Value of Rectal Ultrasound in Predicting Staging and Outcome in Patients With Rectal Adenocarcinoma

Roman, Sabine; Cenni, Jean-Claude; Roy, Pascal; Pujol, B.; Napoléon, Bertrand; Keriven-Souquet, O; Souquet, Jean-Christophe

doi:10.1007/s10350-004-0583-2

Cited by 16 publications

(13 citation statements)

References 24 publications

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“…This finding may prove to be of significance during planning of surgical treatment. The percentage of patients with "T-downstaging" in the group submitted to long-term radiotherapy and radiochemotherapy ranged from 23/88 (26.0%) to 15/20 (75.0%) [14,17,[20][21][22][23][24]27,[34][35][36]39,[46][47][48][49]51,52] . Among patients submitted to short-term preoperative radiotherapy "T-downstaging" ranged between 10/28 (35.7%) and 44/104 (43%) [11,14,18,19] .…”

Section: Discussionmentioning

confidence: 99%

“…Reports have been published showing the prognostic value of "T-downstaging" for overall survival [17,28,34] , cancer-specific survival [48] , recurrence-free survival [48] , disease-free survival [25,28] , local recurrence risk [26,34,48] , and the risk of distant metastases [48] . Read et al [50] showed that the local staging following neo-adjuvant therapy enables the risk assessment of lymph node metastases.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound-histopathological tumor regression parameter, "T-downstaging" represents a simple marker of rectal cancer radiosensitivity both in patients submitted to shortterm preoperative radiotherapy [11,18,19,44,45] as well as in patients with surgery delayed by 1 to 8 wk following irra diation [17,20,21,23,[25][26][27][28][34][35][36]39,[46][47][48][49] . Reports have been published showing the prognostic value of "T-downstaging" for overall survival [17,28,34] , cancer-specific survival [48] , recurrence-free survival [48] , disease-free survival [25,28] , local recurrence risk [26,34,48] , and the risk of distant metastases [48] .…”

Section: Discussionmentioning

confidence: 99%

Section: Colorectal Cancermentioning

confidence: 99%

“…The value of ypT parameter equal or higher than uT indicates lack of tumor regression [11,14,[17][18][19][20][21] . This parameter may also be applied to the regression of metastatic regional lymph nodes in rectal cancer, "N-downstaging" [17,20,[22][23][24][25][26] . Preoperative radiotherapy and radiochemotherapy evokes a rang e of mor phological chang es in the microscopic picture of rectal cancer including increased tumor necrosis, cellular and nuclear atypia, endocrine differentiation of tumor cells, increased stromal fibrosis, quantitative and qualitative changes of the stromal inflammatory exudates, formation of mucin pools, surface ulceration, peritumoral eosinophilic infiltrate, dysplastic and adenomatous changes (high-grade dysplasia, and lowgrade adenoma component in the intestinal mucosa) [5,27,28] .…”

Section: Colorectal Cancermentioning

confidence: 99%

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Usefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy

Lukasz¹,

Liszka²,

Ewa³

et al. 2007

WJG

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INTRODUCTIONColorectal cancer is the third most common malignancy diagnosed in the USA [1] . The estimated colorectal cancer mortality in the USA in 2006 is 55 170 [2] . The primary treatment method for rectal cancer is surgery, namely anterior rectal resection, abdomino-perineal resection or local excision [3][4][5][6] . Preoperative radiotherapy and radiochemotherapy play an increasing role in the treatment of rectal cancer [7][8][9][10][11][12][13] . The effectiveness of neo-adjuvant therapy may be assessed and monitored by means of longterm survival follow up, incidence of local recurrence, estimation of the percentage of patients with primary high stage tumor suitable for radical surgery, estimation of the percentage of patients suitable for sphincter-saving surgery or by monitoring the tumor stage using visualizing diagnostic methods [14,15] . Transrectal ultrasound (TRUS) is a useful method for the assessment of the local tumor stage and the regional lymph node status prior to neo-adjuvant therapy [3,4,6,16] . Basing on TRUS and histopathological examination one can define the tumor reg ression parameter "T-downstaging". Lower ypT parameter value (local tumor stage assessed by the pathologist in surgical specimen following neo-adjuvant therapy) than uT (local Abstract AIM: To assess the usefulness of two independent histopathological classifications of rectal cancer regression following neo-adjuvant therapy. METHODS:Forty patients at the initial stage cT3NxM0 submitted to preoperative radiotherapy (42 Gy during 18 d) and then to radical surgical treatment. The relationship between "T-downstaging" versus regressive changes expressed by tumor regression grade (TRG 1-5) and Nasierowska-Guttmejer classification (NG 1-3) was studied as well as the relationship between TRG and NG versus local tumor stage ypT and lymph nodes status, ypN. RESULTS:Complete regression (ypT0, TRG 1) was found in one patient. "T-downstaging" was observed in 11 (27.5%) patients. There was a weak statistical significance of the relationship between "T-downstaging" and TRG staging and NG stage. Patients with ypT1 were diagnosed as TRG 2-3 while those with ypT3 as TRG5.No lymph node metastases were found in patients with TRG 1-2. None of the patients without lymph node metastases were diagnosed as TRG 5. Patients in the ypT1 stage were NG 1-2. No lymph node metastases were found in NG 1. There was a significant correlation between TRG and NG. CONCLUSION:Histopathological classifications may be useful in the monitoring of the effects of hyperfractionated preoperative radiotherapy in patients

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Colorectal Cancermentioning

confidence: 99%

Section: Colorectal Cancermentioning

confidence: 99%

See 3 more Smart Citations

Usefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy

Lukasz¹,

Liszka²,

Ewa³

et al. 2007

WJG

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Is T classification still correlated with lymph node status after preoperative chemoradiotherapy for rectal cancer?

Kim

et al. 2006

Cancer

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BACKGROUNDIt is well known that the risk of lymph node involvement increases according to pathologic T classification in rectal cancers, but to the authors' knowledge, the correlation between risk of lymph node involvement and ypT classification in rectal cancers treated with preoperative chemoradiotherapy (CRT) remains unclear. The current study investigated the correlation between tumor involvement in regional lymph nodes and rectal mural tumor status in patients who underwent preoperative CRT for rectal cancer.METHODSBetween October 2001 and February 2005, 282 patients underwent preoperative CRT followed by proctectomy for locally advanced rectal adenocarcinoma. Correlations between lymph node status and ypT classification, Dworak regression grade, and magnetic resonance (MR) volumetry findings were explored.RESULTSLymph nodes harboring tumors were found in 87 of 282 (30.9%) patients. The rate of lymph node involvement was found to be correlated with ypT‐classification (P < .001); positive lymph nodes were detected in 1 of 45 (2.2%) ypT0 patients, 1 of 13 (7.7%) ypT1 patients, 13 of 77 (16.9%) ypT2 patients, 69 of 140 (49.3%) ypT3 patients, and 3 of 7 (42.9%) ypT4 patients. The rate of lymph node involvement decreased as Dworak regression grade increased (P < .001); tumor‐harboring lymph nodes were found in 62.3% of Grade 1 patients, 31.4% of Grade 2 patients, 16.1% of Grade 3 patients, and 2.2% of Grade 4 patients. There were no differences noted with regard to MR volumetry findings, including mean volume of pre‐ or post‐CRT tumor and the tumor volume reduction rate between lymph node‐negative and lymph node‐positive patients.CONCLUSIONSPathologic T classification is still the most reliable predictor of lymph node metastasis in rectal cancer patients who have undergone preoperative CRT. The risk of lymph node metastasis was found to be 3.4% in rectal cancer that had regressed to ypT0 or ypT1. Cancer 2006. © 2006 American Cancer Society.

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Kolorektales Karzinom

Layer

Kopp

Müller-Schimpfle

2008

Radiologische Diagnostik in Der Onkologie

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Value of Rectal Ultrasound in Predicting Staging and Outcome in Patients With Rectal Adenocarcinoma

Cited by 16 publications

References 24 publications

Usefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy

Usefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy

Is T classification still correlated with lymph node status after preoperative chemoradiotherapy for rectal cancer?

Kolorektales Karzinom

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