Cancer Screening In High-Risk Individuals Research Articles

Pancreatic cancer screening in high-risk individuals: look, but maybe not that hard

Pancreatic cancer screening in high-risk individuals: look, but maybe not that hard

Co-designing a recruitment strategy for lung cancer screening in high-risk individuals: protocol for a mixed-methods study.

Lung cancer is a significant cause of cancer-related mortality globally, with early detection through screening critical to improving patient outcomes. However, recruiting high-risk individuals, particularly in deprived populations, for screening remains a considerable challenge. This study aims to co-design a targeted recruitment strategy for lung cancer screening, tailored to the specific needs and experiences of high-risk individuals, in collaboration with a Patient and Public Involvement (PPI) panel and expert stakeholders in Ireland. We will employ a mixed-methods design guided by the Medical Research Council (MRC) framework for developing complex interventions. Our approach will integrate systematic review findings on screening participation interventions, evaluation of the recruitment strategy's feasibility in an Irish context, and the application of behavioural science frameworks. The target population includes individuals over 55 years, either current smokers or those who quit within the last year, who reside in highly deprived areas. This co-designed recruitment strategy will combine evidence-based research, local context understanding, and stakeholder input to develop a solution that is both scientifically robust and tailored to the target population's needs. This patient-centred approach aims to increase the potential for successful implementation of lung cancer screening programs, thereby improving early detection and patient outcomes.

Editorial Comment: Improving Pancreatic Cancer Screening in High-Risk Individuals Through Standardized MRI Screening and Reporting.

Editorial Comment: Improving Pancreatic Cancer Screening in High-Risk Individuals Through Standardized MRI Screening and Reporting.

Abstract 6202: Plasma cell-free DNA fragmentation patterns combined with tumor mutation detection in diagnosis of lung cancer

Abstract Background: Lung cancer is one of the deadliest types of cancer in China. Its 5-year survival rates at early stages are significantly higher than advanced stages. LDCT has been adopted for lung cancer screening in high-risk individuals; however, debate regarding its accuracy is still ongoing. Mutation detection on cell free DNA (cfDNA) has traditionally been used to monitor DNA molecular changes derived from lung cancer cells in blood, while recently fragmentation pattern profiling of cfDNA has been shown as a promising alternative for early cancer detection. We aimed to combine mutation detection and fragmentation pattern analysis on cfDNA to develop a non-invasive assay to screen early lung cancer. Methods: Candidate DNA mutations were curated from literature and public databases, including COSMIC and TCGA. DNA fragmentation markers were collected from literature and whole genome sequencing (WGS) datasets. A panel of 407 primers covering selected mutation and fragmentation markers was developed to distinguish lung adenocarcinoma (ADC) plasma and normal plasma. We enrolled a total of 122 plasma samples (64 normal, 58 ADC) for this study. 49 normal samples and 44 ADC samples were used to construct a mutation-based classification model and a fragmentation-based classification model separately. The tuning parameters and features were determined by inner 4-fold cross validation. For the mutation-based model, baseline was set using normal samples in training set. Maximum allele frequency was calculated for each sample in test data (15 normal, 14 ADC), which was filtered by the background baseline. For the fragmentation-based model, we used the DELFI fragment score to construct fragmentation profiles, which was the ratio between short fragments (100-150bp) and long fragments (151-220bp). After optimization, the two models were integrated by Logistic Regression to create a combined model, which was validated by 4-fold nested cross validation. Results: ADC and normal plasma were sequenced by the aforementioned panel at an average depth of 2,000X to ensure the reliability of model construction and classification results. In classifying normal and ADC plasma, the mutation model alone is only modestly accurate as it produced an AUC of 0.69. But the fragmentation model demonstrated significantly higher accuracy, achieving AUC of 0.85. Furthermore, the combined model performed better than either model along, achieving an elevated AUC of 0.87. Conclusions: We demonstrate that DNA mutation and fragmentation pattern of cfDNA can classify lung cancer and normal plasmas separately, but fragmentation pattern are more accurate than mutation in this task. Combining the two models further improved prediction accuracy, suggesting they complement each other. Although this is a pilot study of limited cases, it demonstrated the potential of combining markers for accurate lung ADC detection in plasma. Citation Format: Zhoufeng Wang, Minjie Xu, Hua Chen, Kehui Xie, Minyang Su, Qiye He, Zhixi Su, Rui Liu, Weimin Li. Plasma cell-free DNA fragmentation patterns combined with tumor mutation detection in diagnosis of lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6202.

Outcomes of upper gastrointestinal cancer screening in high-risk individuals: a population-based prospective study in Northeast China

ObjectivesThe strategy for upper gastrointestinal cancer (UGC) screening has not yet been determined, especially in northeast China.DesignThe sample was from an ongoing prospective population-based cohort for cancer screening.ParticipantsThis study belonged...

Understanding factors associated with uptake of lung cancer screening among individuals at higher risk.

10559 Background: Lung cancer is the leading cause of cancer death in the U.S, accounting for about 25% of all cancer mortality. The U.S Preventive Services Task Force has recommended annual screening for lung cancer using low-dose computed tomography (LDCT) scanning for individuals at higher risk (aged 55-80 years with a >30 pack-year smoking history). Early detection using LDCT scanning reduces lung cancer specific mortality by 20%. Despite its efficacy, the uptake of annual lung cancer screening among high-risk individuals remains low ( < 18%). The purpose of this study was to identify factors associated with the uptake of lung cancer screening in high-risk individuals in the U.S population. Methods: Data for this study were obtained from the 2017-2019 Behavioral Risk Factor Surveillance System (BRFSS), a population-based survey conducted annually by the Centers for Disease Control and Prevention (CDC) in collaboration with health departments in all 50 states, Washington, DC, and the U.S territories. We restricted our sample to high-risk individuals aged 55-80 years with a >30 pack-year smoking history. Only subjects with complete data on all predictor variables (age, gender, race/ethnicity, marital status, education, income, insurance, COPD, current smoking status, primary care provider) and the outcome variable (uptake of lung cancer screening) (n = 11, 714) were included in the final analysis. Chi-square tests were used to compare the uptake of lung cancer screening by demographic and socioeconomic factors. Multivariable logistic regression models were used to model the association between the predictors and the outcome variable. Results: Individuals with no health insurance (OR: 0.64; 95%CI: 0.46-0.90), no primary healthcare provider (OR: 0.40; 95%CI: 0.31-0.52), no chronic obstructive pulmonary disease (COPD) (OR: 0.35; 95%CI: 0.31-0.0.40) and who were females (OR: 0.86; 95%CI: 0.76-0.96) were less likely to participate in annual lung cancer screening. Individuals aged 65–69 years (OR: 1.65; 95%CI: 1.38-1.97), 70–74 years (OR: 1.77; 95%CI: 1.46-2.14) or 75–80 years (OR: 1.42; 95%CI: 1.16-1.76) were more likely to receive annual lung cancer screening compared with those aged 55-59 years. Race/ethnicity, level of education, level of income, marital status, and current smoking status had no significant association with the uptake of annual lung cancer screening. Conclusions: Our study identifies factors associated with lower uptake of annual lung cancer screening (no health insurance coverage, no primary healthcare provider, no COPD, and female gender). The findings from this study have important implications for the design of more effective interventions to target specific subgroups for the uptake of annual lung cancer screening.

AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review

The purpose of this American Gastroenterological Association Institute Clinical Practice Update is to describe the indications for screening for pancreas cancer in high-risk individuals. The evidence reviewed in this work is based on reports of pancreas cancer screening studies in high-risk individuals and expert opinion. BEST PRACTICE ADVICE 1: Pancreas cancer screening should be considered in patients determined to be at high risk, including first-degree relatives of patients with pancreas cancer with at least 2 affected genetically related relatives. BEST PRACTICE ADVICE 2: Pancreas cancer screening should be considered in patients with genetic syndromes associated with an increased risk of pancreas cancer, including all patients with Peutz-Jeghers syndrome, hereditary pancreatitis, patients with CDKN2A gene mutation, and patients with 1 or more first-degree relatives with pancreas cancer with Lynch syndrome, and mutations in BRCA1, BRCA2, PALB2, and ATM genes. BEST PRACTICE ADVICE 3: Genetic testing and counseling should be considered for familial pancreas cancer relatives who are eligible for surveillance. A positive germline mutation is associated with an increased risk of neoplastic progression and may also lead to screening for other relevant associated cancers. BEST PRACTICE ADVICE 4: Participation in a registry or referral to a pancreas Center of Excellence should be pursued when possible for high-risk patients undergoing pancreas cancer screening. BEST PRACTICE ADVICE 5: Clinicians should not screen average-risk individuals for pancreas cancer. BEST PRACTICE ADVICE 6: Pancreas cancer screening in high-risk individuals should begin at age 50 years, or 10 years younger than the initial age of familial onset. Screening should be initiated at age 40 years in CKDN2A and PRSS1 mutation carriers with hereditary pancreatitis and at age 35 years in the setting of Peutz-Jeghers syndrome. BEST PRACTICE ADVICE 7: Magnetic resonance imaging and endoscopic ultrasonography (EUS) should be used in combination as the preferred screening modalities in individuals undergoing pancreas cancer screening. BEST PRACTICE ADVICE 8: The target detectable pancreatic neoplasms are resectable stage I pancreatic ductal adenocarcinoma and high-risk precursor neoplasms, such as intraductal papillary mucinous neoplasms with high-grade dysplasia and some enlarged pancreatic intraepithelial neoplasias. BEST PRACTICE ADVICE 9: Screening intervals of 12 months should be considered when there are no concerning pancreas lesions, with shortened intervals and/or the performance of EUS in 6-12 months directed towards lesions determined to be low risk (by a multidisciplinary team). EUS evaluation should be performed within 3-6 months for indeterminate lesions and within 3 months for high-risk lesions, if surgical resection is not planned. New-onset diabetes in a high-risk individual should lead to additional diagnostic studies or change in surveillance interval. BEST PRACTICE ADVICE 10: Decisions regarding therapy directed towards abnormal findings detected during screening should be made by a dedicated multidisciplinary team together with the high-risk individual and their family. BEST PRACTICE ADVICE 11: Surgical resection should be performed at high-volume centers. BEST PRACTICE ADVICE 12: Clinicians should consider discontinuing pancreas cancer screening in high-risk individuals when they are more likely to die of non-pancreas cancer-related causes due to comorbidity and/or are not candidates for pancreas resection. BEST PRACTICE ADVICE 13: The limitations and potential risks of pancreas cancer screening should be discussed with patients before initiating a screening program.

Su1007 - Cost-Effectiveness of Pancreatic Cancer Screening in High-risk Individuals: An Economic Analysis

Su1007 - Cost-Effectiveness of Pancreatic Cancer Screening in High-risk Individuals: An Economic Analysis

Tu1348 - Diagnostic Yield of Pancreatic Cancer Screening in High-Risk Individuals: A Systematic Review and Meta-Analysis

Tu1348 - Diagnostic Yield of Pancreatic Cancer Screening in High-Risk Individuals: A Systematic Review and Meta-Analysis

Pancreatic cancer screening in high-risk individuals with germline genetic mutations

Pancreatic cancer (PC) is a deadly disease that is most commonly diagnosed at an incurable stage. Different high-risk genetic variants and cancer syndromes increase the lifetime risk of developing PC. This study aims to assess the yield of initial PC screening in patients with high-risk germline mutations. Asymptomatic adults underwent PC screening by EUS, magnetic resonance imaging, or CT during a 10-year period and were retrospectively identified. High-risk individuals were defined as carrying germline mutations in BRCA1, BRCA2, p53 (Li-Fraumeni), STK11 (Peutz-Jeghers), MSH2 (Lynch), ATM (ataxia-telangiectasia), or APC (familial adenomatous polyposis). Patients without germline mutations were excluded. In total, 86 patients met the study criteria. The median age was 48.5 years (interquartile range, 40-58), 79.1% (68) were women, and 43.0% (37) had a family history of PC. The genetic mutations were BRCA2 (50,58.1%), BRCA1 (14, 16.3%), p53 (12, 14.0%), STK11 (5, 5.8%), MSH2 (3, 3.5%), ATM (1, 1.2%), and APC (1,1.2%). Screening detected a pancreatic abnormality (PA) in 26.7% (23/86), including cysts (11, 47.8%), hyperechoic strands and foci (10, 43.5%), and mild pancreatic duct dilation (2, 8.7%). Patients older than 60 years were more likely to have a PA detected (P= .043). EUS detected more PAs than magnetic resonance imaging or CT. Nocases of PC were diagnosed by screening or during follow-up (median, 29.8 months; interquartile range, 21.7-43.5). Unless indicated otherwise by family or personal history, PC screening under the age of 50 is low yield. Linear EUS may be the preferred modality for initial PC screening.

Determination of the optimal screen interval in low-dose CT lung cancer screening: are we there yet?

In view of the prospective results of the largest randomized controlled lung cancer screening trial worldwide, the National Lung Screening Trial (NLST), and baseline results of other trials, interest in low-dose chest CT for lung cancer screening in high-risk individuals is increasing. In 2011, the U.S. NLST demonstrated that screening using annual low-dose chest CT reduces lung cancer mortality by 15–20% compared to screening by chest radiography (1). This result was translated by several U.S. medical associations, including the U.S. Preventive Services Task Force, into a recommendation to screen subjects at high-risk for developing lung cancer by annual low-dose chest CT (2-5). According to the recommendation of the U.S. Preventive Services Task Force, all individuals between 55 and 80 years old who smoked at least 30 pack-years and quit not longer than 15 years ago are eligible for lung cancer screening. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery (5).

Primary Care Provider and Patient Perspectives on Lung Cancer Screening. A Qualitative Study.

The U.S. Preventive Services Task Force recommends annual low-dose computed tomography (LDCT) for lung cancer screening in high-risk individuals. Preventive healthcare is provided predominantly by primary care providers (PCPs). Successful implementation of a screening program requires acceptance and participation by both providers and patients, with available collaboration with pulmonologists. To identify perceptions of and perspectives on lung cancer screening and implementation among PCPs and eligible veteran patients at high risk for lung cancer. We conducted a qualitative study using grounded theory in which 28 veterans and 13 PCPs completed a questionnaire and participated in focus groups. Sessions were recorded, transcribed verbatim, and analyzed with NVivo 10 software. Counts and percentages were used to report questionnaire results. While 58% percent of providers were aware of lung cancer screening guidelines, many could not recall the exact patient eligibility criteria. Most patients were willing to undergo LDCT screening and identified smoking as a risk factor for lung cancer, but they did not recall their PCP explaining the reason for the testing. All providers assessed smoking behavior, but only 23% referred active smokers for formal cessation services. Patients volunteered information regarding their hurdles with smoking cessation while discussing risk factors for cancer. PCPs cited time constraints as a reason for lack of appropriate counseling and shared decision making. Both parties were willing to explore modalities and decision aid tools to improve shared decision making; however, while patients were interested in individual risk prediction, few PCPs believed statistical approaches to counseling would confuse patients. While patients and providers are receptive to LDCT screening, efforts are needed to improve guideline knowledge and adherence among providers. System-level interventions are necessary to facilitate time and resources for shared decision making and smoking cessation counseling and treatment. Further research is needed to identify optimal strategies for effective lung cancer screening in the community.

Oral Cancer Screening in High-Risk Individuals: The Need for Awareness by the Primary Care Physician

Oral Cancer Screening in High-Risk Individuals: The Need for Awareness by the Primary Care Physician

Integration of lung cancer screening into practice is lacking.

Integration of lung cancer screening into practice is lacking.

MiR-Test: a blood test for lung cancer early detection.

Lung cancer is the leading cause of cancer death worldwide. Low-dose computed tomography screening (LDCT) was recently shown to anticipate the time of diagnosis, thus reducing lung cancer mortality. However, concerns persist about the feasibility and costs of large-scale LDCT programs. Such concerns may be addressed by clearly defining the target "high-risk" population that needs to be screened by LDCT. We recently identified a serum microRNA signature (the miR-Test) that could identify the optimal target population. Here, we performed a large-scale validation study of the miR-Test in high-risk individuals (n = 1115) enrolled in the Continuous Observation of Smoking Subjects (COSMOS) lung cancer screening program. The overall accuracy, sensitivity, and specificity of the miR-Test are 74.9% (95% confidence interval [CI] = 72.2% to 77.6%), 77.8% (95% CI = 64.2% to 91.4%), and 74.8% (95% CI = 72.1% to 77.5%), respectively; the area under the curve is 0.85 (95% CI = 0.78 to 0.92). These results argue that the miR-Test might represent a useful tool for lung cancer screening in high-risk individuals.

Lung cancer screening in high-risk individuals with annual low-dose chest CT in a community setting.

e12529 Background: National Lung Screening Trial (NLST) establisehd the role of lung ca screening in high-risk individuals. Annual screening with a low dose CT-chest for 3 years resulted in a 20% r...

