Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, 411-8777, Japan.
Int J Clin Oncol. 2013 Oct;18(5):864-8. doi: 10.1007/s10147-012-0452-2. Epub 2012 Aug 7.
The number of cases of metastatic colorectal cancer treated by chemotherapy without primary tumor resection has recently increased. However, evaluation of primary tumor response by computed tomography is difficult in such cases. In this study, the usefulness of evaluation of primary tumor response to chemotherapy by endoscopy was investigated.
This retrospective analysis was performed at the Shizuoka Cancer Center and included 31 patients (88 evaluations) with metastatic colorectal cancer. Computed tomography and endoscopy were performed concomitantly between September 2002 and June 2006. Patients were treated by systemic chemotherapy without prophylactic primary tumor resection. Definitions of primary tumor response were as follows: (1) complete response, confirmed by colorectal biopsy; (2) progressive disease, enlargement of at least one of five tumor parameters; and (3) neither (1) nor (2). Computed tomography was performed to evaluate primary tumor response according to the Response Evaluation Criteria in Solid Tumors and to identify colorectal stenosis secondary to primary tumors.
The rate of concordance between endoscopy and computed tomography for evaluation of primary tumor response was 75%. Colorectal stenosis was detected 14 times by endoscopy (9 cases) and 3 times by computed tomography (3 cases). Of the 7 patients in whom surgery was required, 6 exhibited stenotic symptoms before endoscopic detection.
With regard to primary tumor response evaluation, a high concordance rate was observed between endoscopy and computed tomography, although endoscopic evaluation appeared more sensitive in detecting colorectal stenosis requiring surgical treatment.
最近，未经原发肿瘤切除而接受化疗治疗转移性结直肠癌的病例数量有所增加。然而，在这种情况下，通过计算机断层扫描评估原发肿瘤的反应较为困难。在本研究中，我们探讨了通过内镜评估化疗后原发肿瘤反应的有效性。
本回顾性分析在静冈癌症中心进行，纳入了 31 例（88 次评估）转移性结直肠癌患者。2002 年 9 月至 2006 年 6 月期间同时进行计算机断层扫描和内镜检查。患者接受全身化疗，未进行预防性原发肿瘤切除。原发肿瘤反应的定义如下：（1）完全缓解，通过直肠活检证实；（2）进展性疾病，至少有五个肿瘤参数中的一个增大；（3）既不属于（1）也不属于（2）。根据实体瘤反应评估标准对计算机断层扫描进行评估，以确定是否存在原发性肿瘤引起的结直肠狭窄。
内镜和计算机断层扫描评估原发肿瘤反应的一致性率为 75%。内镜检查发现结直肠狭窄 14 次（9 例），计算机断层扫描发现 3 次（3 例）。在需要手术的 7 例患者中，6 例在内镜检测到狭窄症状之前就出现了该症状。
在评估原发肿瘤反应方面，内镜和计算机断层扫描的一致性较高，但内镜评估在检测需要手术治疗的结直肠狭窄方面更为敏感。
