Staging following preoperative chemoradiotherapy for advanced rectal cancer
Preoperative high-dose radiation for treatment of patients with advanced rectal cancer has been used to enhance resectability, facilitate sphincter-saving procedures, reduce the local recurrence rate and potentially improve survival. More recently concomitant chemotherapy as a sensitizing agent has been added in attempt to improve these results. One explanation of the greater efficacy and tolerance to preoperative radiotherapy is that radiation is much more effective in a surgically undisturbed bed. Well-oxygenated and vascularized tissue is vital for radiotherapy cell-killing and a postoperative surgical bed is naturally hypoxic. Evaluation of patients who have received preoperative radiochemotherapy often shows significant tumor regression. Accurate staging following radiation is more difficult since radiotherapy can significantly hamper the assessment of wall invasion by the ERUS [1, 2]. This is probably because after irradiation the rectal wall is thickened, more hypoechoic and the different layers are less clearly visualized (Fig. V.1).
KeywordsRectal Cancer Preoperative Radiotherapy Rectal Wall Advanced Rectal Cancer Preoperative Chemoradiotherapy
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