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SEOM/SERAM consensus statement on radiological diagnosis, response assessment and follow-up in colorectal cancer

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Abstract

Colorectal cancer (CRC) is one of the world’s most common cancers, and has one of the highest mortality rates. The last few decades have seen great progress in preventing, diagnosing and treating this disease, providing undeniable impact on patients’ prognosis and quality of life. At all these stages of CRC management, imaging techniques play an essential role. This article reviews some important issues concerning the use of various radiological techniques in the screening, diagnosis, staging, assessment of treatment response, and follow-up of patients with CRC. It also includes a number of practical recommendations on indications for use, technical requirements, minimum information required in the radiology report, evaluation criteria for the response to various drugs, and the recommended frequency at which different examinations should be performed. This consensus statement is the result of cooperation between the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Radiology (SERAM).

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References

  1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. http://globocan.iarc.fr. Accessed 1 Sept 2015.

  2. Casado-Saenz E, Feliu J, Gomez-Espana MA, Sanchez-Gastaldo A, Garcia-Carbonero R. SEOM clinical guidelines for the treatment of advanced colorectal cancer 2013. Clin Transl Oncol Off Publ Fed Span Oncol Soc Natl Cancer Inst Mexico. 2013;15(12):996–1003. doi:10.1007/s12094-013-1082-5.

    CAS  Google Scholar 

  3. Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, et al. ESMO consensus guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol. 2012;23(10):2479–516. doi:10.1093/annonc/mds236.

    Article  CAS  PubMed  Google Scholar 

  4. Provenzale D, Jasperson K, Ahnen DJ, Aslanian DJ, Bray T, Cannon JA, et al. NCCN Clinical practice guidelines in oncology (NCCN guidelines®). Colorectal cancer screening. Version 1. 2015. http://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf. Accessed June 2015.

  5. Escudier B, Albiges L. Vascular endothelial growth factor-targeted therapy for the treatment of renal cell carcinoma. Drugs. 2011;71(9):1179–91. doi:10.2165/11591410-000000000-00000.

    Article  CAS  PubMed  Google Scholar 

  6. Spada C, Stoker J, Alarcon O, Barbaro F, Bellini D, Bretthauer M, et al. Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline. Eur Radiol. 2015;25(2):331–45. doi:10.1007/s00330-014-3435-z.

    Article  PubMed  Google Scholar 

  7. Bouzas SR. Optical colonoscopy and virtual colonoscopy: the current role of each technique. Radiologia. 2015;57(2):95–100. doi:10.1016/j.rx.2014.04.003.

    Article  Google Scholar 

  8. Neri E, Halligan S, Hellstrom M, Lefere P, Mang T, Regge D, et al. The second ESGAR consensus statement on CT colonography. Eur Radiol. 2013;23(3):720–9. doi:10.1007/s00330-012-2632-x.

    Article  PubMed  Google Scholar 

  9. Lambea J, Hinojo C, Lainez N, Lazaro M, Leon L, Rodriguez A, et al. Quality of life and supportive care for patients with metastatic renal cell carcinoma. Cancer Metastasis Rev. 2012;31(Suppl 1):S33–9. doi:10.1007/s10555-012-9357-9.

    Article  PubMed  Google Scholar 

  10. Tudyka V, Blomqvist L, Beets-Tan RG, Boelens PG, Valentini V, van de Velde CJ, et al. EURECCA consensus conference highlights about colon & rectal cancer multidisciplinary management: the radiology experts review. Eur J Surg Oncol. 2014;40(4):469–75. doi:10.1016/j.ejso.2013.10.029.

    Article  CAS  PubMed  Google Scholar 

  11. Benson AB, Venook AP, Bekaii-Saab T, Chan E, Chen YJ, Cooper HS, et al. NCCN clinical practice guidelines in oncology (NCCN guidelines®). Colon cancer. Version 2. 2015. http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Accessed June 2015.

  12. Tan YN, Li XF, Li JJ, Song YM, Jiang B, Yang J, et al. The accuracy of computed tomography in the pretreatment staging of colorectal cancer. Hepatogastroenterology. 2014;61(133):1207–12.

