Accuracy of radiological staging in identifying high-risk colon cancer patients suitable for neoadjuvant chemotherapy: a multicentre experience
Article first published online: 5 MAR 2012
© 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland
Volume 14, Issue 4, pages 438–444, April 2012
How to Cite
Dighe, S., Swift, I., Magill, L., Handley, K., Gray, R., Quirke, P., Morton, D., Seymour, M., Warren, B. and Brown, G. (2012), Accuracy of radiological staging in identifying high-risk colon cancer patients suitable for neoadjuvant chemotherapy: a multicentre experience. Colorectal Disease, 14: 438–444. doi: 10.1111/j.1463-1318.2011.02638.x
- Issue published online: 5 MAR 2012
- Article first published online: 5 MAR 2012
- Accepted manuscript online: 4 APR 2011 11:15AM EST
- Received 27 October 2010; accepted 31 January 2011; Accepted Article online 4 April 2011
- colon cancer;
- neoadjuvant chemotherapy
Aim A pilot study was undertaken to determine the accuracy of computed tomography (CT) staging in identifying patients with high-risk colon cancers who would be considered as candidates for a neoadjuvant therapy trial (FOxTROT) and those at low risk (T1/T2) who would be excluded.
Method Participating radiologists from 19 centres attended workshops for standardization of image interpretation according to previously defined prognostic criteria: good prognosis tumours, including, T1/T2; intermediate prognosis, T3 < 5 mm tumour invasion beyond the muscularis propria (MP); and poor prognosis tumours, including T3 with tumour extension ≥ 5 mm beyond the MP or T4. The CT findings were compared with histopathology as the reference standard.
Results Of 94 patients with radiological and pathological data, 71% were categorized by CT as having a poor prognosis. The sensitivity and specificity of CT in identifying these tumours were 87% (95% CI, 74–94) and 49% (95% CI, 33–65). Sensitivity and specificity for tumour infiltration beyond the MP (T3/T4 vs T1/T2) were 95% (95% CI, 87–98) and 50% (95% CI, 22–77), respectively. Including all CT-staged T3 and T4 patients in the trial would have increased the proportion eligible for entry to 89% (n = 84) without affecting the false-positive rate of 7%. Some 20% of T3/T4 patients would have been ineligible for FOxTROT because of synchronous metastases.
Conclusion In a multicentre setting, CT scanning identified high-risk (T3/4) colon cancers with minimal overstaging of T1/T2 tumours, thus establishing the feasibility of radiologically guided neoadjuvant chemotherapy.