Updated S3 Guidelines – Diagnosis and Treatment of Colorectal Carcinoma: Relevance for Radiological Diagnosis and Intervention

Abstract

The updated German S3 guidelines “Colorectal Carcinoma“ were created as part of the oncology program of the Association of the Scientific Medical Societies (AWMF), German Cancer Society and the German Cancer Aid under the auspices of the German Society for Digestive and Metabolic Disorders (DGVS) and they replace the previous guidelines from 2013. The main changes in the updated guidelines include the latest recommendations regarding endoscopy and adjuvant/neoadjuvant therapies as well as a complete restructuring of the section regarding therapeutic approach in metastases and in the palliative situation. The present manuscript discusses the importance of the current recommendations for radiological diagnosis and treatment and is intended to enhance the quality of patient information and patient care by widespread distribution.

Key Points: 

• Radiological recommendations for treating patients with colorectal carcinoma are presented.

• The different possibilities of radiological imaging for diagnosis are documented in detail.

• Radiologists should be acquainted with the different possibilities of oncological intervention in patients with colorectal carcinoma.

Citation Format

• Vogl TJ, Pereira PL, Schreyer AG et al. Updated S3 Guidelines – Diagnosis and Treatment of Colorectal Carcinoma: Relevance for Radiological Diagnosis and Intervention. Fortschr Röntgenstr 2019; 191: 298 – 310

