International Journal of Radiation Oncology * Biology * Physics
Volume 81, Issue 2 , Pages 439-444 , 1 October 2011

Patterns of Response After Preoperative Intensity-Modulated Radiation Therapy and Capecitabine/Oxaliplatin in Rectal Cancer: Is There Still a Place for Ecoendoscopic Ultrasound?

  • Leire Arbea, M.D.

      Affiliations

    • Department of Oncology, Radiation Oncology Division, Clinica Universidad de Navarra, Pamplona, Spain
    • Corresponding Author InformationReprint requests to: Leire Arbea, M.D., Department of Oncology, Radiation Oncology Division, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31080 Pamplona, Spain. Tel.: +34 948 255400; Fax: +34 948 255500
    • ,
  • Juan A. Díaz-González, M.D.

      Affiliations

    • Department of Oncology, Radiation Oncology Division, Clinica Universidad de Navarra, Pamplona, Spain
    • ,
  • Jose Carlos Subtil, M.D.

      Affiliations

    • Department of Gastroenterology, Endoscopy Division Unit, Clinica Universidad de Navarra, Pamplona, Spain
    • ,
  • Josu Sola, M.D.

      Affiliations

    • Department of Pathology, Clinica Universidad de Navarra, Pamplona, Spain
    • ,
  • Jose Luis Hernandez-Lizoain, M.D.

      Affiliations

    • Department of General Surgery, Clinica Universidad de Navarra, Pamplona, Spain
    • ,
  • Rafael Martínez-Monge, M.D.

      Affiliations

    • Department of Oncology, Radiation Oncology Division, Clinica Universidad de Navarra, Pamplona, Spain
    • ,
  • Marta Moreno, M.D.

      Affiliations

    • Department of Oncology, Radiation Oncology Division, Clinica Universidad de Navarra, Pamplona, Spain
    • ,
  • Javier Aristu, M.D.

      Affiliations

    • Department of Oncology, Radiation Oncology Division, Clinica Universidad de Navarra, Pamplona, Spain

Received 26 February 2010 ,Revised 7 May 2010 ,Accepted 12 May 2010.

