Maslova Marina, Herden Heinz, Schork Karin, Turewicz Michael, Eisenacher Martin, Schroers Roland, Baraniskin Alexander, Mika Thomas
Department of Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.
Department of Radiology, VAMED Clinic, Bad Berleburg, Germany.
Front Oncol. 2021 May 31;11:623144. doi: 10.3389/fonc.2021.623144. eCollection 2021.
Therapeutic strategies for patients with locally advanced rectal cancer (LARC) who are achieving a pathological complete response (pCR) after neoadjuvant radio-chemotherapy (neoCRT) are being increasingly investigated. Recent trials challenge the current standard therapy of total mesorectal excision (TME). For some patients, the treatment strategy of "watch-and-wait" seems a preferable procedure. The key factor in determining individual treatment strategies following neoCRT is the precise evaluation of the tumor response. Contrast-enhanced computer tomography (ceCT) has proven its ability to discriminate benign and malign lesions in multiple cancers. In this study, we retrospectively analyzed the ceCT based density of LARC in 30 patients, undergoing neoCRT followed by TME. We compared the tumors´ pre- and post-neoCRT density and correlated the results to the amount of residual vital tumor cells in the resected tissue. Overall, the density decreased after neoCRT, with the highest decrease in patients achieving pCR. Densitometry demonstrated a specificity of 88% and sensitivity of 68% in predicting pCR. Thus, we claim that ceCT based densitometry is a useful tool in identifying patients with LARC who may benefit from a "watch-and-wait" strategy and suggest further prospective studies.
对于局部晚期直肠癌（LARC）患者，在新辅助放化疗（neoCRT）后实现病理完全缓解（pCR）的治疗策略正受到越来越多的研究。最近的试验对当前全直肠系膜切除术（TME）的标准治疗提出了挑战。对于一些患者，“观察等待”的治疗策略似乎是更可取的方法。新辅助放化疗后确定个体治疗策略的关键因素是对肿瘤反应的精确评估。对比增强计算机断层扫描（ceCT）已证明其在多种癌症中区分良性和恶性病变的能力。在本研究中，我们回顾性分析了30例接受新辅助放化疗后行全直肠系膜切除术的局部晚期直肠癌患者基于ceCT的密度。我们比较了新辅助放化疗前后肿瘤的密度，并将结果与切除组织中残留的存活肿瘤细胞数量相关联。总体而言，新辅助放化疗后密度降低，达到病理完全缓解的患者降低幅度最大。密度测定在预测病理完全缓解方面显示出88%的特异性和68%的敏感性。因此，我们认为基于ceCT的密度测定是识别可能从“观察等待”策略中获益的局部晚期直肠癌患者的有用工具，并建议进一步开展前瞻性研究。
