Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v4i3.5462
Abstract
The possibility of preoperatively predict the complete pathological response in rectal cancer has been studied in order to identify patients who would respond to neoadjuvant and individualize therapeutic strategies. The endoscopic ultrasound of the rectum is an accurate method for the evaluation of the local invasion of the tumor and the lymph nodes. Aim. To evaluate the potential of endoscopic ultrasound as a predictor of the complete pathological response to neoadjuvant after surgery in patients with locally advanced rectal cancer. Material and methods. A retrospective study was realized in patients with rectal cancer from January 2014 to December 2016. Results. We obtained a statistical association between the stage of the T by endoscopic ultrasound and the complete pathological response (p = 0.015). Not so for N, sphincter involvement, circumferential involvement and maximum tumor thickness (p = 0.723, p = 0.510, p = 0.233 and p = 0.114, respectively). When applying the multivariate logistic regression analysis to assess the degree of influence of the predictor variables on the pathological response, none of these variables was associated with the complete pathological response. Conclusion. The prediction of the complete pathological response in rectal cancer has been considered as the crucial point on which treatments for rectal cancer could be individualized. So far, no imaging method has been able to demonstrate efficacy in predicting the complete pathological response, and in turn there is no direct association between an endosonography finding that can accurately predict it.
Keywords
complete pathological response; rectal cancer; endoscopic ultrasound
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[3] Moaven J, Shami VM. Predicting pathologic response: the "bottom line" in the management of locally advanced rectal cancer. Gastrointest Endosc 2017; 85: 675-676.
[4] Garland ML, Vather R, Bunkley N, Pearse M, Bissett IP. Clinical tumour size and nodal status predict pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer. Int J Colorectal Dis 2014; 29: 301-307.
[5] Smith JJ, Garcia-Aguilar J. Advances and challenges in treatment of locally advanced rectal cancer. J Clin Oncol 2015; 33: 1797-1808.
[6] Ryan JE, Warrier SK, Lynch AC, Ramsay RG, Phillips WA, Heriot AG. Predicting pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a systematic review. Colorectal Dis 2016; 18: 234-246.
[7] Russo AL, Ryan DP, Borger DR, Wo JY, Szymonia J, Liang WY, Kwak EL, Blaszkowsky LS, Clark JW, Allen JN, Zhu AX, Berger DL, Cusack JC, Mamon HJ, Haigis KM, Hong TS. Mutational and clinical predictors of pathologic complete response in the treatment of locally advanced rectal cancer. J Gastrointest Cancer 2014; 45: 34-39.
[8] Yoo BC, Yeo SG. Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review. EPMA J 2017; 8: 61-67.
[9] Pérez RO. Predicting response to neoadjuvant treatment for rectal cancer: a step toward individualized medicine. Dis Colon Rectum 2011; 54: 1057-1058.
[10] Habr-Gama A, Pérez RO, São Julião GP, Proscurshim I, Gama-Rodrigues J. Nonoperative approaches to rectal cancer: a critical evaluation. Semin Radiat Oncol 2011; 21: 234-239.
[11] Qiu HZ, Wu B, Xiao Y, Lin GL. Combination of differentiation and T stage can predict unresponsiveness to neoadjuvant therapy for rectal cancer. Colorectal Dis 2011; 13: 1353-1360.
[12] Huh JW, Kim HR, Kim YJ. Clinical prediction of pathological complete response after preoperative chemo radiotherapy for rectal cancer. Dis Colon Rectum 2013; 56: 698-703.
[13] Cârţânå ET, Gheonea DI, Såoiu A. Advances in endoscopic ultrasound imaging of colorectal diseases. World J Gastroenterol 2016; 22: 1756-1766.
[14] Siddiqui AA, Fayiga Y, Huerta S. The role of endoscopic ultrasound in the evaluation of rectal cancer. Int Semin Surg Oncol 2006; 3: 36.
[15] Marone P, de Bellis M, Avallone A, Delrio P, di Nardo G, D'Angelo V, Tatangelo F, Pecori B, Di Girolamo E, Iaffaioli V, Lastoria S, Battista Rossi G. Accuracy of endoscopic ultrasound in staging and restaging patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation. Clin Res Hepatol Gastroenterol 2011; 35: 666-670.
[16] Vanagunas A, Lin DE, Stryker SJ. Accuracy of endoscopic ultrasound for restaging rectal cancer following neoadjuvant chemo-radiation therapy. Am J Gastroenterol 2004; 99: 109-112.
[17] de Jong EA, ten Berge JC, Dwarkasing RS, Rijkers AP, van Eijck CH. The accuracy of MRI, endorectal ultrasonography, and computed tomography in predicting the response of locally advanced rectal cancer after preoperative therapy: A metaanalysis. Surgery 2016; 159: 688-699.
[18] Li N, Dou L, Zhang Y, Jin J, Wang G, Xiao Q, Li Y, Wang X, Ren H, Fang H, Wang W, Wang S, Liu Y, Song Y. Use of sequential endorectal US to predict the tumor response of preoperative chemoradiotherapy in rectal cancer. Gastrointest Endosc 2017; 85: 669-674.
[19] Kim SH, Chang HJ, Kim DY, Park JW, Baek JY, Kim SY, Park SC, Oh JH, Yu A, Nam BH. What is the ideal tumor regression grading system in rectal cancer patients after preoperative chemoradiotherapy? Cancer Res Treat 2016; 48: 998-1009.
[20] Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemo radiotherapy for rectal cancer. Br J Surg 2012; 99: 918-928.
[21] Kawai K, Ishihara S, Nozawa H, Hata K, Kiyomatsu T, Morikawa T, Fukayama M, Watanabe T. Prediction of pathological complete response using endoscopic findings and outcomes of patients who underwent watchful waiting after chemoradiotherapy for rectal cancer. Dis Colon Rectum 2017; 60: 368-375.
[22] São Julião GP, Habr-Gama A, Vailati BB, Araujo SEA, Fernández LM, Perez RO. New strategies in rectal cancer. Surg Clin North Am 2017; 97: 587-604.
[23] Pérez RO, Habr-Gama A, São Julião GP, Vailati BB, Fernández LM, Gama-Rodrigues J, Camargo AA. Should we give up the search for a clinically useful gene signature for the prediction of response of rectal cancer to neoadjuvant chemo-radiation? Dis Colon Rectum 2016; 59: 895-897.
[24] Habr-Gama A, Sabbaga J, Gama-Rodrigues J, São Julião GP, Proscurshim I, Bailão Aguilar P, Nadalin W, Pérez RO. Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management? Dis Colon Rectum 2013; 56: 1109-1117.
[25] Heald RJ, Beets G, Carvalho C. Report from a consensus meeting: response to chemoradiotherapy in rectal cancer-predictor of cure and a crucial new choice for the patient: on behalf of the Champalimaud 2014 Faculty for 'Rectal cancer: when NOT to operate'. Colorectal Dis 2014; 16: 334-337.
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