    Google Scholar 

  13. Rodriguez KL, Bayliss N, Alexander SC, Jeffreys AS, Olsen MK, Pollak KI, et al. How oncologists and their patients with advanced cancer communicate about health-related quality of life. Psychooncology. 2010;19(5):490–9. doi:10.1002/pon.1579.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sibileau E, Ridereau-Zins C, Vanel D, Pavageau AH, Bertrais S, Metivier-Cesbron E, et al. Accuracy of water-enema multidetector computed tomography (WE-MDCT) in colon cancer staging: a prospective study. Abdom Imaging. 2014;39(5):941–8. doi:10.1007/s00261-014-0150-9.

    Article  CAS  PubMed  Google Scholar 

  15. Benson AB, Venook AP, Bekaii-Saab T, Chan E, Chen YJ, Cooper HS, et al. NCCN clinical practice guidelines in oncology (NCCN guidelines®). Rectal cancer. Version 2. 2015. http://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf. Accessed June 2015.

  16. Beets-Tan RG, Lambregts DM, Maas M, Bipat S, Barbaro B, Caseiro-Alves F, et al. Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 2013;23(9):2522–31. doi:10.1007/s00330-013-2864-4.

    Article  PubMed  Google Scholar 

  17. Kim MJ. Transrectal ultrasonography of anorectal diseases: advantages and disadvantages. Ultrasonography. 2015;34(1):19–31. doi:10.14366/usg.14051.

    Article  CAS  PubMed  Google Scholar 

  18. Colella JRA, Llinas MP, Colella CA. Staging rectal cancer. Radiologia. 2010;52(1):18–29. doi:10.1016/j.rx.2009.11.001.

    Article  Google Scholar 

  19. Branagan G, Chave H, Fuller C, McGee S, Finnis D. Can magnetic resonance imaging predict circumferential margins and TNM stage in rectal cancer? Dis Colon Rectum. 2004;47(8):1317–22.

    Article  PubMed  Google Scholar 

  20. Arii K, Takifuji K, Yokoyama S, Matsuda K, Higashiguchi T, Tominaga T, et al. Preoperative evaluation of pelvic lateral lymph node of patients with lower rectal cancer: comparison study of MR imaging and CT in 53 patients. Langenbecks Arch Surg. 2006;391(5):449–54. doi:10.1007/s00423-006-0066-0.

    Article  PubMed  Google Scholar 

  21. Poon FW, McDonald A, Anderson JH, Duthie F, Rodger C, McCurrach G, et al. Accuracy of thin section magnetic resonance using phased-array pelvic coil in predicting the T-staging of rectal cancer. Eur J Radiol. 2005;53(2):256–62. doi:10.1016/j.ejrad.2004.03.011.

    Article  CAS  PubMed  Google Scholar 

  22. Peeters KC, van de Velde CJ, Leer JW, Martijn H, Junggeburt JM, Kranenbarg EK, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J Clin Oncol. 2005;23(25):6199–206. doi:10.1200/JCO.2005.14.779.

    Article  CAS  PubMed  Google Scholar 

  23. Brown G, Richards CJ, Newcombe RG, Dallimore NS, Radcliffe AG, Carey DP, et al. Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology. 1999;211(1):215–22. doi:10.1148/radiology.211.1.r99ap35215.

    Article  CAS  PubMed  Google Scholar 

  24. Taylor FG, Quirke P, Heald RJ, Moran B, Blomqvist L, Swift I, et al. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg. 2011;253(4):711–9. doi:10.1097/SLA.0b013e31820b8d52.

    Article  PubMed  Google Scholar 

  25. Smith NJ, Barbachano Y, Norman AR, Swift RI, Abulafi AM, Brown G. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg. 2008;95(2):229–36. doi:10.1002/bjs.5917.

    Article  CAS  PubMed  Google Scholar 

  26. Smith N, Brown G. Preoperative staging of rectal cancer. Acta Oncol. 2008;47(1):20–31. doi:10.1080/02841860701697720.