Key words

colorectal cancer - ablation procedures - staging - S3 guidelines - follow-up

• References

• 1 Zauber AG, Winawer SJ, O’Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
• 2 Faivre J. Endoscopic monitoring after excision of colorectal cancer. J Chir (Paris) 1997; 134: 283-285
• 3 Chen CC, Yang SH, Lin JK. et al. Is it reasonable to add preoperative serum level of CEA and CA19-9 to staging for colorectal cancer. J Surg Res 2005; 124: 169-174
• 4 Barillari P, Ramacciato G, De Angelis R. et al. Effect of preoperative colonoscopy on the incidence of synchronous and metachronous neoplasms. Acta Chir Scand 1990; 156: 163-166
• 5 Rogalla P, Janka R, Baum U. et al. CT colography: guideline of the Gastrointestinal Diagnostics Team of the German Radiological Society regarding the indication and technical implementation of endoluminal colon diagnostics using computed tomography (known as virtual colonoscopy). Rofo 2008; 180: 466-469
• 6 Purkayastha S, Tekkis PP, Athanasiou T. et al. Magnetic resonance colonography versus colonoscopy as a diagnostic investigation for colorectal cancer: a meta-analysis. Clin Radiol 2005; 60: 980-989
• 7 Hartmann D, Bassler B, Schilling D. et al. Colorectal polyps: detection with dark-lumen MR colonography versus conventional colonoscopy. Radiology 2006; 238: 143-149
• 8 Neri E, Giusti P, Battolla L. et al. Colorectal cancer: role of CT colonography in preoperative evaluation after incomplete colonoscopy. Radiology 2002; 223: 615-619
• 9 Javeri K, Williams TR, Bonnett JW. An overview of the method, application, and various findings of computed tomographic colonography in patients after incomplete colonoscopy. Curr Probl Diagn Radiol 2010; 39: 262-274
• 10 Hartmann D, Bassler B, Schilling D. et al. Incomplete conventional colonoscopy: magnetic resonance colonography in the evaluation of the proximal colon. Endoscopy 2005; 37: 816-820
• 11 Spada C, Stoker J, Alarcon O. et al. Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline. Endoscopy 2014; 46: 897-915
• 12 de Haan MC, van Gelder RE, Graser A. et al. Diagnostic value of CT-colonography as compared to colonoscopy in an asymptomatic screening population: a meta-analysis. Eur Radiol 2011; 21: 1747-1763
• 13 El-Maraghi RH, Kielar AZ. CT colonography versus optical colonoscopy for screening asymptomatic patients for colorectal cancer a patient, intervention, comparison, outcome (PICO) analysis. Acad Radiol 2009; 16: 564-571
• 14 Halligan S, Altman DG, Taylor SA. et al. CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis, and proposed minimum data set for study level reporting. Radiology 2005; 237: 893-904
• 15 Pickhardt PJ, Choi JR, Hwang I. et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 2003; 349: 2191-2200
• 16 Mitry E, Guiu B, Cosconea S. et al. Epidemiology, management and prognosis of colorectal cancer with lung metastases: a 30-year population-based study. Gut 2010; 59: 1383-1388
• 17 Parnaby CN, Bailey W, Balasingam A. et al. Pulmonary staging in colorectal cancer: a review. Colorectal Dis 2012; 14: 660-670
• 18 Floriani I, Torri V, Rulli E. et al. Performance of imaging modalities in diagnosis of liver metastases from colorectal cancer: a systematic review and meta-analysis. J Magn Reson Imaging 2010; 31: 19-31
• 19 Quaia E, D’Onofrio M, Palumbo A. et al. Comparison of contrast-enhanced ultrasonography versus baseline ultrasound and contrast-enhanced computed tomography in metastatic disease of the liver: diagnostic performance and confidence. Eur Radiol 2006; 16: 1599-1609
• 20 Rafaelsen SR, Jakobsen A. Contrast-enhanced ultrasound vs multidetector-computed tomography for detecting liver metastases in colorectal cancer: a prospective, blinded, patient-by-patient analysis. Colorectal Dis 2011; 13: 420-425
• 21 Niekel MC, Bipat S, Stoker J. Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology 2010; 257: 674-684
• 22 Barton JB, Langdale LA, Cummins JS. et al. The utility of routine preoperative computed tomography scanning in the management of veterans with colon cancer. Am J Surg 2002; 183: 499-503
• 23 McAndrew MR, Saba AK. Efficacy of routine preoperative computed tomography scans in colon cancer. Am Surg 1999; 65: 205-208
• 24 Dighe S, Purkayastha S, Swift I. et al. Diagnostic precision of CT in local staging of colon cancers: a meta-analysis. Clin Radiol 2010; 65: 708-719
• 25 Abdel-Nabi H, Doerr RJ, Lamonica DM. et al. Staging of primary colorectal carcinomas with fluorine-18 fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings. Radiology 1998; 206: 755-760
• 26 Akiyoshi T, Oya M, Fujimoto Y. et al. Comparison of preoperative whole-body positron emission tomography with MDCT in patients with primary colorectal cancer. Colorectal Dis 2009; 11: 464-469
• 27 Furukawa H, Ikuma H, Seki A. et al. Positron emission tomography scanning is not superior to whole body multidetector helical computed tomography in the preoperative staging of colorectal cancer. Gut 2006; 55: 1007-1011
