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Fidan M, Nural MS, Çamlıdağ İ, Yürüker SS, Meydan BC. Evaluation of treatment response by multiparametric MR imaging in locally advanced rectal tumors following neoadjuvant chemotherapy. Abdom Radiol (NY) 2024:10.1007/s00261-024-04389-3. [PMID: 38822855 DOI: 10.1007/s00261-024-04389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE To investigate the effectiveness of multiparametric MRI examination in determining tumor response after neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal tumors. METHODS 46 patients with locally advanced rectal adenocarcinoma were included and were divided into two groups as complete responders and nonresponders based on Mandard score. On MRI, relative T2w signal intensity and ADC values obtained before and after treatment and tumour volumes in dynamic contrast enhanced images (DCI) were used to determine complete response to treatment. RESULTS There were no significant differences between mean ADC values obtained by single slice ADC and three circular ROI methods. There were significant differences between two groups in terms of Post-CRT ADC value, ΔADC and %ΔADC obtained by whole tumour volume ADC method (p < 0.05). There were significant differences between Pre-CRT and Post-CRT volume values. ΔV DCI and %ΔV DCI, ΔV ADC and T2w volume values were significantly lower in complete responders (p < 0.05). In multivariate analysis, sensitivity and specificity were calculated as 88.9% and 91.9% (AUC = 0.943) when Post-CRT mean ADC value and Post-CRT DCI volume values were used together, and sensitivity and specificity were calculated as 88.9% and 94.6% (AUC = 0.949) when ΔADC and Post-CRT DCI volume values were used together. CONCLUSION Whole tumour volume mean ADC value is the most useful method to determine treatment response. Post-CRT DCI volume measurement stands out as the most useful method in assessing complete response alone. The highest diagnostic values are achieved when the post-CRT DCI volume is combined with the ADC change value of the whole tumor volume.
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Affiliation(s)
- Murat Fidan
- Department of Radiology, Ordu Fatsa State Hospital, Evkaf, Hastane Yolu No:5, 52400, Fatsa/Ordu, Turkey
| | - Mehmet Selim Nural
- Department of Radiology, Ondokuz Mayıs University, 55210, Kurupelit/Samsun, Turkey
| | - İlkay Çamlıdağ
- Department of Radiology, Ondokuz Mayıs University, 55210, Kurupelit/Samsun, Turkey.
| | - Saim Savaş Yürüker
- Department of Radiology, Ondokuz Mayıs University, 55210, Kurupelit/Samsun, Turkey
| | - Bilge Can Meydan
- Department of Radiology, Ondokuz Mayıs University, 55210, Kurupelit/Samsun, Turkey
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Huang Y, Xie Y, Wang P, Chen Y, Qin S, Li F, Wu Y, Huang M, Hou Z, Cai Y, He X, Lin H, Hu B, Qin Q, Ma T, Tan S, Liao Y, Ke J, Zhang D, Lai S, Jiang Z, Wang H, Xiang J, Cai Z, Wang H, He X, Yang Z, Ren D, Wu X, Hong Y, Huang M, Luo Y, Liu G, Lin J. Evaluation of transrectal ultrasound-guided tru-cut biopsy as a complementary method for predicting pathological complete response in rectal cancer after neoadjuvant treatment: a phase II prospective and diagnostic trial. Int J Surg 2024; 110:3230-3236. [PMID: 38348893 PMCID: PMC11175734 DOI: 10.1097/js9.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/26/2024] [Indexed: 06/15/2024]
Abstract
IMPORTANCE Patients with pathological complete response (pCR) of rectal cancer following neoadjuvant treatment had better oncological outcomes. However, reliable methods for accurately predicting pCR remain limited. OBJECTIVE To evaluate whether transrectal ultrasound-guided tru-cut biopsy (TRUS-TCB) adds diagnostic value to conventional modalities for predicting pathological complete response in patients with rectal cancer after neoadjuvant treatment. DESIGN, SETTING, AND PARTICIPANTS This study evaluated data of patients with rectal cancer who were treated with neoadjuvant treatment and reassessed using TRUS-TCB and conventional modalities before surgery. This study is registered with ClinicalTrials.gov. MAIN OUTCOMES AND MEASURES The primary outcome was accuracy, along with secondary outcomes including sensitivity, specificity, negative predictive value, and positive predictive value in predicting tumour residues. Final surgical pathology was used as reference standard. RESULTS Between June 2021 and June 2022, a total of 74 patients were enroled, with 63 patients ultimately evaluated. Among them, 17 patients (28%) exhibited a complete pathological response. TRUS-TCB demonstrated an accuracy of 0.71 (95% CI, 0.58-0.82) in predicting tumour residues. The combined use of TRUS-TCB and conventional modalities significantly improved diagnostic accuracy compared to conventional modalities alone (0.75 vs. 0.59, P =0.02). Furthermore, TRUS-TCB correctly reclassified 52% of patients erroneously classified as having a complete clinical response by conventional methods. The occurrence of only one mild adverse event was observed. CONCLUSIONS AND RELEVANCE TRUS-TCB proves to be a safe and accessible tool for reevaluation with minimal complications. The incorporation of TRUS-TCB alongside conventional methods leads to enhanced diagnostic performance.
