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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
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 of preoperative therapy are also expected [1].
Furthermore,
neoadjuvant chemotherapy and radiotherapy are substantially more effective than similar postoperative therapy in oesophageal,
gastric,
and rectal cancer [2,
3].
A phase III clinical trial,
the FOxTROT Collaborative Group Trial [4],
is now in course evaluating the benefits of neoadjuvant chemotherapy (NACT) in potentially resectable LACC.
- LACC includes tumours staged pre-operatively as T4 or T3 with ≥5mm invasion beyond the muscular layer.
- Non locally advanced colon cancer (NLACC) includes tumours in stages T1,
T2,
T3 with <5mm invasion beyond the muscular layer.
Pilot study results suggested that:
- NACT in potentially resectable LACC is likely to prove superiority compared to standard treatment.
- Patients can be appropriately selected for neoadjuvant chemotherapy with CT scanning.
The value of MDCT in CC staging has already been covered by several studies.
However,
if NACT proves to have a positive impact in the survival of patients with potentially resectable LACC,
the distinction between NLACC and LACC (based on the invasion <5mm or ≥5mm beyond the muscularis layer) may become the most relevant feature to be determined preoperatively [4].