title: Consequence of restaging after neoadjuvant treatment for locally advanced rectal cancer.
abstract: BACKGROUND
  Locally advanced rectal cancer is customarily treated with neoadjuvant chemoradiotherapy (CRT) followed by a total mesorectal excision. During the course of CRT, previously non-detectable distant metastases can appear. Therefore, a restaging CT scan of the chest and abdomen was performed prior to surgery. The aim of this study was to determine the frequency of a change in treatment strategy after this restaging CT scan.
  
  
  METHODS
  Patients treated with neoadjuvant CRT for locally advanced rectal cancer between January 2003 and July 2013 were included retrospectively. To determine the value of the restaging CT scan, the surgical treatment as planned before CRT was compared with the treatment ultimately received.
  
  
  RESULTS
  A total of 153 patients (91 male) were eligible, and median age was 62 (32-82) years. The restaging CT scan revealed the presence of distant metastases in 19 patients (12.4, 95 % confidence interval [CI] 7.0-17.8). In 17 patients (11.1, 95 % CI 6.1-16.1), a change in treatment strategy occurred due to the detection of metastases with a restaging CT scan.
  
  
  CONCLUSIONS
  A restaging CT scan after completion of neoadjuvant CRT may detect newly developed metastases and consequently alter the initial treatment strategy. This study demonstrated the added value of the restaging CT scan prior to surgery.
authors.affiliation: Department of Medical Oncology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands, c.bisschop@umcg.nl.
authors.forename: C
authors.initials: C
authors.lastname: Bisschop
authors.forename: J J J
authors.initials: JJ
authors.lastname: Tjalma
authors.forename: G A P
authors.initials: GA
authors.lastname: Hospers
authors.forename: D
authors.initials: D
authors.lastname: Van Geldere
authors.forename: J W B
authors.initials: JW
authors.lastname: de Groot
authors.forename: E M
authors.initials: EM
authors.lastname: Wiegman
authors.forename: M
authors.initials: M
authors.lastname: Van't Veer-Ten Kate
authors.forename: M G
authors.initials: MG
authors.lastname: Havenith
authors.forename: J
authors.initials: J
authors.lastname: Vecht
authors.forename: J C
authors.initials: JC
authors.lastname: Beukema
authors.forename: G
authors.initials: G
authors.lastname: Kats-Ugurlu
authors.forename: S V K
authors.initials: SV
authors.lastname: Mahesh
authors.forename: B
authors.initials: B
authors.lastname: van Etten
authors.forename: K
authors.initials: K
authors.lastname: Havenga
authors.forename: J G M
authors.initials: JG
authors.lastname: Burgerhof
authors.forename: D J A
authors.initials: DJ
authors.lastname: de Groot
authors.forename: W H
authors.initials: WH
authors.lastname: de Vos Tot Nederveen Cappel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed