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Aim: To assess the changes in the angiogenic status of rectal cancer before and after preoperative radiotherapy (RT) using endosonography (ES)., Material and Methods: Fifty-four patients with rectal cancer were examined by ES before and 6-7 weeks after preoperative RT and . The tumour size, stage, echostructure and vascularization before and after RT were compared. Tumour vascularization was determined by qualitative power Doppler and by computer-assisted method., Results: Compared to the histological data, ES restaging after RT was accurate in 65% of the cases for the T parameter and in 83% for the N parameter (TNM tumour classification). The histological data compared with the initial ES examination revealed downstaging in relation to the T parameter in 33% and for the N stage in 24% of the cases. The tumour structure following RT became hyperechogenic in 89% of tumours and remained hypoechogenic in 11% of tumours. Power Doppler found a reduction in tumour vascularization after RT in 61% of the tumours. The PDVI before RT was 10.7+/-5.8% and 6.3+/-4.6% after RT (р<0.05). A strong correlation between the qualitative assessment of the vascularization and PDVI was found (r=0.536, p<0.001). The vascularization reduction after RT was found to be a protective factor which decreased the death risk by about 86 % (ОR=0.14, р=0.001)., Conclusions: Endorectal Doppler sonographic findings are promising in the evaluation of tumour vascularization in patients with rectal cancer. The qualitative and quantitative digital assessment of the vascularization gives supplementary information about the patients' prognosis.

Background/aims: The accuracy of endoluminal ultrasonographic restaging of rectal cancer after chemoradiation has not been extensively studied and its definitive clinical utility has yet to be defined. The aim of the present study is to assess the benefit of endoluminal ultrasonography with Doppler evaluation for rectal cancer restaging after preoperative radiotherapy., Methodology: Twenty six patients (10 female, 16 males, mean age--58 years) with histologically proven rectal cancer underwent preoperative radiotherapy. All patients were examined by endoluminal (endorectal or endovaginal) ultrasonography. Endosonography was repeated on 13 patients after small fractions preoperative radiotherapy., Results: The mean transversal diameter of lesions before preoperative radiotherapy established by endoluminal ultrasonography is 33mm +/- 11 mm. After preoperative radiotherapy we detect significant reduction of 33% in the transversal tumor size--mean 23mm +/- 7mm (p < 0.001). After radiation the mean distance from the tumor to the internal anal sphincter increases without statistical significance by 5%: from 59 +/- 18 mm to 62 +/- 16 mm (p = 0.165). Compared to histological data, endosonographic restaging after radiotherapy is accurate in 9/13 (69%) for T parameter and 11/13 (85%) for N. After preoperative radiotherapy tumor sonographic structure is hyperechoic (homogeneous or inhomogeneous)--in 9 patients and only in 4 cases the tumor remains hypoechoic. Power Doppler exam before radiotherapy shows poor vascularization in 5 tumors--(19%). Abundant vascularization is found in 9 cases--(35%). In the remaining 12 patients tumor vascularization is considered as moderate. In 8 out of 13 cases (61.5%) after radiotherapy, vascular signals are less expressed. Lack of vascular alterations on pulse color and power Doppler flow is detected in the remaining 5 patients. No patients have more expressed vascularization on power Doppler examination after radiotherapy., Conclusion: According to our results the accuracy of endosonographic restaging after radiotherapy is lower for assessment of T criterion and is better for N parameter. Doppler findings are promising in the evaluation of tumor vascularity, respectively its predictive and prognostic values.