Tu1905 Exploring the Relevance and Effect Size of Factors Associated With the Outcome of Pancreatic Cancer Screening in High-Risk Individuals

Background: The clinical significance of pancreatic intraepithelial neoplasia (PanIN)-III, known as carcinoma in situ of pancreatic ductal adenocarcinoma (PDAC), remains unclear yet. Recent research showed inflammation enhanced early cellular invasion of PanIN-III by facilitating epithelial to mesenchymal transition (EMT), even before frank malignancy in experimental model. Therefore we decided to investigate whether PanIN-III accompanying chronic pancreatitis (CP) might have an important prognostic impact in patient who underwent curative resection for PDAC. Methods: Medical records of 125 PDAC patients with R0 resection were reviewed. Presence and grade of PanIN and CP in resected specimen were determined based on College of American Pathologists protocol. Overall survival (OS) and disease free survival (DFS) were analyzed according to PanIN-III and CP. Results: CP was observed in 27.2% (34/125) of resected specimen and PanIN-III in 25.6% (32/125). In the group with CP, PanIN-III was associated with poor prognosis in univariate analysis (4.3 months vs. 15.5 months, P=0.021 for DFS and 16.3 months vs. 30.9 months, P=0.004 for OS), whereas PanIN-III was not a prognostic factor in the group without CP. When we divided into two groups [PanIN-III accompanying CP (n=12) vs. the others (n=113)], it showed that median DFS and OS were significantly shorter in PanIN-III and CP group than those of the others (4.3 months and 16.3 months vs. 11.3 months and 21.3 months, p= 0.034 and p=0.019, respectively). In multivariate analysis, PanIN-III accompanying CP remained a statistically significant poor prognostic factor (HR: 2.97; 95% CI: 1.36 to 6.30; P=0.006 for DFS, HR: 2.31; 95% CI: 1.13 to 4.73; P=0.022 for OS using Cox proportional hazard ratio). Conclusions: PanIN-III accompanying CP might influence on poor long-term outcomes in patients who underwent R0 resection for PDAC. Therefore, it would support that chronic inflammation could enhance the dissemination of carcinoma in situ.

Lung Cancer Screening: The Radiologist's Perspective

Lung cancer is the leading cause of cancer death worldwide and accounts for more deaths than breast, prostate, colon, and pancreatic cancers combined. A distinct minority (15%) of lung cancers are diagnosed at an early stage; 5-year survival (all lung cancers) approximates 15%. Randomized, controlled trials in the 1960s and 1970s found that chest radiographic screening did not confer a survival benefit for high-risk patients. Recently, however, the randomized, controlled National Lung Screening Trail (NLST) provided category 1 evidence that low-dose computed tomography (CT) screening conferred a significant survival benefit for screened individuals: lung cancer-specific mortality was reduced by 20% after 6.5 years of follow-up; even all-cause mortality decreased by 6%. The positive outcome triggered many national medical societies in the United States to recommend lung cancer screening in high-risk individuals. However, the favorable results of the NLST trial have not yet been reproduced. Currently, nine randomized, controlled trials are being or have been performed in various European countries. In contrast to the NLST study, three published European studies found no benefit from low-dose CT scanning in at-risk patients. Additional studies are required to establish the benefit and risks associated with repetitive low-dose CT for screening at-risk patients. Many unanswered questions remain. Who should be screened and how often? What is the appropriate workup when lesions are noted in asymptomatic individuals? What is the risk of cumulative radiation exposure from repetitive low-dose CT scans? What is the responsibility of health care personnel to evaluate nonpulmonary issues detected by CT (e.g., coronary calcifications). In this review, we address these and other questions that arise. Further, implementation of screening programs may be logistically difficult, require additional personnel and computer software, and will incur significant health care costs.

