Endorectal ultrasound of T3 and T4 rectal cancers after preoperative chemoradiation

作者：Paul R. Williamson, Michael D. Hellinger, Sergio W. Larach, Andrea Ferrara · 发表于：Diseases of the Colon & Rectum · 年份：1996 · DOI：10.1007/bf02048268 · 被引用次数：74 · 研究领域：Colorectal Cancer Surgical Treatments、Colorectal and Anal Carcinomas、Anorectal Disease Treatments and Outcomes

PURPOSE: This study was undertaken to assess the accuracy and ability of endorectal ultrasound (ERUS) to predict changes in rectal tumor stage after a preoperative chemoradiation protocol. METHODS: Since December 1990, all rectal malignancies at our institution have been preoperatively staged with ERUS. ERUS has been an essential tool in preoperative staging of rectal cancer patients, possessing an overall accuracy of 84 percent for T stage and 81 percent for lymph node status in our hands (Williamson PR, unpublished data). Beginning in July 1992, all patients staged with T3 or T4 lesions on initial ERUS have been entered into a protocol consisting of preoperative chemoradiation therapy (CRT). This protocol consists of patients receiving 4,500 to 5,040 rads for five to eight weeks and concomitantly receiving sensitizing doses of 5-fluorouracil and/or leucovorin. All patients were scheduled for sphincter-saving or abdomino-perineal resections six to eight weeks following completion of CRT. A repeat ERUS was performed on each patient one week before surgery. RESULTS: The study group consisted of 15 patients who completed CRT, including 12 males and 3 females. Evidence of tumor shrinkage via ERUS measurement was seen in all patients. Average tumor shrinkage as assessed by ERUS was 16 percent by width and 32 percent by depth of invasion. Sonographic level of invasion and nodal status were each downstaged in 38 percent of patients. Pathologic evaluation comparison revealed that th...