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Affiliation(s)
- Yaoyi Huang
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Yumo Xie
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Puning Wang
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | | | | | | | - Yuanhui Wu
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Mingzhe Huang
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Zehui Hou
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Yonghua Cai
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Xiaosheng He
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Hongcheng Lin
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Bang Hu
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Qiyuan Qin
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Tenghui Ma
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Shuyun Tan
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Yi Liao
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Jia Ke
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Di Zhang
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Sicong Lai
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - ZhiPeng Jiang
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Huaiming Wang
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Jun Xiang
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Zerong Cai
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Hui Wang
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Xiaowen He
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Zuli Yang
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Donglin Ren
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Xiaojian Wu
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Yisong Hong
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Meijin Huang
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Yanxin Luo
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Guangjian Liu
- Medical Ultrasonics
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Jinxin Lin
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University
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Wu Q, Yi Y, Lai B, Li J, Lian Y, Chen J, Wu Y, Wang X, Cao W. Texture analysis of apparent diffusion coefficient maps: can it identify nonresponse to neoadjuvant chemotherapy for additional radiation therapy in rectal cancer patients? Gastroenterol Rep (Oxf) 2024; 12:goae035. [PMID: 38651169 PMCID: PMC11035003 DOI: 10.1093/gastro/goae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/15/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
Background Neoadjuvant chemotherapy (NCT) alone can achieve comparable treatment outcomes to chemoradiotherapy in locally advanced rectal cancer (LARC) patients. This study aimed to investigate the value of texture analysis (TA) in apparent diffusion coefficient (ADC) maps for identifying non-responders to NCT. Methods This retrospective study included patients with LARC after NCT, and they were categorized into nonresponse group (pTRG 3) and response group (pTRG 0-2) based on pathological tumor regression grade (pTRG). Predictive texture features were extracted from pre- and post-treatment ADC maps to construct a TA model using RandomForest. The ADC model was developed by manually measuring pre- and post-treatment ADC values and calculating their changes. Simultaneously, subjective evaluations based on magnetic resonance imaging assessment of TRG were performed by two experienced radiologists. Model performance was compared using the area under the curve (AUC) and DeLong test. Results A total of 299 patients from two centers were divided into three cohorts: the primary cohort (center A; n = 194, with 36 non-responders and 158 responders), the internal validation cohort (center A; n = 49, with 9 non-responders) and external validation cohort (center B; n = 56, with 33 non-responders). The TA model was constructed by post_mean, mean_change, post_skewness, post_entropy, and entropy_change, which outperformed both the ADC model and subjective evaluations with an impressive AUC of 0.997 (95% confidence interval [CI], 0.975-1.000) in the primary cohort. Robust performances were observed in internal and external validation cohorts, with AUCs of 0.919 (95% CI, 0.805-0.978) and 0.938 (95% CI, 0.840-0.985), respectively. Conclusions The TA model has the potential to serve as an imaging biomarker for identifying nonresponse to NCT in LARC patients, providing a valuable reference for these patients considering additional radiation therapy.