    Article  PubMed  Google Scholar 

  27. Al-Sukhni E, Milot L, Fruitman M, Beyene J, Victor JC, Schmocker S, et al. Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2012;19(7):2212–23. doi:10.1245/s10434-011-2210-5.

    Article  PubMed  Google Scholar 

  28. Girela-Baena E, Jimenez-Lopez de Oñate G, Soler-Fernandez R, Méndez-Fernández R, Ayuso-Colella JR, Vargas-Serrano B, et al. Guía para el informe de estadificación del cáncer de recto con RM. Sociedad Española de Diagnóstico por Imagen (SEDIA). http://www.sedia.es/documentos/guia-informe-cancer-recto-con-rm/guia-informe-cancer-recto-con-rm.php. Accessed April 2015.

  29. Kennedy ED, Milot L, Fruitman M, Al-Sukhni E, Heine G, Schmocker S, et al. Development and implementation of a synoptic MRI report for preoperative staging of rectal cancer on a population-based level. Dis Colon Rectum. 2014;57(6):700–8. doi:10.1097/DCR.0000000000000123.

    Article  PubMed  Google Scholar 

  30. Rosen M, Chan L, Beart RW Jr, Vukasin P, Anthone G. Follow-up of colorectal cancer: a meta-analysis. Dis Colon Rectum. 1998;41(9):1116–26.

    Article  CAS  PubMed  Google Scholar 

  31. Hogan J, O’Rourke C, Duff G, Burton M, Kelly N, Burke J, et al. Preoperative staging CT thorax in patients with colorectal cancer: its clinical importance. Dis Colon Rectum. 2014;57(11):1260–6. doi:10.1097/DCR.0000000000000210.

    Article  PubMed  Google Scholar 

  32. Yongue G, Hotouras A, Murphy J, Mukhtar H, Bhan C, Chan CL. The diagnostic yield of preoperative staging computed tomography of the thorax in colorectal cancer patients without hepatic metastases. Eur J Gastroenterol Hepatol. 2015;27(4):467–70. doi:10.1097/MEG.0000000000000315.

    Article  PubMed  Google Scholar 

  33. AJCC Cancer Staging Manual. Springer. 2010. http://www.springer.com/it/book/9780387884400. Accessed April 2015.

  34. Ridereau-Zins C. Imaging in colonic cancer. Diagn Interv Imaging. 2014;95(5):475–83. doi:10.1016/j.diii.2014.03.004.

    Article  CAS  PubMed  Google Scholar 

  35. Kim HJ, Lee SS, Byun JH, Kim JC, Yu CS, Park SH, et al. Incremental value of liver MR imaging in patients with potentially curable colorectal hepatic metastasis detected at CT: a prospective comparison of diffusion-weighted imaging, gadoxetic acid-enhanced MR imaging, and a combination of both MR techniques. Radiology. 2015;274(3):712–22. doi:10.1148/radiol.14140390.

    Article  PubMed  Google Scholar 

  36. Pierredon-Foulongne MA, Nougaret S, Bibeau F, Rouanet P, Delhom E, Lonjon J, et al. Utility of reassessment after neoadjuvant therapy and difficulties in interpretation. Diagn Interv Imaging. 2014;95(5):495–503. doi:10.1016/j.diii.2014.03.010.

    Article  PubMed  Google Scholar 

  37. Beets-Tan RG, Beets GL. MRI for assessing and predicting response to neoadjuvant treatment in rectal cancer. Nat Rev Gastroenterol Hepatol. 2014;11(8):480–8. doi:10.1038/nrgastro.2014.41.

    Article  CAS  PubMed  Google Scholar 

  38. Patel UB, Blomqvist LK, Taylor F, George C, Guthrie A, Bees N, et al. MRI after treatment of locally advanced rectal cancer: how to report tumor response—the MERCURY experience. AJR Am J Roentgenol. 2012;199(4):W486–95. doi:10.2214/AJR.11.8210.

    Article  PubMed  Google Scholar 

  39. Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis. 1997;12(1):19–23.

