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Abstract Although stages T3 and T4 rectal cancer can be reduced to T1 or T2 after neoadjuvant radiochemotherapy, the accuracy of the endorectal ultrasonography (ERUS) for the post-radiochemotherapy evaluation of low rectal cancer has seldom been reported. We aimed to investigate the value of ERUS in the assessment of invasion staging in low rectal cancer with local progression, and the factors affecting its accuracy, after neoadjuvant radiochemotherapy. A total of 114 patients administered with neoadjuvant radiochemotherapy for stages II and III low rectal cancer (local stage T3/T4) from February 2018 to December 2020 were enrolled in the study. The changes in local lesions were evaluated using ERUS before and after radiochemotherapy, and compared with the pathological T staging. The accuracy of post-neoadjuvant radiochemotherapy re-staging examined with ERUS was evaluated, and univariate analysis was used to identify the factors affecting the accuracy. After neoadjuvant radiochemotherapy, the blood flow distribution within the lesion significantly declined (P<0.05), the max length and max thickness of the longitudinal axis of the lesion were reduced (P<0.05), and the uT staging was decreased (P<0.05), when compared with lesions before the treatment. Compared with postoperative pathological T staging, the accuracies of ERUS in T1, T2, T3 and T4 stages were 11.11%, 28.57%, 27.27% and 100%, respectively. Univariate analysis indicated that review time of ERUS, post-operative T staging and Wheeler rectal regression stage were factors affecting the accuracy of ERUS re-staging. ERUS is more accurate for T4 re-staging, follow-up reviewed six weeks after neoadjuvant radiochemotherapy and low regression tumors, with a high application value for the assessment of the efficacy of neoadjuvant radiochemotherapy for low rectal cancer.
Resumen Aunque el cáncer de recto en estadios T3 y T4 se puede reducir a T1 o T2 después de la radioquimioterapia neoadyuvante, rara vez se ha informado la precisión de la ecografía endorrectal (ERUS) para la evaluación posterior a la radioquimioterapia del cáncer de recto inferior. Nuestro objetivo fue investigar el valor de ERUS en la evaluación de la estadificación de la invasión en el cáncer de recto inferior con progresión local, después de la radioquimioterapia neoadyuvante y los factores que afectan su precisión. Se incluyeron en el estudio un total de 114 pacientes a los que se les administró radioquimioterapia neoadyuvante para el cáncer de recto inferior en estadios II y III (estadio local T3/T4), desde febrero de 2018 hasta diciembre de 2020. Los cambios en las lesiones locales se evaluaron mediante ERUS antes y después de la radioquimioterapia y se compararon con la estadificación patológica T. Se evaluó la precisión de la re-estadificación examinada con ERUS, después de la radioquimioterapia neoadyuvante y se utilizó un análisis univariado para identificar los factores que afectan su precisión. Después de la radioquimioterapia neoadyuvante, la distribución del flujo sanguíneo dentro de la lesión disminuyó significativamente (P<0,05), la longitud máxima y el espesor máximo del eje longitudinal de la lesión se redujeron (P<0,05) y la estadificación uT disminuyó (P<0,05), en comparación con las lesiones antes del tratamiento. En comparación con la estadificación T patológica posoperatoria, las precisiones de ERUS en las etapas T1, T2, T3 y T4 fueron del 11,11%, 28,57%, 27,27% y 100%, respectivamente. El análisis univariable indicó que el tiempo de revisión de ERUS, la estadificación T postoperatoria y la etapa de regresión rectal de Wheeler fueron factores que afectaron la precisión de la re-estadificación con ERUS. ERUS es más preciso para la re-estadificación de T4, el seguimiento seis semanas después de la radioquimioterapia neoadyuvante y en tumores de baja regresión, con un alto valor de aplicación para la evaluación de la eficacia de la radioquimioterapia neoadyuvante para el cáncer rectal bajo.
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Objective:To systematic review the clinical efficacy and safety of neoadjuvant chemotherapy and neoadjuvant concurrent chemoradiotherapy for resectable esophageal squamous cell carcinoma.Methods:Literature search was performed from Web of Science, Pubmed, Cochrane Library, Embase, CBM, Wanfang Data, CNKI and Chongqing VIP. The clinical controlled studies of neoadjuvant chemotherapy versus neoadjuvant concurrent chemoradiation in the treatment of resectable esophageal squamous cell carcinoma was searched. Relevant outcome indicators were analyzed by Revman 5.3 statistical software.Results:Nine studies were included, with a total of 1, 369 patients. Compared with the neoadjuvant chemoradiotherapy, the neoadjuvant chemotherapy had lower overall survival rates at 3 and 5 years( OR=0.68, 95% CI: 0.53-0.86, P<0.05; OR=0.51, 95% CI: 0.34-0.77, P<0.05) , lower pathological complete remission rate( OR=0.28, 95% CI: 0.18-0.45, P<0.05)and R0 resection rate( OR=0.39, 95% CI: 0.22-0.68, P<0.05), The total postoperative complication rate is similar( OR=1.07, 95% CI: 0.75-1.51, P>0.05). Conclusion:Neoadjuvant concurrent radiochemotherapy maybe superior to neoadjuvant chemotherapy among patients with resectable esophageal squamous cell carcinoma.