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Affiliation(s)
- Qianyu Wu
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Research Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yongju Yi
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Research Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Department of Information Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Bingjia Lai
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Jiao Li
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Research Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yanbang Lian
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Junhong Chen
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong, P. R. China
| | - Yue Wu
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Research Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xinhua Wang
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Research Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Wuteng Cao
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Research Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
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Jayaprakasam VS, Alvarez J, Omer DM, Gollub MJ, Smith JJ, Petkovska I. Watch-and-Wait Approach to Rectal Cancer: The Role of Imaging. Radiology 2023; 307:e221529. [PMID: 36880951 PMCID: PMC10068893 DOI: 10.1148/radiol.221529] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 03/08/2023]
Abstract
The diagnosis and treatment of rectal cancer have evolved dramatically over the past several decades. At the same time, its incidence has increased in younger populations. This review will inform the reader of advances in both diagnosis and treatment. These advances have led to the watch-and-wait approach, otherwise known as nonsurgical management. This review briefly outlines changes in medical and surgical treatment, advances in MRI technology and interpretation, and landmark studies or trials that have led to this exciting juncture. Herein, the authors delve into current state-of-the-art methods to assess response to treatment with MRI and endoscopy. Currently, these methods for avoiding surgery can be used to detect a complete clinical response in as many as 50% of patients with rectal cancer. Finally, the limitations of imaging and endoscopy and future challenges will be discussed.
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Affiliation(s)
- Vetri Sudar Jayaprakasam
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - Janet Alvarez
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - Dana M. Omer
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - Marc J. Gollub
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - J. Joshua Smith
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - Iva Petkovska
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
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Downstaging in Advanced Rectal Cancers: A Propensity-Matched Comparison Between Short-Course Radiotherapy Followed by Chemotherapy and Long-Course Chemoradiotherapy. Dis Colon Rectum 2022; 65:1215-1223. [PMID: 34907988 DOI: 10.1097/dcr.0000000000002331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Short-course radiotherapy followed by chemotherapy has not been widely evaluated as an alternative to traditional long-course chemoradiotherapy in locally advanced rectal cancer. OBJECTIVE This study compared the oncological and short-term outcomes between short-course radiotherapy + chemotherapy and long-course chemoradiotherapy in locally advanced rectal cancer. DESIGN This is a retrospective propensity-matched study. SETTINGS The study was conducted in a colorectal department at a tertiary care oncology center in India. PATIENTS There were 173 patients. Group A had 47 patients and group B had 126 patients. A 1:2.7 matching was done for age, sex, distance of tumor from the anal verge, sphincter preservation surgeries, MRI-based pretreatment T stage, and circumferential resection margin. INTERVENTIONS The interventions performed were short-course radiotherapy + chemotherapy (group A) and long-course chemoradiotherapy (group B) in locally advanced rectal cancer. MAIN OUTCOME MEASURES The primary measures were pathological circumferential resection margin positivity, downstaging, tumor regression grade, and postoperative complications. RESULTS Of the patients, 52% had a positive circumferential resection margin on MRI, 57% had low rectal tumors, and 20% had T4 tumors. Distribution of rectal surgeries