    Article  CAS  PubMed  Google Scholar 

  40. Moreno CC, Sullivan PS, Kalb BT, Tipton RG, Hanley KZ, Kitajima HD, et al. Magnetic resonance imaging of rectal cancer: staging and restaging evaluation. Abdom Imaging. 2015;. doi:10.1007/s00261-015-0394-z.

    Google Scholar 

  41. van der Paardt MP, Zagers MB, Beets-Tan RG, Stoker J, Bipat S. Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology. 2013;269(1):101–12. doi:10.1148/radiol.13122833.

    Article  PubMed  Google Scholar 

  42. Figueiras RG, Dominguez PC, Dorrego RG, Martin AV, Caamano AG. Prognostic factors and functional imaging in rectal cancer. Radiologia. 2012;54(1):45–58. doi:10.1016/j.rx.2011.05.017.

    Article  Google Scholar 

  43. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47. doi:10.1016/j.ejca.2008.10.026.

    Article  CAS  PubMed  Google Scholar 

  44. Giessen C, Laubender RP, Fischer von Weikersthal L, Schalhorn A, Modest DP, Stintzing S, et al. Early tumor shrinkage in metastatic colorectal cancer: retrospective analysis from an irinotecan-based randomized first-line trial. Cancer Sci. 2013;104(6):718–24. doi:10.1111/cas.12148.

    Article  CAS  PubMed  Google Scholar 

  45. Piessevaux H, Buyse M, Schlichting M, Van Cutsem E, Bokemeyer C, Heeger S, et al. Use of early tumor shrinkage to predict long-term outcome in metastatic colorectal cancer treated with cetuximab. J Clin Oncol. 2013;31(30):3764–75. doi:10.1200/JCO.2012.42.8532.

    Article  CAS  PubMed  Google Scholar 

  46. Douillard JY, Siena S, Peeters M, Koukakis R, Terwey JH, Tabernero J. Impact of early tumour shrinkage and resection on outcomes in patients with wild-type RAS metastatic colorectal cancer. Eur J Cancer. 2015;51(10):1231–42. doi:10.1016/j.ejca.2015.03.026.

    Article  PubMed  Google Scholar 

  47. Cremolini C, Loupakis F, Antoniotti C, Lonardi S, Masi G, Salvatore L, et al. Early tumor shrinkage and depth of response predict long-term outcome in metastatic colorectal cancer patients treated with first-line chemotherapy plus bevacizumab: results from phase III TRIBE trial by the Gruppo Oncologico del Nord Ovest. Ann Oncol. 2015;26(6):1188–94. doi:10.1093/annonc/mdv112.

    Article  CAS  PubMed  Google Scholar 

  48. Petrelli F, Pietrantonio F, Cremolini C, Di Bartolomeo M, Coinu A, Lonati V, et al. Early tumour shrinkage as a prognostic factor and surrogate end-point in colorectal cancer: a systematic review and pooled-analysis. Eur J Cancer. 2015;51(7):800–7. doi:10.1016/j.ejca.2015.02.011.

    Article  PubMed  Google Scholar 

  49. Saltz LB, Clarke S, Diaz-Rubio E, Scheithauer W, Figer A, Wong R, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol. 2008;26(12):2013–9. doi:10.1200/JCO.2007.14.9930.

    Article  CAS  PubMed  Google Scholar 

  50. Grothey A, Hedrick EE, Mass RD, Sarkar S, Suzuki S, Ramanathan RK, et al. Response-independent survival benefit in metastatic colorectal cancer: a comparative analysis of N9741 and AVF2107. J Clin Oncol. 2008;26(2):183–9. doi:10.1200/JCO.2007.13.8099.

    Article  CAS  PubMed  Google Scholar 

  51. Boonsirikamchai P, Asran MA, Maru DM, Vauthey JN, Kaur H, Kopetz S, et al. CT findings of response and recurrence, independent of change in tumor size, in colorectal liver metastasis treated with bevacizumab. AJR Am J Roentgenol. 2011;197(6):W1060–6. doi:10.2214/AJR.11.6459.