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Neoadjuvant chemoradiotherapy is the preferred treatment mode for the diagnosis and treatment of locally advanced operable esophageal carcinoma recommended by many guidelines. However, some problems remain to be further explored. In this article, current problems perplexing clinical practice were sorted out, aiming to provide constructive suggestions for the smooth development of neoadjuvant chemoradiotherapy for esophageal carcinoma in the future.
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Objective@#To investigate the value of shear wave elastography(SWE) to evaluate local advanced rectal cancer after neoadjuvant radiochemotherapy.@*Methods@#In a retrospective study, endorectal ultrasound(ERUS) and endorectal SWE were performed in 73 patients with local advanced rectal cancer before and after neoadjuvant radiochemotherapy. The mean and maximum values of Young′s modulus for SWE to evaluate the lesions before and after neoadjuvant radiochemotherapy were recorded. According to the postoperative pathological T stage, the lesions were divided into reduction of T stage group and non-reduction of T stage group. The efficacy of ERUS in diagnosing reduction of T stage was calculated, and the differences of the mean and maximum values of Young′s modulus between reduction of T stage group and non-reduction of T stage group was calculated, and the differences between the two groups were compared. ROC curves were constructed by the difference of mean and maximum Young′s modulus of lesions before and after neoadjuvant radiochemotherapy, respectively, to evaluate the diagnostic value of the difference in predicting reduction of T stage.@*Results@#A total of 57 cases had reduction of T stage after neoadjuvant radiochemotherapy (57/73, 78.1%). The mean and maximum values of Young′s modulus before and after neoadjuvant radiochemotherapy were compared, and the differences were statistically significant(all P<0.01). After neoadjuvant radiochemotherapy, the values of Young′s modulus of the lesions increased with the increase of pT stage. Compared with the mean values of Young′s modulus of the lesions in pT3 stage, the differences of the mean values of Young′s modulus of the lesions in pT0, pT1 and pT2 stages were statistically significant(all P<0.01). Compared with the maximum values of Young′s modulus of the lesions in pT3 stage, the differences of the maximum values of Young′s modulus of the lesions in pT0 and pT1 stage were statistically significant(all P<0.01). The differences of the mean value and the maximum value of Young′s modulus in the reduction of T stage group and the non-reduction of T stage group was statistically significant(all P<0.01). The ROC curve was established and determined by calculation. Taking the average difference of 34.7 kPa as the best diagnostic threshold, the average hardness of the lesion after neoadjuvant radiochemotherapy decreased more than 34.7 kPa to diagnose the reduction of T stage, the sensitivity, specificity and accuracy were 87.7%, 93.8% and 89.0%, respectively. Compared with ERUS, the difference was statistically significant(P=0.032).@*Conclusions@#Shear wave elastography is an effective technology to help ERUS in evaluating the lesions of rectal cancer after neoadjuvant radiochemotherapy and has a promising future.
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Objective To investigate the value of shear wave elastography ( SWE) to evaluate local advanced rectal cancer after neoadjuvant radiochemotherapy . Methods In a retrospective study ,endorectal ultrasound( ERUS) and endorectal SWE were performed in 73 patients with local advanced rectal cancer before and after neoadjuvant radiochemotherapy . T he mean and maximum values of Young′s modulus for SWE to evaluate the lesions before and after neoadjuvant radiochemotherapy were recorded . According to the postoperative pathological T stage ,the lesions were divided into reduction of T stage group and non‐reduction of T stage group . T he efficacy of ERUS in diagnosing reduction of T stage was calculated ,and the differences of the mean and maximum values of Young′s modulus between reduction of T stage group and non‐reduction of T stage group was calculated ,and the differences between the two groups were compared . ROC curves were constructed by the difference of mean and maximum Young′s modulus of lesions before and after neoadjuvant radiochemotherapy ,respectively ,to evaluate the diagnostic value of the difference in predicting reduction of T stage . Results A total of 57 cases had reduction of T stage after neoadjuvant radiochemotherapy ( 57/73 ,78 .1% ) . The mean and maximum values of Young′s modulus before and after neoadjuvant radiochemotherapy were compared ,and the differences were statistically significant ( all P ＜ 0 .01) . After neoadjuvant radiochemotherapy ,the values of Young′s modulus of the lesions increased with the increase of pT stage . Compared with the mean values of Young′s modulus of the lesions in pT3 stage , the differences of the mean values of Young′s modulus of the lesions in pT 0 ,pT1 and pT2 stages were statistically significant ( all P ＜ 0 .01 ) . Compared with the maximum values of Young′s modulus of the lesions in pT3 stage ,the differences of the maximum values of Young′s modulus of the lesions in pT0 and pT1 stage were statistically significant( all P ＜0 .01) . T he differences of the mean value and the maximum value of Young′s modulus in the reduction of T stage group and the non‐reduction of T stage group was statistically significant ( all P ＜ 0 .01 ) . T he ROC curve was established and determined by calculation . Taking the average difference of 34 .7 kPa as the best diagnostic threshold ,the average hardness of the lesion after neoadjuvant radiochemotherapy decreased more than 34 .7 kPa to diagnose the reduction of T stage ,the sensitivity ,specificity and accuracy were 87 .7% ,93 .8% and 89 .0% ,respectively . Compared with ERUS , the difference was statistically significant ( P ＝ 0 .032 ) . Conclusions Shear wave elastography is an effective technology to help ERUS in evaluating the lesions of rectal cancer after neoadjuvant radiochemotherapy and has a promising future .