References 

  1. Huh JW, Jung EJ, Park YA, et al. Sphincter-preserving operations following preoperative chemoradiation: an alternative to abdominoperineal resection for lower rectal cancer?. World J Surg. 2008;32:1116–1123
  2. Kim JS, Hur H, Kim NK, et al. Oncologic outcomes after radical surgery following preoperative chemoradiotherapy for locally advanced lower rectal cancer: Abdominoperineal resection versus sphincter-preserving procedure. Ann Surg Oncol. 2009;15(5):1266–1273
  3. Bonnen M, Crane C, Vauthey JN, et al. Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients. Int J Radiat Oncol Biol Phys. 2004;60:1098–1105
  4. Kim CJ, Yeatman TJ, Coppola D, et al. Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg. 2001;234:352–358
  5. Mohiuddin M, Marks G, Bannon J. High-dose preoperative radiation and full thickness local excision: A new option for selected T3 distal rectal cancers. Int J Radiat Oncol Biol Phys. 1994;30:845–849
  6. Ruo L, Guillem JG, Minsky BD, et al. Preoperative radiation with or without chemotherapy and full-thickness transanal excision for selected T2 and T3 distal rectal cancers. Int J Colorectal Dis. 2002;17:54–58
  7. Schell SR, Zlotecki RA, Mendenhall WM, et al. Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy. J Am Coll Surg. 2002;194:584–590
  8. Barbaro B, Schulsinger A, Valentini V, et al. The accuracy of transrectal ultrasound in predicting the pathological stage of low-lying rectal cancer after preoperative chemoradiation therapy. Int J Radiat Oncol Biol Phys. 1999;43:1043–1047
  9. Kahn H, Alexander A, Rakinic J, et al. Preoperative staging of irradiated rectal cancers using digital rectal examination, computed tomography, endorectal ultrasound, and magnetic resonance imaging does not accurately predict T0, N0 pathology. Dis Colon Rectum. 1997;40:140–144
  10. Liersch T, Langer C, Jakob C, et al. [Preoperative diagnostic procedures in locally advanced rectal carcinoma > or =T3 or N+. What does endoluminal ultrasound achieve at staging and restaging after neoadjuvant radiochemotherapy. in contrast to computed tomography?]. Chirurgie. 2003;74:224–234
  11. Maretto I, Pomerri F, Pucciarelli S, et al. The potential of restaging in the prediction of pathologic response after preoperative chemoradiotherapy for rectal cancer. Ann Surg Oncol. 2007;14:455–461
  12. Rau B, Hunerbein M, Barth C, et al. Accuracy of endorectal ultrasound after preoperative radiochemotherapy in locally advanced rectal cancer. Surg Endosc. 1999;13:980–984
  13. Vanagunas A, Lin DE, Stryker SJ. Accuracy of endoscopic ultrasound for restaging rectal cancer following neoadjuvant chemoradiation therapy. Am J Gastroenterol. 2004;99:109–112
  14. Williamson PR, Hellinger MD, Larach SW, Ferrara A. Endorectal ultrasound of T3 and T4 rectal cancers after preoperative chemoradiation. Dis Colon Rectum. 1996;39:45–49
  15. Guillem JG, Diaz-Gonzalez JA, Minsky BD, et al. cT3N0 rectal cancer: Potential overtreatment with preoperative chemoradiotherapy is warranted. J Clin Oncol. 2008;26:368–373
  16. Aristu JJ, Arbea L, Rodriguez J, et al. Phase I–II trial of concurrent capecitabine and oxaliplatin with preoperative intensity-modulated radiotherapy in patients with locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2008;71:748–755
  17. Aristu J, Azcona JD, Moreno M, Martinez-Monge R. Rectal cancer case study. In: Mundt A, Roeske JC, editors. Intensity modulated radiation therapy. A clinical perspective. BC Decker Inc Hamilton, ON: 2005.
  18. Compton C, Fenoglio-Preiser CM, Pettigrew N, Fielding LP. American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group. Cancer. 2000;88:1739–1757
  19. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum. 1985;28:42–46
  20. Ruo L, Tickoo S, Klimstra DS, et al. Long-term prognostic significance of extent of rectal cancer response to preoperative radiation and chemotherapy. Ann Surg. 2002;236:75–81
  21. Vecchio FM, Valentini V, Minsky BD, et al. The relationship of pathologic tumor regression grade TRG. and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys. 2005;62:752–760
  22. Tio TL, Coene PP, van Delden OM, Tytgat GN. Colorectal carcinoma: Preoperative TNM classification with endosonography. Radiology. 1991;179:165–170
  23. Saitoh N, Okui K, Sarashina H, et al. Evaluation of echographic diagnosis of rectal cancer using intrarectal ultrasonic examination. Dis Colon Rectum. 1986;29:234–242
  24. Katsura Y, Yamada K, Ishizawa T, et al. Endorectal ultrasonography for the assessment of wall invasion and lymph node metastasis in rectal cancer. Dis Colon Rectum. 1992;35:362–368
  25. Hulsmans FJ, Tio TL, Fockens P, et al. Assessment of tumor infiltration depth in rectal cancer with transrectal sonography: caution is necessary. Radiology. 1994;190:715–720
  26. Herzog U, von Flue M, Tondelli P, Schuppisser JP. How accurate is endorectal ultrasound in the preoperative staging of rectal cancer?. Dis Colon Rectum. 1993;36:127–134
  27. Goldman S, Arvidsson H, Norming U, et al. Transrectal ultrasound and computed tomography in preoperative staging of lower rectal adenocarcinoma. Gastrointest Radiol. 1991;16:259–263
  28. Glaser F, Kleikamp G, Schlag P, et al. [Endosonography in preoperative assessment of rectal tumors]. Chirurgie. 1989;60:856–861
  29. Machiels JP, Duck L, Honhon B, et al. Phase II study of preoperative oxaliplatin, capecitabine and external beam radiotherapy in patients with rectal cancer: The RadiOxCape study. Ann Oncol. 2005;16:1898–1905
  30. Rodel C, Grabenbauer GG, Papadopoulos T, et al. Phase I/II trial of capecitabine, oxaliplatin, and radiation for rectal cancer. J Clin Oncol. 2003;21:3098–3104
  31. Habr-Gama A, Perez RO, Proscurshim I, et al. Absence of lymph nodes in the resected specimen after radical surgery for distal rectal cancer and neoadjuvant chemoradiation therapy: What does it mean?. Dis Colon Rectum. 2008;51:277–283
  32. Pucciarelli S, Capirci C, Emanuele U, et al. Relationship between pathologic T-stage and nodal metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer. Ann Surg Oncol. 2005;12:111–116
  33. Perez RO, Habr-Gama A, Proscurshim I, et al. Local excision for ypT2 rectal cancer—much ado about something. J Gastrointest Surg. 2007;11:1431–1438

 L. Arbea and J.A. Díaz-González, M.D. contributed equally to this study.

 Conflict of interest: none.

PII: S0360-3016(10)00751-0

doi: 10.1016/j.ijrobp.2010.05.028

International Journal of Radiation Oncology * Biology * Physics
Volume 81, Issue 2 , Pages 439-444 , 1 October 2011

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