Year 2021 / Volume 113 / Number 5
Original
Assessing tumor response to neoadjuvant chemoradiation in rectal cancer with rectoscopy and 18F-FDG PET/CT: results from a prospective series

307-312

DOI: 10.17235/reed.2020.6954/2020

Víctor López-López, Jesús Abrisqueta Carrión, Juan Luján, Patricio B. Lynn, Laura Frutos, Akiko Ono, Eduardo Ortiz, José J. López-Espín, José Gil, Pascual Parrilla,

Abstract
Introduction: rectoscopy and 18F-FDG PET/CT as a diagnostic algorithm for the assessment of tumor response in rectal cancer after neoadjuvant chemoradiation therapy (CRT) is very useful. Material and methods: this was a prospective longitudinal study in patients with locally advanced rectal cancer treated with neoadjuvant CRT. Patients were assessed after CRT completion with a digital rectal examination, proctoscopy and 18F-FDG PET/CT. Patients were subdivided as clinical (cCR) or radiologic (rCR) responders and non-responders according to tumor response. Clinical and radiological re-assessment was compared with the surgical specimen. Pathological tumor regression (pCR) grade was determined according to Mandard’s classification. Of the 68 patients included, 15 (22 %) presented pCR in the surgical specimen and tumor persistence (non-PCR) was detected in the remaining 53 (78 %). Clinical assessment (DRE+ rectoscopy) identified 15 patients as cCR and 53 as non-cCR, two were false positives and two were false negatives. The overall accuracy was 94 %. 18F-FDG PET/CT identified 18 patients as rCR and 50 as non-rCR, one was a false positive and four were false negatives. The overall accuracy was 92 %. A combination of clinical findings and 18F-FDG PET/CT resulted in an accuracy of 96 %. The combination of clinical findings + 18F-FDG PET/CT was able to correctly identify all cases of pCR, with the exception of one case that presented a tumor regression of 80 %. In this series, 18F-PET-CT and clinical assessment had excellent accuracies in differentiating PCR from non-PCR after CRT completion. PET-CT combined with clinical assessment had a better accuracy than both modalities independently. 18F-FDG PET/CT is a valid tool that complements the clinical assessment of tumor response.
Share Button
New comment
Comments
No comments for this article
References
1. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–1740.
2. Sanghera P, Wong DWY, McConkey CC, Geh JI, Hartley A. Chemoradiotherapy for rectal cancer: an updated analysis of factors affecting pathological response. Clin Oncol (R Coll Radiol). 2008;20:176–183.
3. Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 2010;11:835–844.
4. Kim HJ1, Song JH, Ahn HS. Wait and see approach for rectal cancer with a clinically complete response after neoadjuvant concurrent chemoradiotherapy. Int J Colorectal Dis. 2017;32:723-727.
5. Habr-Gama A, São Julião GP, Fernandez LM, et al. Achieving a Complete Clinical Response After Neoadjuvant Chemoradiation That Does Not Require Surgical Resection: It May Take Longer Than You Think! Dis Colon Rectum. 2019;62:802-808.
6. Cienfuegos JA, Baixauli J, Pastor C, et al. Long-term oncologic results in cancer of the rectum treated by preoperative chemoradiotherapy and surgery: An analysis of 500 cases. Rev Esp Enferm Dig. 2015;107:340-6.
7. Mezzi G, Arcidiacono PG, Carrara S, et al. Endoscopic ultrasound and magnetic resonance imaging for re-staging rectal cancer after radiotherapy. World J Gastroenterol. 2009;15:5563–5567.
8. Suppiah A, Hunter IA, Cowley J, et al. Magnetic resonance imaging accuracy in assessing tumour down-staging following chemoradiation in rectal cancer. Colorectal Dis.2009;11:249–253.
9. Habr-Gama A, Perez RO, Wynn G, Marks J, Kessler H, Gama-Rodrigues J. Complete clinical response after neoadjuvant chemoradiation therapy for distal rectal cancer: characterization of clinical and endoscopic findings for standardization. Diseases of the colon and rectum. 2010;53:1692–1698.
10. Colon and rectum. in: S.B. Edge, S.R. Byrd, C.C. Compton et al, (Eds.) AJCC Cancer Staging Manual. 7th ed. Springer-Verlag, New York; 2010:143–164.
11. Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma: clinicopathologic correlations. Cancer. 1994;73:2680–6.
