How reliable is current imaging in restaging rectal cancer after neoadjuvant therapy?

作     者：Paola De Nardi Michele Carvello 

作者机构：Department of Surgery San Raffaele Scientific Institute Department of Surgery Utrecht University Medical Center 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2013年第19卷第36期

页      面：5964-5972页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Rectal cancer Restaging Neoadjuvant therapies Diagnostic accuracy Complete pathological response 

摘      要：In patients with advanced rectal cancer,neoadjuvant chemo radiotherapy provides tumor downstaging and downsizing and complete pathological response in up to 30%of *** proctectomy complete pathological response is associated with low rates of local recurrence and excellent long term *** authors claim a less invasive surgery or a non operative policy in patients with partial or clinical complete response respectively,however to identify patients with true complete pathological response before surgical resection remains a *** imaging techniques have been reported to be highly accurate in the primary staging of rectal cancer,however neoadjuvant therapy course produces deep modifications on cancer tissue and on surrounding structures such as overgrowth fibrosis,deep stroma alteration,wall thickness,muscle disarrangement,tumor necrosis,calcification,and inflammatory *** a result,the same imaging techniques,when used for restaging,are far less *** tumor extent may be overestimated or *** diagnostic accuracy of clinical examination,rectal ultrasound,computed tomography,magnetic resonance imaging,and positron emission tomography using 18F-fluoro-2’-deoxy-Dglucose ranges between 25%and 75%being less than 60%in most studies,both for rectal wall invasion and for lymph nodes *** particular the ability to predict complete pathological response,in order to tailor the surgical approach,remains *** to the radio-induced tissue modifications,combined with imaging technical aspects,low rate accuracy is achieved,making modern imaging techniques still unreliable in restaging rectal cancer after chemo-radiotherapy.