was similar between the 2 groups. pT downstaging and tumor regression scores were significantly better in group B ( p = 0.028 and 0.026). Pathological circumferential resection margin, distal resection margin, and nodal yield were similar. On multivariate analysis, pretreatment N status was the only independent predictive factor for pathological circumferential resection margin status. Grade 3 to 4 Clavien-Dindo complications, anastomotic leak rates, and hospital stay were similar between the 2 groups. LIMITATIONS This was a retrospective study. Although propensity matching was performed, selection bias cannot be eliminated completely, as seen in the difference in the surgical approaches between the 2 groups. CONCLUSIONS In a cohort containing a significant portion of MRI circumferential resection margin-positive low rectal cancers, short-course radiotherapy + chemotherapy followed by delayed surgery resulted in lower T downstaging and lower tumor regression scores compared with long-course chemoradiotherapy, but pathological circumferential margin status, distal resection margin, nodal yield, and perioperative morbidity were similar between the 2 groups. This suggests that short-course radiotherapy + chemotherapy could be a viable alternative to long-course chemoradiotherapy in locally advanced rectal cancers. See Video Abstract at http://links.lww.com/DCR/B855 . REDUCCIN DEL ESTADIO EN LOS CNCERES RECTALES AVANZADOS UNA COMPARACIN DE PROPENSIN EQUIPARADA ENTRE LA RADIACIN DE CICLO CORTO SEGUIDA DE QUIMIOTERAPIA Y LA QUIMIO RADIACIN DE CICLO LARGO ANTECEDENTES:La radioterapia de ciclo corto seguida de quimioterapia no ha sido evaluada ampliamente como una alternativa a la tradicional quimio radioterapia de ciclo largo en el cáncer de recto localmente avanzado.OBJETIVO:Estudio que compara los resultados oncológicos y a corto plazo entre la radioterapia de ciclo corto + quimioterapia y la quimio radioterapia de ciclo largo en el cáncer de recto localmente avanzado.DISEÑO:Estudio comparado de propensión de manera retrospectiva.AJUSTE:Departamento colorrectal en un centro de atención oncológica de tipo terciario en la India.PACIENTES:Hubo 173 pacientes. El grupo A tenía 47 y el grupo B tenía 126 pacientes. Se realizó una comparación de 1: 2,7 para edad, sexo, distancia del tumor desde el margen anal, cirugías de preservación del esfínter, estadio T previo al tratamiento basada en resonancia magnética y margen de resección circunferencial (CRM).INTERVENCIONES:Radioterapia de ciclo corto + quimioterapia (grupo A) y quimio radioterapia de ciclo largo (grupo B) en cáncer de recto localmente avanzado (LARC).PRINCIPALES MEDIDAS DE RESULTADO:Positividad histopatológica de CRM, reducción del estadio tumoral, grado de regresión tumoral, complicaciones posoperatorias.RESULTADOS:El 52% de los pacientes han tenido un margen de resección circunferencial positivo en la resonancia magnética, 57% de tumores rectales bajos, 20% de tumores T4. La distribución de cirugías rectales fue similar entre los 2 grupos. Las puntuaciones de regresión tumoral y de reducción del estadio de pT fueron significativamente mejores en el grupo B ( p = 0.028 y 0.026 respectivamente). El margen de resección circunferencial patológico, el margen de resección distal y los ganglios arrojados fueron similares. En el análisis multivariado, el estadio N previo al tratamiento fue el único factor predictivo independiente para el estadio de pCRM. Las complicaciones Clavien-Dindo de grado 3-4, las tasas de fuga anastomótica y la estancia hospitalaria fueron similares entre los dos grupos.LIMITACIONES:Retrospectiva; aunque la propensión coincide, existe potencial sesgo de selección.CONCLUSIONES:En una cohorte que contenía una porción significativa de cánceres rectales bajos con margen de resección circunferencial positivo por resonancia magnética, la radioterapia de ciclo corto + quimioterapia seguida de cirugía tardía dio como resultado una mayor reducción del estadio T y de regresión tumoral en comparación con la quimio radioterapia de ciclo largo. Pero el estatus histopatológico del margen circunferencial, el margen de resección distal, el rendimiento ganglionar y la morbilidad perioperatoria fueron similares entre los dos grupos. Esto sugiere que la radioterapia de ciclo corto + quimioterapia podría ser una alternativa viable a la quimio radioterapia de ciclo largo en cánceres rectales localmente avanzados. Consulte Video Resumen en http://links.lww.com/DCR/B855 . (Traducción-Dr. Osvaldo Gauto ).
