Evaluation of Neoadjuvant Chemo- Radiotherapy with Locally Advanced Rectal Cancer by Comparing Tumour Volume before and after Treatment

Czech version

Authors: P. Diviš ¹; P. Vlček ¹; I. Čapov ¹; K. Divišová ²; J. Katolická ²; J. Vaníček ³; E. Kotulánová ³
Authors‘ workplace: I. chirurgická klinika, Fakultní nemocnice u sv. Anny v Brně ¹; Oddělení chirurgické onkologie, Fakultní nemocnice u sv. Anny v Brně ²; Klinika zobrazovacích metod, Fakultní nemocnice u sv. Anny v Brně ³
Published in: Klin Onkol 2010; 23(6): 421-427
Category: Original Articles

Overview

Backgrounds:
Neoadjuvant chemotherapy is a standard preoperative therapeutical procedure with locally advanced rectal adenocarcinoma. The aim of the study was to compare the tumour volume reduction before and after the oncological therapy in relation to the change in the CEA value and to the outcome of the histopathological evaluation of response to the treatment.

Patients and Methods:
In the years 2004– 2008, 274 rectal cancer patients were evaluated, of which 64 underwent neoadjuvant CRT with subsequent surgery and had also completed other inclusion criteria. The tumour volume before and after the CRT, percentage reduction in the tumour volume and the relation to the change in the CAE value and the histopathological evaluation were evaluated.

Results:
The distance between the anus and the tumour was from 3 to 15 centimetres, the average value being 8.1 centimetres. In 5 cases the tumour was not histologically found in the resected specimen. Average value of the CEA value before the CRT was 18.12 ng/ ml, range 0.7– 98.1 ng/ ml, after the CRT the average value was 7.00 ng/ ml, range 0.5– 18.7 ng/ ml. The average tumour volume before CRT was 32.48, range 10.3– 88.5, after the CRT the average volume was 20.13, range 4.7– 55.1.

Conclusion:
A relation between the change in the T value and the volume reduction before and after the CRT of statistical significance has been proven in this group of patients. This relation however has not been proved in the N value change. Only in one– third of the evaluated patients was there a positive change in both T and N classification. No relation between the CEA value and the tumour volume change has been proven.

Key words:
rectal cancer – tumor volume – tumor staging – neoadjuvant therapy – radiotherapy – chemotherapy

Sources

1. Janjan NA, Khoo VS, Abbruzzese J et al. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys 1999; 44(5): 1027– 1038.

2. Valentini V, Coco C, Cellini N et al. Preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response and sphincter preservation. Int J Radiat Oncol Biol Phys 1998; 40(5): 1067– 1075.

3. Benzoni E, Terrosu G, Bresadola V et al. Prognostic value of tumour regression grading and depth of neoplastic infiltration within the perirectal fat after combined neoadjuvant chemoradiotherapy and surgery for rectal cancer. J Clin Pathol 2006; 59: 505– 512.

4. Kim NK, Baik SH, Min BS et al. A comparative study of volumometric analysis, histopatologic downstaging and tumor regression grade in evaluating tumor response in locally advanced rectal cancer following preoparative chemoradiation. Int J Radiation Oncology Biol Phys 2007; 67(1): 204– 210.

5. Sauer R, Becker H, Hohenberger W et al. for the German Rectal Cancer Group. Preoparative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351(17): 1731– 1740.

6. Bosset JF, Collette L, Calais G et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006; 355(11): 1114– 1123.

7. Baxter NN, Garcia- Aguilar J. Organ preservation for rectal cancer. J Clin Oncol 2007; 25(8): 1014– 1120.

8. Vlček P, Čapov I, Chalupník Š et al. Robot- Assisted Colorectal Surgery. A Two Years Single Center Experience. Colorectal Disease 2008; 10 (Suppl 2). Wiley- Blackwell: 9.

9. Sauer R, Becker H, Hohenberger W et al. Preoperative vers. postoperative Chemoradiotherapy for retal cancer. N Engl J Med 2004; 351: 1731– 1740.

10. Glynne- Jones R, Mawdsley S, Pearce T et al. Alternative clinical endpoints in Rectal cancer – are we getting closer? Ann Oncol 2006; 17(8): 1239– 1248.

11. Thomas K. Weber. Preoperative chemoradiation for Rectal Cancer: „Apples and Pears, Tables and Chairs …“, Annals of Surgical Oncology 2002; 9: 532– 534.

12. Rödel C, Martus P, Papadopulos T et al. Prognostic Significance of Tumor Regression After Preoperative Chemoradiotherapy for Rectal Cancer. J Clini Oncol 2005; 23(34): 8688– 8696.