12. Herbertson RA, Scarsbrook AF, Lee ST, Tebbutt N, Scott AM. Established, emerging and future roles of PET/CT in the management of colorectal cancer. Clin Radiol. 2009;64:225-37.
13. Li YL, Wu LM, Chen XX, et al. Is diffusion-weighted MRI superior to FDG-PET or FDG-PET/CT in evaluating and predicting pathological response to preoperative neoadjuvant therapy in patients with rectal cancer? J Dig Dis. 2014;15:525-37.
14. Leccisotti L, Gambacorta MA, de Waure C, et al. The predictive value of 18F-FDG PET/CT for assessing pathological response and survival in locally advanced rectal cancer after neoadjuvant radiochemotherapy. Eur J Nucl Med Mol Imaging. 2015;42:657–666.
15. Perez RO, Habr-Gama A, Gama-Rodrigues J, et al. Accuracy of positron emission tomography/computed tomography and clinical assessment in the detection of complete rectal tumor regression after neoadjuvant chemoradiation: Long-term results of a prospective trial (National Clinical Trial 00254683). Cancer. 2011;118:3501-11.
16. Lovinfosse P, Polus M, Van Daele D. FDG PET/CT radiomics for predicting the outcome of locally advanced rectal cancer. Eur J Nucl Med Mol Imaging. 2018;45:365-375.
17. Giannini V, Mazzetti S, Bertotto I, et al. Predicting locally advanced rectal cancer response to neoadjuvant therapy with 18F-FDG PET and MRI radiomics features. Eur J Nucl Med Mol Imaging. 2019;46:878-888.
18. Melton GB, Lavely WC, Jacene HA, et al. Efficacy of preoperative combined 18-fluorodeoxyglucose positron emission tomography and computed tomography for assessing primary rectal cancer response to neoadjuvant therapy. J Gastrointest Surg. 2007;11:961–9–discussion969.
19. Avallone A, Aloj L, Pecori B, et al. 18F-FDG PET/CT Is an Early Predictor of Pathologic Tumor Response and Survival After Preoperative Radiochemotherapy with Bevacizumab in High-Risk Locally Advanced Rectal Cancer. J Nucl Med. 2019;60:1560-1568.
20. Leibold T, Akhurst TJ, Chessin DB, et al. Evaluation of ¹⁸F-FDG-PET for early detection of suboptimal response of rectal cancer to preoperative chemoradiotherapy: a prospective analysis. Ann Surg Oncol. 2011;18:2783–2789.
21. Rufini V, Collarino A, Calcagni ML, et al. The role of 18F-FDG-PET/CT in predicting the histopathological response in locally advanced cervical carcinoma treated by chemo-radiotherapy followed by radical surgery: a prospective study. Eur J Nucl Med Mol Imaging. 2019 Aug 14.
22. Niccoli Asabella A, Simone M, Ballini A, et al. Predictive value of 18F-FDG PET/CT on survival in locally advanced rectal cancer after neoadjuvant chemoradiation. Eur Rev Med Pharmacol Sci. 2018 Dec;22:8227-8236.
23. Lambrecht M, Deroose C, Roels S, et al. The use of FDG-PET/CT and diffusion-weighted magnetic resonance imaging for response prediction before, during and after preoperative chemoradiotherapy for rectal cancer. Acta Oncol. 2010;49:956–963.
24. Deantonio L, Caroli A, Puta E, et al. Does baseline [18F] FDG-PET/CT correlate with tumor staging, response after neoadjuvant chemoradiotherapy, and prognosis in patients with rectal cancer? Radiat Oncol. 2018;13:211.
25. Perez RO, Habr-Gama A, São Julião GP, et al. Predicting complete response to neoadjuvant CRT for distal rectal cancer using sequential PET/CT imaging. Tech Coloproctol. 2014;18:699–708.
26. Probst CP, Becerra AZ, Aquina CT, et al. Extended Intervals after Neoadjuvant Therapy in Locally Advanced Rectal Cancer: The Key to Improved Tumor Response and Potential Organ Preservation. J Am Coll Surg. 2015;221:430–440.
27. Petrillo A, Fusco R, Petrillo M, et al. Standardized Index of Shape (SIS): a quantitative DCE-MRI parameter to discriminate responders by non-responders after neoadjuvant therapy in LARC. Eur Radiol. 2015;25:1935–1945.
28. Birlik B, Obuz F, Elibol FD, et al. Diffusion-weighted MRI and MR- volumetry--in the evaluation of tumor response after preoperative chemoradiotherapy in patients with locally advanced rectal cancer. Magnetic resonance imaging. 2015;33:201–212.
29. Schurink NW, Min LA, Berbee M, van Elmpt W, et al. Value of combined multiparametric MRI and FDG-PET/CT to identify well-responding rectal cancer patients before the start of neoadjuvant chemoradiation. Eur Radiol. 2020 Feb 7.
Related articles