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Lu QY, Guan Z, Zhang XY, Li XT, Sun RJ, Li QY, Sun YS. Contrast-enhanced MRI for T Restaging of Locally Advanced Rectal Cancer Following Neoadjuvant Chemotherapy and Radiation Therapy. Radiology 2022; 305:364-372. [DOI: 10.1148/radiol.212905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Qiao-Yuan Lu
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Zhen Guan
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Xiao-Yan Zhang
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Xiao-Ting Li
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Rui-Jia Sun
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Qing-Yang Li
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Ying-Shi Sun
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
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Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates. Cancers (Basel) 2021; 13:cancers13194823. [PMID: 34638307 PMCID: PMC8507625 DOI: 10.3390/cancers13194823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Tumors with good response to preoperative chemoradiotherapy have a favorable prognosis, and these findings raise interest in rectum-sparing strategies. This study aimed to compare the oncologic outcome between local excision and radical resection in ypT0-1 patients and to analyze prognostic factors. Patients with primary rectal cancer diagnosed with ypT0-1 after PCRT followed by either radical resection (RR) or local excision (LE) between 2005 and 2014 were included in this study (LE = 78, RR = 442). Clinicopathologic features, recurrence-free survival (RFS), and OS were analyzed. There was no statistically significant difference in the RFS and OS between the LE and RR groups. Clinical T stage (cT3-4) before PCRT was related to RFS and in the LE group (p = 0.022). Lymph node metastasis (HR: 4.884, 95% confidence interval: 2.451-9.732, p < 0.001) in the final pathology was the only factor associated with RFS, showing a statistically significant difference in the RR group. Lymph node metastasis and age were associated with OS in the RR group. This study confirms the oncologic feasibility of LE in ypT0-1 rectal cancer after PCRT. Additionally, careful patient selection with higher accuracy modalities should be updated to improve treatment outcomes of LE.
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Turgeon MK, Gamboa AC, Keilson JM, Maniko J, Maguire L, Hrebinko K, Holder-Murray J, Wiseman JT, Abdel-Misih S, Hamdan S, Hawkins AT, Bauer P, Silviera M, Maithel SK, Balch GC. Radiological assessment of persistent retroperitoneal and lateral pelvic lymph nodes after neoadjuvant therapy for rectal cancer: An analysis of the United States Rectal Cancer Consortium. J Surg Oncol 2021; 124:818-828. [PMID: 34270097 DOI: 10.1002/jso.26600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Management of retroperitoneal and lateral pelvic lymph nodes (RLPN) in rectal cancer remains unclear. With total neoadjuvant therapy (TNT), more patients have radiologic complete clinical response (rCR). We sought to evaluate the impact of radiographic persistent RLPN after neoadjuvant therapy on survival. MATERIALS AND METHODS Patients with rectal adenocarcinoma with isolated RLPN metastasis, who received neoadjuvant therapy before surgery were included from the United States Rectal Cancer Consortium database. Primary outcomes were recurrence-free survival (RFS) and overall survival (OS). RESULTS Of 77 patients, all received neoadjuvant therapy, with 35 (46%) receiving TNT. Posttreatment, 33 (43%) had rCR while 44 (57%) had radiographic persistent RLPN. Median number of radiographic positive RLPN was 1 (IQR 1-2). Receipt of TNT was associated with radiographic RLPN rCR (OR 4.77, 95% CI 1.81-12.60, p < .01). However, there was no difference in RFS and OS between patients who achieved rCR or with persistent RLPN (all p > .05). CONCLUSIONS Radiographic persistence of RLPN was not associated with worse survival in well-selected patients and may not be a reliable indicator of pathological response. TNT may be the preferred management strategy to select patients given its association with rCR. Radiographic persistence of RLPN after preoperative therapy should not necessarily preclude surgery.
