Re-staging following pre-operative chemoradiotherapy for rectal cancer: does it influence management?

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Introduction

Long-course chemo-radiotherapy (LCCRT) is recommended prior to surgical management of locally advanced rectal tumours. The need for re-staging has been questioned. The purpose of this study was to determine if re-staging affected the management of patients receiving pre-operative LCCRT for rectal cancer.

Methods

A retrospective review of patients with rectal cancer re-staged following pre-operative LCCRT was performed. Patients were identified from the Audit Department, Lower Gastrointestinal Multidisciplinary Meeting (LGIMDT) notes and patient records. Imaging results were obtained from our electronic radiological database. Data including dermographics, staging, LGIMDT discussion and changes in management were collected using a proforma

Results

Seventy-one patients were identified (M:F 36:35; age range 31 – 85 years). Fifty-nine patients were re-staged. Twelve patients did not undergo re-staging and were excluded. Nineteen patients had a change in management following re-staging. The most common change was ‘not to operate’. Ten patients had a complete response to LCCRT. Nine patients required palliation.

Conclusion

Re-staging changed the management plan in thirtytwo per cent of patients receiving pre-operative LCCRT for rectal cancer. We recommend therefore that patients with rectal cancer be re-staged following LCCRT as surgery may be avoided in a significant number of patients.