Combined application of spiral computed tomography and transrectal ultrasound in the evaluation of neoadjuvant chemoradiotherapy in rectal cancer
DOI:
https://doi.org/10.14739/2310-1210.2019.1.155810Keywords:
rectal cancer, neoadjuvant therapy, spiral computed tomography, transrectal ultrasound diagnosisAbstract
Aim. To study the possibilities of spiral computed tomography and transrectal ultrasound using for the evaluation of neoadjuvant chemoradiotherapy effectiveness in patients with locally advanced rectal cancer in order to expand opportunities for sphincter-preserving surgery.
Materials and methods. 85 patients with locally advanced rectal cancer were examined with the help of computer tomography and transrectal ultrasound before and after neoadjuvant chemoradiotherapy.
Results. The changes received as a result of dynamic examination were studied qualitatively and quantitatively. Almost all examined patients had sufficiently pronounced positive changes (reduction in tumor volume as well as malignant invasion through intestinal wall and perirectal fat with a decrease in its density).
It has been established that spiral computed tomography has advantages of the possibility to diagnose tumors localized in all parts of the rectum, but this method of examination does not allow for visualization of tumor invasion into different layers of the intestinal wall, in particular into the muscular layer that is a determining factor in differential diagnosis of localized and locally advanced rectal cancer. All of this makes it necessary to supplement the method of spiral computer tomography with the transrectal ultrasound to control the treatment effectiveness. Moreover, the additional use of transrectal ultrasound in locally advanced T3 rectal cancer statistically significantly increases diagnostic informativeness by 1.4 times (P = 0.0021). In the time following, all patients were subjected to radical operations.
Conclusions. Thus, the combined application of spiral computed tomography and transrectal ultrasound examination in locally advanced rectal cancer after neoadjuvant chemoradiotherapy makes it possible to objectivize a tumor response to treatment, in particular, chemoradiotherapy, both by size and depth of bowel wall involvement. It allowed to determine the method and volume of surgical interventions at the preoperative stage and contributed to an increase in resectability and percentage of sphincter-preserving surgery by 12.7 %.
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