Screening for Lung Cancer With Chest Radiographs

WITHIN THE SPACE OF SEVERAL MONTHS, 2 VERY large randomized trials of screening for lung cancer have reported their findings, which fortunately complement one another. The National Lung Screening Study (NLST) found that annual lowdose computed tomography (CT) reduced lung cancer mortality by 20% relative to annual chest radiography. In this issue of JAMA, investigators from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Randomized Trial report that annual screening chest radiography does not reduce lung cancer mortality relative to no screening. Should clinicians infer that screening with low-dose CT reduces lung cancer mortality by 20% relative to no screening? This editorial addresses that question and several other aspects of the PLCO trial. Why would the National Cancer Institute sponsor a large trial of screening for lung cancer with chest radiography? Although 6 randomized trials, most of them published in the 1980s, found no evidence that screening radiography reduced lung cancer mortality, the control group received screening chest radiography in all but the Mayo Lung Project. This study had important protocol deviations and was relatively small (9211 participants randomized; 366 cancers detected). So the body of evidence was inconclusive according to the investigators who designed the PLCO trial. The PLCO trial measured the effect of a package of screening interventions aimed at preventing death from 4 cancers. Patients were individually randomized to a usual care group or to an intervention group that was screened periodically for prostate, lung, colorectal, and ovarian cancer for 3 years and then monitored for PLCO cancers (a stop-screen design). Recruiting targeted the US general population aged 55 through 74 years. The study was designed to have a 90% probability of detecting a 10% reduction in lung cancer mortality. Over 8 years, 77 445 participants were randomized to screening and 77 456 to usual care. Half of the participants were ever-smokers; 10% were current smokers. Lung cancer mortality, the primary end point, was 14.0 per 10 000 person-years of follow-up in the intervention group and 14.2 in the control group (rate ratio, 0.99; 95% CI, 0.87 to 1.22). In high-risk patients who met the NLST eligibility criteria, the outcome was similar except for higher lung cancer mortality rates. The PLCO trial shows that a short-term chest radiography screening program has no effect on lung cancer mortality. The only potential concern about the validity of this conclusion is the reporting of follow-up contact with the trial participants. The authors’ diagram of the flow of participants through the trial (Figure 1) does not state the number of participants in the usual care group that the authors were unable to contact during follow-up. Differential ascertainment of lung cancer mortality and, especially, incidence could occur if follow-up rates were unequal in the screening and usual care groups for reasons linked to lung cancer incidence and mortality. Most of the 1696 cancers were interval cancers (n=198), arose in patients who were never screened (n=193), or arose in patients who had completed 3 rounds of screening (n=998). These far outnumbered the screen-detected cancers (n=307). The large number of deaths from cancers diagnosed after screening is a reminder of the transitory benefit from a short-term program of screening for lung cancer. The best test of lung cancer screening in high-risk individuals would be a trial of lifelong screening. With a stop-screen design, the true effect of screening is unclear because of uncertainty about how long to monitor patients after screening. At one extreme, stopping right after the last screen will miss cancers that screening did not detect but that would have been diagnosed if monitoring had been extended into the postscreening period. Stopping monitoring too soon, therefore, may overestimate the effect of screening by covering up some of its failures. At the other extreme, extending the period of monitoring long past the time when the last cancer missed by screening would have been diagnosed will underestimate the

W1155 Burden of Undergoing EUS-MRI Based Pancreatic Cancer Screening in High-Risk Individuals; First Experiences

Colorectal cancer (CRC) is the second most frequent cause of cancer-related death in Western countries: one third of CRC is represented by rectal cancer (RC). Accurate staging is recommended to provide an optimal treatment strategy. Neoadjuvant chemoradiotherapy (NCRT) is increasingly used in the treatment of advanced RCwith the intention of downsizing and downstaging the tumour and to reduce tumour recurrence. Accuracy of EUS staging is reported to be 75-94% for tumour penetration and 7283% for nodal metastases. However after NCRT the EUS accuracy for T staging may decrease (50%) because marked fibrosis, peritumoral infiltration of inflammatory cell necrosis. AIMS: the aims of this study was to verify the accuracy of EUS in restaging RC after neoadjuvant CRT and the efficacy of the therapy in the downstaging and downsizing the tumour. METHODS: we prospectively enrolled consecutive patients affected by RC in stage II-b and III who underwent EUS and MRI or CT or PET before and after neoadjuvant CRT. EUS scanning was performed by one endosonographer using an electronic radial ecoendoscope (Olympus GF UE 160-AL5) with imaging at 7,5-10 MHz. Patients underwent surgical resection after reassessment staging. The reduction of diameter of RC was evaluated using RECIST criteria. Pathological staging was undertaken according to the TNM classification. RESULTS: 14 patients with locally advanced RC were assessed: 10 male, median age 64 yrs (range 56-73). The median distance from the anus was 5 cm. Seven patients were in in stage II-b and 7 in stage III. All patients underwent radiotherapy with no complication associated with chemotherapy (10 pts with CDDP, 2 pts with FOLFOX and 2 pts with FUFA). The downstaging after neadjuvant therapy was observed in 7/14 patients, and significant reduction of tumor diameter in 13/14 patients. There were 13 anterior resections and 1 abdominoperineal resections. EUS post-NCRT T stage was correct in 11/14 pts (3 T0, 5 T3, 3 T2), while 3 pts were over staged (2 T2 and 1 T1). Overall accuracy of EUS post-RCT for pathologic T stage was 93% for T0-T1 stage and 86% for T3 stage. EUS accuracy for N-stage was 79%. CONCLUSION: in our preliminary study neoadjuvant CRT was useful to downstage and downsize locally advanced RC. EUS seems to be an accurate tool to restage RC after neoadjuvant CRT. However our results needed to be confirmed in a large cohort of patients with locally advanced RC.