Accuracy of endorectal ultrasound after preoperative radiochemotherapy in locally advanced rectal cancer |
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Authors: | B Rau M Hünerbein C Barth P Wust W Haensch H Riess R Felix P M Schlag |
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Institution: | (1) Division of Surgery and Surgical Oncology, Charité Campus Buch, Robert-Roessle Hospital and Tumor Institute of Humboldt University at Berlin, Lindenberger Weg 80, 13122 Berlin, Germany, DE;(2) Department of Radiation Oncology, Charité Campus Virchow-Klinikum, Humbolt University, Berlin, Germany, DE;(3) Department of Oncology and Haematology, Humboldt University, Berlin, Germany, DE |
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Abstract: | Objectives: Factors limiting the accuracy of endorectal ultrasound in staging, locally advanced primary rectal cancer after preoperative
neoadjuvant radiochemotherapy (RCT) were evaluated.
Methods: Patients (n= 84) with initial locally advanced rectal cancer (uT3/uT4) undergoing R0 resection were investigated after preoperative treatment
that combined radiotherapy up to 45 Gy with two cycles of chemotherapy (5-FU and leucovorin on d 1–5 and 22–28). At 4 to 6
weeks after completion of RCT and before tumor resection, preoperative endoluminal ultrasound was performed.
Results: The accuracy to predict the depth of tumor infiltration (T-category) was found to correlate with downstaging. The T-category
was correctly staged before surgery in 15 of the 51 responders (29%) and in 27 of 33 nonresponders (82%), whereas misinterpretation
occurred in 36 of the responders (71%) and in 6 of the nonresponders (18%) (p < 0.001). Neither tumor distance from anal verge nor tumor location correlated with the staging accuracy. Lymph node involvement
was correctly assessed in 48 patients (57%). Wall invasion was correctly ascertained in 42 patients (50%), with under estimation
in 11 patients (13%) and overestimation in 31 patients (37%).
Conclusions: After radiochemotherapy, endosonography does not provide a satisfactory accuracy for preoperative staging of rectal cancer.
New interpretation and diagnostic criteria are needed for the prediction of treatment response.
Received: 28 February 1999/Accepted: 2 April 1999 |
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Keywords: | : Rectal cancer — Preoperative staging — Endorectal ultrasound — Preoperative radiochemotherapy |
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