Is decrease of tumor volume correlated with stage change after preoperative concurrent chemoradiotherapy?
OBJECTIVE
The significance of tumor volume and its change after concurrent chemoradiotherapy (CCRT) was evaluated.


METHODS
Standard-dose external radiation and oral UFUR plus leucovorin were used to treat 30 middle and lower rectal adenocarcinoma patients. Volume of tumor calculated from images obtained by dynamic MRI of the rectum before and after CCRT was compared to pathological results after definite resection and other clinical data.


RESULTS
The T-stage in 15 patients (50%), the N-stage in 13 (72.2%), and overall, the TNM stage in 18 (60%), were downstaged, including 7 (23.3%) with complete responses (CR). Volume of tumor before CCRT (Vpre) and after CCRT (VPost) was 10.3+/-6.1cm3 and 4.2+/-2.2cm3, respectively, and VPre correlated with initial T stage, N stage, age, and location. The net decrease ratio (NDR) of tumor volume was related to Vpre and initial T stage. As to the downstaging effect, VPre was related to incidence of CR; NDR was related to the downstaging of the N stage.


CONCLUSIONS
All tumors showed volume reduction after CCRT, but the downstaging benefits were not in proportion to the size change. Initially larger tumors had higher ratios of volume reduction, and smaller tumors had higher chance of CR.
Yang
Shung-Haur
SH
Division of Colon and Rectal Surgery, Department of Surgery, Cancer Center Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Lee
Rheun-Chuan
RC
Chen
Chien-Chih
CC
Jiang
Jeng-Kae
JK
Lin
Jen-Kou
JK
Li
Anna Fen-Yau
AF
Liang
Wen-Yih
WY
Wang
Ling-Wei
LW
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011355:Prodrugs / Q000627:therapeutic use; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012007:Rectum / Q000473:pathology; D016896:Treatment Outcome; D014498:Uracil / Q000008:administration & dosage
D011355:Prodrugs; D014498:Uracil; D005472:Fluorouracil