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Neoadjuvant chemoradiotherapy plus total mesorectal excision (TME) is the standard care for locally advanced middle-low rectal cancer. Some patients could benefit from neoadjuvant chemoradiotherapy to achieve clinical complete response (cCR). Therefore, in recent years, for patients with cCR after neoadjuvant therapy, the "watch and wait" strategy has been widely recommended by their doctors to let them enter "waiting period" without surgery, so that the quality of life is improved. However, the "watch and wait" strategy also has many practical problems that have not been resolved. Firstly, the diagnostic criteria for cCR and pathologic complete response (pCR) are not uniform and different significantly. Secondly, some cCR patients have found tumor regrowth and subsequently underwent salvage surgery during the "watch and wait" period. Thirdly, there is no clinical consensus on the adjuvant therapy for patients during the "watch and wait" period. Fourthly, the role of surgery in patients with cCR is controversial. Finally, we need to accumulate more clinical evidence to confirm whether the "watch and wait" strategy can be selected immediately after achieving cCR for rectal cancer. At the same time, we should find novel molecular markers that can predict the efficacy of chemoradiotherapy. Only rational choice of "watch and wait" strategy will allow more patients with rectal cancer to benefit from chemoradiotherapy.
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The morbidity and nortality of esophageal carcinoma showed an upward trend in recent years.Neoadjuvant radiochemotherapy is the nain mode of treatment for advanced esophageal carcinoma,including neoadjuvant chemotherapy,neoadjuvant radiotherapy and neoadjuvant radiochemotherapy.However,there are still many controversies on efficacies and advantages or disadvantages of treatment mode.In this article,authors will investigate the present situations and future direction of neoadjuvant therapy for locally advanced esophageal carcinoma.
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Objective To evaluate the value of endorectal elastography with strain ratio to estimate local advanced rectal cancer after neoadjuvant radiochemotherapy.Methods In a retrospective study, endorectal ultrasound,endorectal elastography and enhanced rectal MRI were performed in 67 patients with local advanced rectal cancer after neoadjuvant radiochemotherapy.The imaging results were compared with postoperative pathological T stage and NCCN TRG.Results There was no significant difference in the diagnosis accuracy between T stage of ERUS(55.2%)and MRI(56.7%).Endorectal elastography results showed lesions confined to the rectal wall(T0-2 stage)were softer than lesions invaded the peripheral fat (T3)and the difference was statistically significant(P <0.05).When the cut-off point was set at SR<2.78,the sensitivity,specificity and accuracy of diagnosis of T0-2 were 64.7%,87.5% and 70.1% respectively.The lesion tended to have a greater SR value when residual tumor components increased(a higher NCCN TRG).Conclusions Endorectal elastography is an useful and effective imaging method to evaluate local advanced rectal cancer after neoadj uvant radiochemotherapy.It can help ERUS and rectal MRI to evaluate the lesions.
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Objective To evaluate the clinical factors associated with pathological complete response (pCR) after preoperative neoadjuvant chemoradiotherapy for rectal cancer.Methods A retrospective analysis was performed on the clinical data of 116 patients with rectal cancer,who underwent neoadjuvant chemoradiotherapy followed by radical surgery from January 2009 to December 2012.All patients received pelvic intensity-modulated radiotherapy (50 Gy/25 fractions) with concurrent fluorouracilbased chemotherapy and then underwent radical surgery 4-8 weeks later.The clinical factors associated with pCR or non-pCR were analyzed by Logistic regression.Results Of the 116 patients,20 (17.2％) achieved a pCR after neoadjuvant chemoradiotherapy.The univariate analysis showed that percentage of circumference of the rectal tube invaded by the tumor,preoperative serum carcinoembryonic antigen (CEA) level,T stage,N stage,distance from the anal verge,degree of tumor differentiation,and maximum tumor diameter were associated with pCR or non-pCR after neoadjuvant chemoradiotherapy for rectal cancer.The multivariate analysis revealed that percentage of circumference of the rectal tube invaded by the tumor,preoperative serum CEA level,and T stage were predictive factors for pCR or non-pCR after neoadjuvant chemoradiotherapy for rectal cancer.Conclusions Non-circumferential tumor (percentage of circumference of the rectal tube invaded by the tumor ＜ 75 ％),low CEA level,and early T stage before treatment may be associated with pCR after neoadjuvant chemoradiotherapy for rectal cancer.