• 28 Kantorová I, Lipská L, Bêlohlávek O. et al. Routine (18)F-FDG PET preoperative staging of colorectal cancer: comparison with conventional staging and its impact on treatment decision making. J Nucl Med 2003; 44: 1784-1788
• 29 Paskeviciute B, Bölling T, Brinkmann M. et al. Impact of (18)F-FDG-PET/CT on staging and irradiation of patients with locally advanced rectal cancer. Strahlenther Onkol 2009; 185: 260-265
• 30 Positronenemissionstomografie (PET und PET/CT) bei rezidivierendem kolorektalem Karzinom – Vorbericht (vorläufige Nutzerbewertung). 2011
• 31 Taylor FG, Quirke P, Heald RJ. et al. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. J Clin Oncol 2014; 32: 34-43
• 32 Ruers TJ, Wiering B, van der Sijp JR. et al. Improved selection of patients for hepatic surgery of colorectal liver metastases with (18)F-FDG PET: a randomized study. J Nucl Med 2009; 50: 1036-1041
• 33 Moulton CA. An Ontario Clinical Oncology Group (OCOG) randomized controlled trial (RCT) assessing FDG PET/CT in resectable liver colorectal adenocarcinoma metastases (CAM). Clin Oncol 2011 abstr 3520
• 34 Adie S, Yip C, Chu F. et al. Resection of liver metastases from colorectal cancer: does preoperative chemotherapy affect the accuracy of PET in preoperative planning. ANZ J Surg 2009; 79: 358-361
• 35 Lubezky N, Metser U, Geva R. et al. The role and limitations of 18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan and computerized tomography (CT) in restaging patients with hepatic colorectal metastases following neoadjuvant chemotherapy: comparison with operative and pathological findings. J Gastrointest Surg 2007; 11: 472-478
• 36 Bipat S, Glas AS, Slors FJ. et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging--a meta-analysis. Radiology 2004; 232: 773-783
• 37 Puli SR, Reddy JB, Bechtold ML. et al. Accuracy of endoscopic ultrasound to diagnose nodal invasion by rectal cancers: a meta-analysis and systematic review. Ann Surg Oncol 2009; 16: 1255-1265
• 38 Merkel S, Meyer T, Göhl J. et al. Late locoregional recurrence in rectal carcinoma. Eur J Surg Oncol 2002; 28: 716-722
• 39 Ahmetoğlu A, Cansu A, Baki D. et al. MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor. Abdom Imaging 2011; 36: 31-37
• 40 van Gijn W, Marijnen CA, Nagtegaal ID. et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 2011; 12: 575-582
• 41 Agcaoglu O, Aliyev S, Karabulut K. et al. Complementary use of resection and radiofrequency ablation for the treatment of colorectal liver metastases: an analysis of 395 patients. World J Surg 2013; 37: 1333-1339
• 42 Sasaki K, Margonis GA, Andreatos N. et al. Combined resection and RFA in colorectal liver metastases: stratification of long-term outcomes. J Surg Res 2016; 206: 182-189
• 43 van Amerongen MJ, van der Stok EP, Fütterer JJ. et al. Short term and long term results of patients with colorectal liver metastases undergoing surgery with or without radiofrequency ablation. Eur J Surg Oncol 2016; 42: 523-530
• 44 NICE NI. Radiofrequency ablation for the treatment of colorectal metastases in the liver. 2011
• 45 Correa-Gallego C, Fong Y, Gonen M. et al. A retrospective comparison of microwave ablation vs. radiofrequency ablation for colorectal cancer hepatic metastases. Ann Surg Oncol 2014; 21: 4278-4283
• 46 Van Tilborg AA, Meijerink MR, Sietses C. et al. Long-term results of radiofrequency ablation for unresectable colorectal liver metastases: a potentially curative intervention. Br J Radiol 2011; 84: 556-565
• 47 Gillams A, Goldberg N, Ahmed M. et al. Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, The Interventional Oncology Sans Frontières meeting 2013. Eur Radiol 2015; 25: 3438-3454
• 48 Otto G, Düber C, Hoppe-Lotichius M. et al. Radiofrequency ablation as first-line treatment in patients with early colorectal liver metastases amenable to surgery. Ann Surg 2010; 251: 796-803
• 49 Saxena A, Chua TC, Chu FC. et al. Impact of treatment modality and number of lesions on recurrence and survival outcomes after treatment of colorectal cancer liver metastases. J Gastrointest Oncol 2014; 5: 46-56
• 50 Wang DS, Davalos EA. et al. Superselective transhepatic arterial chemoembolization for hepatucellular carcinoma in high risk patients as a bridge towards liver transplantation – Abstract No. 30. Journal of Vascular and Interventional Radiology 2012; 23: S16
• 51 Christophi C, Nikfarjam M, Malcontenti-Wilson C. et al. Long-term survival of patients with unresectable colorectal liver metastases treated by percutaneous interstitial laser thermotherapy. World J Surg 2004; 28: 987-994
• 52 Wietzke-Braun P, Schindler C, Raddatz D. et al. Quality of life and outcome of ultrasound-guided laser interstitial thermo-therapy for non-resectable liver metastases of colorectal cancer. Eur J Gastroenterol Hepatol 2004; 16: 389-395
