidence: 46%

Intersphincteric Resection Is the Optimal Procedure for Very Low Rectal Cancer: Techniques, Morbidity, Oncologic and Functional Outcomes

Zedan¹,

Tawfik²,

Aboeleupn³

et al. 2019

JCT

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Background: The intersphincteric resection the most extreme form of a sphincter-preserving alternative for the abdominoperineal resection. Aim of the Work: We investigated oncological, functional outcomes and morbidity after ISR. Methods: This retrospective study included 164 patients who underwent ISR with between 2010 and 2015, Male 56.1%, Female 43.9%, with a median age was 54.5 years, Median follow-up time was of 48 months, Average surgical time was 230 min, Median blood loss was 700 mL and median hospital stay was nine days. Mean tumour size was 34 mm. The surgical procedure through a laparotomy (72.

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Section: Discussionsupporting

confidence: 46%

Intersphincteric Resection Is the Optimal Procedure for Very Low Rectal Cancer: Techniques, Morbidity, Oncologic and Functional Outcomes

Zedan¹,

Tawfik²,

Aboeleupn³

et al. 2019

JCT

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“…Regarding imaging techniques, high-frequency three-dimensional endorectal ultrasound (3D-ERUS) can identify residual tumors and complete response with a high degree of accuracy [ 75 , 76 ], and can help in the choice of surgical approach or non-surgical management. The appearance of normal anatomy of the rectal wall under ultrasound, at the former tumor site after CRT, can predict complete response with good accuracy [ 75 ], even though the result should be interpreted with care and needs to be integrated with the findings of other imaging and endoscopic examinations.…”

Section: Assessment Of Complete Response: How To Identify the True Rementioning

confidence: 99%

Neoadjuvant chemoradiation therapy and pathological complete response in rectal cancer

Ferrari

Fichera

2015

Gastroenterol. Rep.

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The management of rectal cancer has evolved significantly in the last few decades. Significant improvements in local disease control were achieved in the 1990s, with the introduction of total mesorectal excision and neoadjuvant radiotherapy. Level 1 evidence has shown that, with neoadjuvant chemoradiation therapy (CRT) the rates of local recurrence can be lower than 6% and, as a result, neoadjuvant CRT currently represents the accepted standard of care. This approach has led to reliable tumor down-staging, with 15–27% patients with a pathological complete response (pCR)—defined as no residual cancer found on histological examination of the specimen. Patients who achieve pCR after CRT have better long-term outcomes, less risk of developing local or distal recurrence and improved survival. For all these reasons, sphincter-preserving procedures or organ-preserving options have been suggested, such as local excision of residual tumor or the omission of surgery altogether. Although local recurrence rate has been stable at 5–6% with this multidisciplinary management method, distal recurrence rates for locally-advanced rectal cancers remain in excess of 25% and represent the main cause of death in these patients. For this reason, more recent trials have been looking at the administration of full-dose systemic chemotherapy in the neoadjuvant setting (in order to offer early treatment of disseminated micrometastases, thus improving control of systemic disease) and selective use of radiotherapy only in non-responders or for low rectal tumors smaller than 5 cm.

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“…This imaging modality provides good accuracy for the identification of complete response in the primary cancer (ypT status). However, patient discomfort and the difficulties in assessing mesorectal disease away from the rectal lumen contributed to the replacement of ERUS by alternative radiological imaging modalities [57,58]. Magnetic resonance is currently the imaging modality of choice for baseline staging and assessment of response to neoadjuvant therapy in rectal cancer [43].…”

Section: Radiological Studiesmentioning

confidence: 99%

Rectal Cancer: Nonoperative Management

Garcia‐Aguilar

Perez

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Concepts• A proportion of patients with rectal cancer managed by neoadjuvant chemoradiation may achieve complete disappearance of the primary tumor (complete clinical response) during assessment of response after treatment completion. • Establishing a complete clinical response requires the combination of clinical, endoscopic, and radiological findings consistent with the absence of residual cancer at the site of the original cancer. • Patients that achieve a complete clinical response have been considered for organ preservation strategy with strict surveillance and no immediate surgery (Watch and Wait) to avoid the potential morbidity, mortality, requirement for stomas, and functional consequences of a proctectomy. • Patients that achieve a complete clinical response and are managed by the Watch and Wait strategy have a 25% risk for developing local regrowth of the primary tumor. • The majority of local regrowths are amenable to successful salvage proctectomy with negative resection margins (R0). • Patients that achieve a cCR and are managed by Watch and Wait have similar overall survival rates when compared to patients with pCR managed by radical proctectomy. Disease-free survival rates are superior for patients undergoing radical proctectomy due to the 25% risk of local regrowth following WW requiring salvage proctectomy. • Functional outcomes and quality of life appear to be improved among patients with complete clinical response managed by Watch and Wait when compared to proctectomy.

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Criteria for three-dimensional anorectal ultrasound assessment of response to chemoradiotherapy in rectal cancer patients

Abstract: 3D-AUS was shown to evaluate accurately the response to chemoradiotherapy, helping in the selection of patients for a sphincter-saving resection. The distance between the tumour and the internal anal sphincter was the most important parameter in this respect.

Cited by 10 publications

References 37 publications

Intersphincteric Resection Is the Optimal Procedure for Very Low Rectal Cancer: Techniques, Morbidity, Oncologic and Functional Outcomes

Intersphincteric Resection Is the Optimal Procedure for Very Low Rectal Cancer: Techniques, Morbidity, Oncologic and Functional Outcomes

Neoadjuvant chemoradiation therapy and pathological complete response in rectal cancer

Rectal Cancer: Nonoperative Management

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