title: Routine preoperative restaging CTs after neoadjuvant chemoradiation for locally advanced rectal cancer are low yield: a retrospective case study.
abstract: BACKGROUND
  Pre-operative restaging CT scans are often performed routinely following neoadjuvant chemoradiotherapy for locally advanced rectal cancer. There is a paucity of data on the utility of this common practice. We sought to determine how often restaging CTs identified disease progression or regression that altered management.
  
  
  METHODS
  We performed a single-institution retrospective study. From 2007 to 2011, 182 patients had newly-diagnosed, non-metastatic rectal adenocarcinoma, of which 96 were surgical candidates with clinical stage II/III disease. Ninety-one of these patients (95%) completed neoadjuvant chemoradiation.
  
  
  RESULTS
  Eighty-three out of 91 patients (91%) had restaging CTs. Four patients (5%) had new lesions suspicious for distant metastasis (2 lung, 2 liver) on restaging CT scan reports (1 of these was present on initial staging CT but not reported). All 4 patients had node-positive disease. In no case did restaging CT result in a change in surgical management.
  
  
  CONCLUSIONS
  Because of the financial costs and established risks of intravenous contrast and cumulative radiation exposure, it may be advisable to take a more selective approach to preoperative imaging. Larger, prospective studies may enable identification of an at-risk cohort who would benefit most from restaging CT.
  
  
  CONCLUSIONS
  Routine restaging CT scans are low yield in the management of locally advanced rectal cancer.
authors.affiliation: University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: Jennifer.Davids@umassmemorial.org.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Davids
authors.affiliation: University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: Karim.Alavi@umassmemorial.org.
authors.forename: Karim
authors.initials: K
authors.lastname: Alavi
authors.affiliation: University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: Andres.CerveraServin@swedish.org.
authors.forename: J
authors.initials: J
authors.lastname: Andres Cervera-Servin
authors.affiliation: University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: Christine.Choi@umassmemorial.org.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Choi
authors.affiliation: University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: Paul.Sturrock3@umassmemorial.org.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Sturrock
authors.affiliation: University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: W.Brian.Sweeney@umassmemorial.org.
authors.forename: W Brian
authors.initials: WB
authors.lastname: Sweeney
authors.affiliation: University of Massachusetts Medical School, Division of Colon and Rectal Surgery, Department of Surgery, Worcester, MA 01602, USA. Electronic address: Justin.Maykel@umassmemorial.org.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Maykel
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging / Q000379:methods; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: CT scan; Neoadjuvant chemoradiotherapy; Rectal cancer