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Consequence of Restaging After Neoadjuvant Treatment for Locally Advanced Rectal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Locally advanced rectal cancer is customarily treated with neoadjuvant chemoradiotherapy (CRT) followed by a total mesorectal excision. During the course of CRT, previously non-detectable distant metastases can appear. Therefore, a restaging CT scan of the chest and abdomen was performed prior to surgery. The aim of this study was to determine the frequency of a change in treatment strategy after this restaging CT scan.

Methods

Patients treated with neoadjuvant CRT for locally advanced rectal cancer between January 2003 and July 2013 were included retrospectively. To determine the value of the restaging CT scan, the surgical treatment as planned before CRT was compared with the treatment ultimately received.

Results

A total of 153 patients (91 male) were eligible, and median age was 62 (32–82) years. The restaging CT scan revealed the presence of distant metastases in 19 patients (12.4, 95 % confidence interval [CI] 7.0–17.8). In 17 patients (11.1, 95 % CI 6.1–16.1), a change in treatment strategy occurred due to the detection of metastases with a restaging CT scan.

Conclusion

A restaging CT scan after completion of neoadjuvant CRT may detect newly developed metastases and consequently alter the initial treatment strategy. This study demonstrated the added value of the restaging CT scan prior to surgery.

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Acknowledgment

The authors would like to thank Stichting PALGA, The Netherlands, for providing a database of pathological specimens from patients who were eligible for inclusion in the study.

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Authors and Affiliations

  1. Department of Medical Oncology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands

    C. Bisschop MD, J. J. J. Tjalma MD, G. A. P. Hospers MD, PhD & D. J. A. de Groot MD, PhD

  2. Department of Surgery, Isala Hospital, Zwolle, The Netherlands

    D. Van Geldere MD, PhD

  3. Department of Medical Oncology, Isala Hospital, Zwolle, The Netherlands

    J. W. B. de Groot MD, PhD

  4. Department of Radiation Oncology, Isala Hospital, Zwolle, The Netherlands

    E. M. Wiegman MD, PhD

  5. Department of Radiology, Isala Hospital, Zwolle, The Netherlands

    M. Van’t Veer-ten Kate MD, PhD

  6. Department of Pathology, Isala Hospital, Zwolle, The Netherlands

    M. G. Havenith MD, PhD

  7. Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands

    J. Vecht MD, PhD & W. H. de Vos tot Nederveen Cappel MD, PhD

  8. Department of Radiation Oncology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands

    J. C. Beukema MD

  9. Department of Pathology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands

    G. Kats-Ugurlu MD

  10. Department of Radiology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands

    S. V. K. Mahesh MD

  11. Department of Surgical Oncology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands

    B. van Etten MD, PhD & K. Havenga MD, PhD

  12. Department of Epidemiology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands

    J. G. M. Burgerhof MSc

Authors
  1. C. Bisschop MD
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  2. J. J. J. Tjalma MD
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  3. G. A. P. Hospers MD, PhD
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  4. D. Van Geldere MD, PhD
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  5. J. W. B. de Groot MD, PhD
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  6. E. M. Wiegman MD, PhD
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  7. M. Van’t Veer-ten Kate MD, PhD
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  8. M. G. Havenith MD, PhD
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  9. J. Vecht MD, PhD
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  10. J. C. Beukema MD
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  11. G. Kats-Ugurlu MD
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  12. S. V. K. Mahesh MD
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  13. B. van Etten MD, PhD
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  14. K. Havenga MD, PhD
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  15. J. G. M. Burgerhof MSc
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  16. D. J. A. de Groot MD, PhD
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  17. W. H. de Vos tot Nederveen Cappel MD, PhD
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Corresponding author

Correspondence to C. Bisschop MD.

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Bisschop, C., Tjalma, J.J.J., Hospers, G.A.P. et al. Consequence of Restaging After Neoadjuvant Treatment for Locally Advanced Rectal Cancer. Ann Surg Oncol 22, 552–556 (2015). https://doi.org/10.1245/s10434-014-3996-8

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  • DOI: https://doi.org/10.1245/s10434-014-3996-8

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