Selection of colon cancer patients for neoadjuvant chemotherapy based on optimised preoperative MDCT A prospective multi-observer radiologic-pathologic agreement study

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Congress:

ECR 2015

Poster Number:

B-0735

Type:

Scientific Paper

Keywords:

Colon, Abdomen, Oncology, CT, Diagnostic procedure, Neoplasia

Authors:

E. Rosado, A. S. C. C. Germano, A. M. D. Costa, R. Theias, A. P. Gomes, C. Leichsenring, I. Santiago; Amadora/PT

DOI:

10.1594/ecr2015/B-0735

DOI-Link:

https://dx.doi.org/10.1594/ecr2015/B-0735

Fig. 1: Information sheet to be filled by each one of the 4 radiologists. It contains...

Fig. 2: Example of the local staging section. The radiologist examines the CT and makes...

Fig. 3: Example of a T3 tumour with less than 5mm invasion beyond the muscular layer....

Fig. 4: Detailed analysis of the depth of invasion of the tumour shown in the previous...

Purpose

To evaluate the accuracy of preoperative MDCT in the differentiation between locally advanced colon cancer (LACC) and non-locally advanced colon cancer (NLACC). Background and relevance of the topic: The current treatment of potentially resectable locally advanced colon cancer (LACC), including high risk stage II or stage III disease is surgery followed by adjuvant chemotherapy. Given proven efficacy in the adjuvant setting, benefits ofpreoperative therapy are also expected [1]. Furthermore, neoadjuvant chemotherapy and radiotherapy are substantially more effective than similar postoperative therapy in oesophageal, gastric, and...

Methods and materials

Observational, cross-sectional, prospective study. All patients with colon cancer referred to our Department for preoperative staging between the 1st of October 2013 and the 6th of August 2014 were included. Contrast-enhanced MCDT was performed with multiplanar reconstructions. Retrograde distention of the colon was achieved with water or air. Independent reading was performed by 4 radiologists, with 3, 6, 15 and 20 years of experience in gastrointestinal imaging. Relevant data was recorded in a specifically elaborated formulary (Fig. 1), with emphasis in local staging (Fig. 2)....

Results

We studied a total of 48 consecutive patients. 26 males and 22 females Median age: 74 years (range 45 to 89) Median time to surgery: 30,5 days (range 1 to 117 days) Regarding the differentiation between LACC and NLACC with MDCT, we obtained: S: 0,64-0,82 E: 0,84-0,92 PPV: 0,5-0,7 NPV: 0,88-0,97 Accuracy: 0,75-0,88 Mean agreement between observers was 0,88 (SD:0,17) per patient.

Conclusion

Our study suggests that: Optimized MDCT is a specific, accurate and reproducible method for distinction between LACC and NLACC. There is a minimal risk of overtreatment of low-risk patient Other studies have also shown a good accuracy of MDCT in CC staging: 1. A metha-analysis [5] published on this topic concluded that preoperative CT can be used to accurately distinguish between tumours confined to the bowel wall and those invading beyond the muscularis layer (differentiation between T1-T2 versus T3-T4): S: 86% E: 78% 2. Nørgaard...

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References

[1] Zheng Zhou, Halla S. Nimeiri, and Al B. Benson III. Preoperative chemotherapy for locally advanced resectable colon cancer - a new treatment paradigm in colon cancer. Ann Transl Med. Jul 2013; 1(2):11. [2] Medical Research Council Oesophageal Cancer Working Party. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet. 2002;359:1727–1733. [3]Sebag-Montefiore D, Stephens RJ, Steele D. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet. 2009;373:811–820....