    Article  PubMed  Google Scholar 

  52. Chun YS, Vauthey JN, Boonsirikamchai P, Maru DM, Kopetz S, Palavecino M, et al. Association of computed tomography morphologic criteria with pathologic response and survival in patients treated with bevacizumab for colorectal liver metastases. JAMA. 2009;302(21):2338–44. doi:10.1001/jama.2009.1755.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Bruinvels DJ, Stiggelbout AM, Kievit J, van Houwelingen HC, Habbema JD, van de Velde CJ. Follow-up of patients with colorectal cancer. A meta-analysis. Ann Surg. 1994;219(2):174–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Ohlsson B, Palsson B. Follow-up after colorectal cancer surgery. Acta Oncol. 2003;42(8):816–26.

    Article  PubMed  Google Scholar 

  55. Renehan AG, Egger M, Saunders MP, O’Dwyer ST. Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. BMJ. 2002;324(7341):813.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Tjandra JJ, Chan MK. Follow-up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum. 2007;50(11):1783–99. doi:10.1007/s10350-007-9030-5.

    Article  PubMed  Google Scholar 

  57. Labianca R, Nordlinger B, Beretta GD, Mosconi S, Mandala M, Cervantes A, et al. Early colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi64–72. doi:10.1093/annonc/mdt354.

    Article  PubMed  Google Scholar 

  58. Meyerhardt JA, Mangu PB, Flynn PJ, Korde L, Loprinzi CL, Minsky BD, et al. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2013;31(35):4465–70. doi:10.1200/JCO.2013.50.7442.

    Article  PubMed  Google Scholar 

  59. Jeffery M, Hickey BE, Hider PN. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2007;1:CD002200. doi:10.1002/14651858.CD002200.pub2.

    Google Scholar 

  60. Pietra N, Sarli L, Costi R, Ouchemi C, Grattarola M, Peracchia A. Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study. Dis Colon Rectum. 1998;41(9):1127–33.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors are grateful for the editorial assistance of Fernando Sánchez-Barbero of HealthCo (Madrid, Spain) in the production of this manuscript.

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Authors and Affiliations

  1. Medical Oncology Department, 12 de Octubre University Hospital, Avenida de Córdoba, s/n, 28041, Madrid, Spain

    R. García-Carbonero

  2. Medical Oncology Department, Navarra Hospital Complex, Pamplona, Spain

    R. Vera

  3. Medical Oncology Department, Marqués de Valdecilla University Hospital, Santander, Spain

    F. Rivera

  4. Radiology Department, Morales Meseguer University Hospital, Murcia, Spain

    E. Parlorio

  5. Radiology Department, Clinic University Hospital, Barcelona, Spain

    M. Pagés

  6. Medical Oncology Department, Virgen de las Nieves University Hospital, Granada, Spain

    E. González-Flores

  7. Medical Oncology Department, Instituto Valenciano de Oncología, Valencia, Spain

    C. Fernández-Martos

  8. Radiology Department, Avila Hospital Complex, Ávila, Spain

    M. Á. Corral

  9. Radiology Department, Vigo Hospital Complex, Vigo, Spain

    R. Bouzas

  10. Radiology Department, San Carlos Clinic University Hospital, Madrid, Spain

    F. Matute

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  1. R. García-Carbonero
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Correspondence to R. García-Carbonero.

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SEOM and SERAM wish to thank to Bayer and Sanofi for the financial support of this project through no restriction grants.

The authors declare that, when writing and revising the text, they did not know the names of the pharmaceutical companies that provided financial support for this project, so this support has not influenced the content of this article.

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The study has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments. This article does not contain any studies with human participants or animals performed by any of the authors.

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Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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García-Carbonero, R., Vera, R., Rivera, F. et al. SEOM/SERAM consensus statement on radiological diagnosis, response assessment and follow-up in colorectal cancer. Clin Transl Oncol 19, 135–148 (2017). https://doi.org/10.1007/s12094-016-1518-9

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