Letter

Rosai-Dorfman disease involving the entire esophagus

DOI: 10.17235/reed.2023.9753/2023

Digestive Diseases Image

Spontaneous regression of a rectal cancer

DOI: 10.17235/reed.2023.9486/2023

Letter

Vaginal lesion as first manifestation of colorectal disease

DOI: 10.17235/reed.2022.9270/2022

Editorial

Acute pancreatitis: an opportunity for gastroenterology hospitalists?

DOI: 10.17235/reed.2022.8573/2022

Review

Practical management of primary biliary cholangitis

DOI: 10.17235/reed.2021.8219/2021

Letter

Pneumatosis intestinalis in anorexia nervosa

DOI: 10.17235/reed.2021.8013/2021

Review

Inflammatory bowel disease and solid organ transplantation

DOI: 10.17235/reed.2020.7361/2020

Review

New non-invasive biomarkers for colorectal cancer screening

DOI: 10.17235/reed.2020.7233/2020

Editorial

Reflex testing. A key tool for the elimination of hepatitis C

DOI: 10.17235/reed.2020.7201/2020

Letter

Medullary colorectal carcinoma. Do we really know it?

DOI: 10.17235/reed.2020.6728/2019

Letter

Signet ring cell carcinoma in a juvenile polyp

DOI: 10.17235/reed.2019.6299/2019

Letter

The rectosigmoid junction: are limits important?

DOI: 10.17235/reed.2019.5983/2018

Editorial

Colorectal cancer screening and survival

DOI: 10.17235/reed.2018.5870/2018

Letter to the Editor

Liver metastasis from colorectal cancer 12 years after liver transplantation

DOI: 10.17235/reed.2017.4507/2016

Review

Serrated lesions and serrated polyposis syndrome

DOI: 10.17235/reed.2017.4065/2015

Letter to the Editor

Endobronchial metastases of colorectal cancer

DOI: 10.17235/reed.2016.4080/2015

Letter to the Editor

Acute transverse colon volvulus with secondary gastric isquemia. Case report

DOI: 10.17235/reed.2016.4024/2015

Case Report

Primary squamous cell carcinoma of the rectum: an atypical histology

DOI: 10.17235/reed.2016.3975/2015

Citation tools
López-López V, Abrisqueta Carrión J, Luján J, B. Lynn P, Frutos L, Ono A, et all. Assessing tumor response to neoadjuvant chemoradiation in rectal cancer with rectoscopy and 18F-FDG PET/CT: results from a prospective series. 6954/2020


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1620 visits.
This article has been downloaded 154 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 09/02/2020

Accepted: 11/04/2020

Online First: 15/10/2020

Published: 10/05/2021

Article revision time: 53 days

Article Online First time: 249 days

Article editing time: 456 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2024 y Creative Commons. The Spanish Journal of Gastroenterology