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Review
. 2023 May 15;15(5):700-712.
doi: 10.4251/wjgo.v15.i5.700.

Restaging rectal cancer following neoadjuvant chemoradiotherapy

Dajana Cuicchi  1 , Giovanni Castagna  2 , Stefano Cardelli  2 , Cristina Larotonda  2 , Benedetta Petrello  2 , Gilberto Poggioli  2
Affiliations
Review

Restaging rectal cancer following neoadjuvant chemoradiotherapy

Dajana Cuicchi et al. World J Gastrointest Oncol. .

Abstract

Correct tumour restaging is pivotal for identifying the most personalised surgical treatment for patients with locally advanced rectal cancer undergoing neoadjuvant therapy, and works to avoid both poor oncological outcome and overtreatment. Digital rectal examination, endoscopy, and pelvic magnetic resonance imaging are the recommended modalities for local tumour restaging, while chest and abdominal computed tomography are utilised for the assessment of distant disease. The optimal length of time between neoadjuvant treatment and restaging, in terms of both oncological safety and clinical effectiveness of treatment, remains unclear, especially for patients receiving prolonged total neoadjuvant therapy. The timely identification of patients who are radioresistant and at risk of disease progression remains challenging.

Keywords: Colonoscopy; Computed tomography scan; Endorectal ultrasound; Locally advanced rectal cancer; Pelvic magnetic resonance imaging; Restaging.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare having no conflicts of interest.

Figures

Figure 1
Figure 1
A case of clinical complete response confirmed at pathology. A-C: A 61-year-old male patient with rectal cancer. Endoscopy (A) and magnetic resonance imaging (MRI) (B and C) findings staged a tumour of the low rectum (cT3aN1, mesorectal fascia negative, extramural venous invasion negative, pelvic nodes negative). The patient underwent neoadjuvant chemoradiotherapy; D-G: Restaging at 15 wk after the beginning of the neoadjuvant chemoradiotherapy showed a clinical complete response at endoscopy (D), MRI (E), endorectal ultrasound (F), and 18-fluorodeoxyglucose-computed tomography/positron emission tomography (G).
Figure 2
Figure 2
A case of clinical complete response confirmed at pathology. A-C: A 57-year-old female patient with rectal cancer. Endoscopy (A) and magnetic resonance imaging (MRI) (B and C) findings staged a tumour of the low of rectum (cT3aN0 mesorectal fascia negative, extramural vascular invasion negative, pelvic nodes negative). The patient underwent neoadjuvant chemoradiotherapy; D-G: Restaging at 15 wk after the beginning of therapy showed a clinical complete response at endoscopy (D), MRI (E), endorectal ultrasound (F), and 18-fluorodeoxyglucose-computed tomography/positron emission tomography (G).
Figure 3
Figure 3
A case of near clinical complete response confirmed at pathology (ypT1N0). A-C: An 84-year-old male patient with rectal cancer. Endoscopy (A) and magnetic resonance imaging (MRI) (B and C) staged a tumour of the low rectum (cT3aN0M0, mesorectal fascia negative, extramural vascular invasion negative, pelvic nodes negative). The patient underwent short-course radiotherapy; D-G: The restaging at 15 wk after the beginning of neoadjuvant radiotherapy showed a near clinical complete response at endoscopy (D), MRI (E and F), and endorectal ultrasound (G).
Figure 4
Figure 4
A case of poor response confirmed at pathology (ypT2N0). A-C: A 42-year-old male with rectal cancer. Endoscopy (A) and MRI (B and C) staged a tumour of the middle rectum (cT3bN2, mesorectal fascia negative, extramural vascular invasion positive, pelvic nodes negative). The patient underwent total neoadjuvant therapy; D-F: Restaging at 20 wk after the beginning of neoadjuvant radiotherapy showed a poor response at endoscopy (D) and MRI (E and F).
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