Limited Role for Routine Restaging After Neoadjuvant Therapy in Locally Advanced Rectal Cancer

Area of Science:

• Oncology
• Medical Imaging
• Surgical Oncology

Background:

• Locally advanced rectal cancer (LARC) management often includes neoadjuvant chemoradiotherapy (nCRT) followed by surgery.
• Restaging imaging after nCRT is common practice but its clinical benefit remains unclear.

Purpose of the Study:

• To evaluate the impact of restaging imaging on oncologic outcomes in patients with LARC.
• To determine the cost-effectiveness of restaging imaging in this patient population.

Main Methods:

• Retrospective analysis of 224 patients with stage 2-3 rectal adenocarcinoma treated with nCRT.
• Comparison of outcomes between patients who underwent restaging and those who proceeded directly to surgery.
• Identification of predictors for outcomes and cost-effectiveness analysis of restaging.

Main Results:

• Restaging imaging led to a change in management in only 6 of 146 patients.
• No significant difference in freedom from recurrence or overall survival was observed between restaged and non-restaged groups.
• Higher risk of death was associated with elevated carcinoembryonic antigen, advanced clinical/pathologic T stage, and advanced N stage; adjuvant chemotherapy was associated with decreased risk of death.

Conclusions:

• Restaging imaging after nCRT for LARC infrequently alters treatment plans and does not improve survival outcomes.
• Restaging may offer benefits for a select group of patients with a higher risk of adverse outcomes.
• The cost-effectiveness of routine restaging is questionable, with significant costs per change in management.