• 53 Solbiati L, Livraghi T, Goldberg SN. et al. Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology 2001; 221: 159-166
• 54 Vogl TJ, Straub R, Eichler K. et al. Malignant liver tumors treated with MR imaging-guided laser-induced thermotherapy: experience with complications in 899 patients (2520 lesions). Radiology 2002; 225: 367-377
• 55 Herfarth KK, Debus J, Wannenmacher M. Stereotactic radiation therapy of liver metastases: update of the initial phase-I/II trial. Front Radiat Ther Oncol 2004; 38: 100-105
• 56 van der Pool AE, Méndez Romero A, Wunderink W. et al. Stereotactic body radiation therapy for colorectal liver metastases. Br J Surg 2010; 97: 377-382
• 57 Ricke J, Mohnike K, Pech M. et al. Local response and impact on survival after local ablation of liver metastases from colorectal carcinoma by computed tomography-guided high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 2010; 78: 479-485
• 58 de Baère T, Aupérin A, Deschamps F. et al. Radiofrequency ablation is a valid treatment option for lung metastases: experience in 566 patients with 1037 metastases. Ann Oncol 2015; 26: 987-991
• 59 Vogl TJ, Eckert R, Naguib NN. et al. Thermal Ablation of Colorectal Lung Metastases: Retrospective Comparison Among Laser-Induced Thermotherapy, Radiofrequency Ablation, and Microwave Ablation. Am J Roentgenol 2016; 207: 1340-1349
• 60 Hendlisz A, Van den Eynde M, Peeters M. et al. Phase III trial comparing protracted intravenous fluorouracil infusion alone or with yttrium-90 resin microspheres radioembolization for liver-limited metastatic colorectal cancer refractory to standard chemotherapy. J Clin Oncol 2010; 28: 3687-3694
• 61 Van Hazel G, Blackwell A, Anderson J. et al. Randomised phase 2 trial of SIR-Spheres plus fluorouracil/leucovorin chemotherapy versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer. J Surg Oncol 2004; 88: 78-85
• 62 BGP G, GA VH. REsect: Blinded assessment of amenability to potentially curative treatment of previously unresectable colorectal cancer liver metastases (CRC LM) after chemotherapy ± RadioEmbolization (SIRT) in the randomized SIRFLOX trial. J Clin Oncol vol. 35: Abstract 3532
• 63 Fiorentini G, Del Conte A, De Simone M. et al. Complete response of colorectal liver metastases after intra-arterial chemotherapy. Tumori 2008; 94: 489-492
• 64 Martin RC, Scoggins CR, Schreeder M. et al. Randomized controlled trial of irinotecan drug-eluting beads with simultaneous FOLFOX and bevacizumab for patients with unresectable colorectal liver-limited metastasis. Cancer 2015; 121: 3649-3658
• 65 Hermanek P, Wiebelt H, Riedl S. et al. Long-term results of surgical therapy of colon cancer. Results of the Colorectal Cancer Study Group. Chirurg 1994; 65: 287-297
• 66 Körner H, Söreide K, Stokkeland PJ. et al. Systematic follow-up after curative surgery for colorectal cancer in Norway: a population-based audit of effectiveness, costs, and compliance. J Gastrointest Surg 2005; 9: 320-328
• 67 Wichmann MW, Müller C, Hornung HM. et al. Results of long-term follow-up after curative resection of Dukes A colorectal cancer. World J Surg 2002; 26: 732-736
• 68 Kievit J. Colorectal cancer follow-up: a reassessment of empirical evidence on effectiveness. Eur J Surg Oncol 2000; 26: 322-328
• 69 Bülow S, Christensen IJ, Harling H. et al. Recurrence and survival after mesorectal excision for rectal cancer. Br J Surg 2003; 90: 974-980
• 70 Berman JM, Cheung RJ, Weinberg DS. Surveillance after colorectal cancer resection. Lancet 2000; 355: 395-399
• 71 Kjeldsen BJ, Kronborg O, Fenger C. et al. A prospective randomized study of follow-up after radical surgery for colorectal cancer. British Journal of Surgery 1997; 84: 666-669
• 72 Schoemaker D, Black R, Giles L. et al. Yearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients. Gastroenterology 1998; 114: 7-14
• 73 Mäkelä JT, Laitinen SO, Kairaluoma MI. Five-year follow-up after radical surgery for colorectal cancer. Results of a prospective randomized trial. Arch Surg 1995; 130: 1062-1067
• 74 Jeffery GM, Hickey BE, Hider P. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev 2002; 1: CD002200
• 75 Hünerbein M, Totkas S, Moesta KT. et al. The role of transrectal ultrasound-guided biopsy in the postoperative follow-up of patients with rectal cancer. Surgery 2001; 129: 164-169
• 76 Pietra N, Sarli L, Costi R. et al. Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study. Dis Colon Rectum 1998; 41: 1127-1133
• 77 Winawer S, Fletcher R, Rex D. et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology 2003; 124: 544-560
• 78 Sobhani I, Tiret E, Lebtahi R. et al. Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer. Br J Cancer 2008; 98: 875-880
• 79 Selvaggi F, Cuocolo A, Sciaudone G. et al. FGD-PET in the follow-up of recurrent colorectal cancer. Colorectal Dis 2003; 5: 496-500