Locally advanced rectal,cancer recievevarticle long course chemoradiotherapy , which last for 6 week. Patients are operated 6 to 8 weeks after finishing lcrt, I.e 3 to 4 months from diagnosis. Some patient progress to metastatic disease in this time
does grade of tumor help in predicting progressive disease or need for restaging in some patients, or do all patients require restaging ct scans before surgery
In rectal cancer treated with neoadjuvant chemoradiotherapy is very important to asses the clinical response in order to evaluate the possibility to avoid radical surgery in distal tumors. In the other hand, a favorable clinical response may help to planning a different surgery approach.
Considering the fact, that in the eligible population, which are metastasis free, the 5 year recurrence rate is 23.9% (NSABP R-03), and the 5 year locoregional recurrence rate is 10.7%, the probability of the development of a metastatic disease during the chemoradiation and the waiting period (13-15 weeks) is really low. So, the complete new staging is not recommended just to detect new metastases. But, if there was a suspect lesion, like a pulmonary nodule, it could be done as a follow up. Staging of the primary tumor for detection of possible progression or the extent of downstaging or downsizing could also been validated just in certain clinical circumstances but not routinely in any cases.
Dear rami
thanks. Have read it, results are very good. Mr beynon and his team have done a great job.
coming to the discussion, while patients planned for Exenteration always require restaging to filter out metastatic patients, not all rectal cancer patients after Lcrt are restaged with ct chest abdomen and MRI. The problem is more acute in indian subcontinent where young patient with rectal cancer and signet ring histology are about 12%, while not cost effective to restate everyone, perhaps poor histology may be the filter I think
In minimally or non-responsive patients, distant mets that were too small to see initially may become visible, changing one's treatment options. But, more importantly, we are moving towards longer waiting times post-treatment, with the aim of picking up more complete responders where the option of a wait-and-watch policy, especially in early tumours is becoming a reality.
- Badges
- Science topic
- Similar topics
- Phytochemistry
- Extracts