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Affiliation(s)
- Michael K Turgeon
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Adriana C Gamboa
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jessica M Keilson
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jeffrey Maniko
- Department of Surgery, Division of Colorectal Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Lillias Maguire
- Department of Surgery, Division of Colorectal Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Katherine Hrebinko
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jennifer Holder-Murray
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jason T Wiseman
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Sherif Abdel-Misih
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Saif Hamdan
- Section of Colon & Rectal Surgery, Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexander T Hawkins
- Section of Colon & Rectal Surgery, Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Philip Bauer
- Department of Surgery, Section of Colon & Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Matthew Silviera
- Department of Surgery, Section of Colon & Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Glen C Balch
- Department of Surgery, Division of Colon & Rectal Surgery, Emory University, Atlanta, Georgia, USA
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Development of a novel apoptosis-based tumor regression grade to assess the efficacy of preoperative chemoradiotherapy for rectal cancer: a retrospective single-center study. Int J Clin Oncol 2021; 26:1679-1688. [PMID: 34085130 DOI: 10.1007/s10147-021-01948-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Preoperative chemoradiotherapy is used preferably for locally advanced rectal cancer, followed by a watch-and-wait strategy for cases showing clinical complete response. However, there is a discordance between pathological and clinical complete response rates. We aimed to propose a tumor regression grade (TRG) that truly reflects the therapeutic effects of preoperative chemoradiotherapy in locally advanced rectal cancer. METHODS Overall, 293 consecutive patients with T3/T4a/T4b rectal cancer who underwent chemoradiotherapy followed by radical surgery between Sep 2003 and Dec 2018 were retrospectively reviewed. We assessed apoptosis using M30 cytoDEATH immunostaining and correlated that with conventional TRG (convTRG) evaluated using hematoxylin-eosin staining, and created a new TRG by evaluating apoptosis and convTRG. The modified TRG1-4 (modifTRG) classification was as follows: modifTRG1 comprised poor TRG, modifTRG2 moderate TRG, modifTRG3 good TRG, modifTRG4 complete apoptosis and convTRG3 (pathological complete response). We assessed the overall survival, relapse-free survival, and local recurrence rate. RESULTS Pathological complete response rate was 10.6% when evaluated using conventional staining. Using M30 staining, apoptosis was observed in the residual disease in convTRG 1a 0%, convTRG 1b 0.3%, convTRG 2 9.2%. Combining the two, modifTRG4 was observed in 20.1%. The survival rates were similar between modifTRG4 and convTRG3, suggesting that modifTRG4 was equivalent to pathological complete response. However, in multivariate analysis, modifTRG but not convTRG was an independent risk factor for local and distant recurrences. CONCLUSION The proposed modifTRG truly reflected the therapeutic effects of chemoradiotherapy and may be superior to the convTRG to stratify rectal cancer patients treated with chemoradiotherapy.
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Pangarkar S, Mistry K, Choudhari A, Smriti V, Ahuja A, Katdare A, Engineer R, Ostwal V, Ramadwar M, Saklani A, Baheti AD. Accuracy of MRI for nodal restaging in rectal cancer: a retrospective study of 166 cases. Abdom Radiol (NY) 2021; 46:498-505. [PMID: 32813028 DOI: 10.1007/s00261-020-02708-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 12/12/2022]
Abstract
AIM Assessing metastatic mesorectal nodal involvement is a challenge in rectal cancer, especially in the post chemoradiation setting. We aim to assess the accuracy of MRI for nodal restaging and the validity of SAR criteria (≥ 5 mm size being metastatic). MATERIALS AND METHODS This was an IRB-approved retrospective study of 166 patients with locally advanced rectal cancers, operated after neoadjuvant treatment. Two dedicated oncoradiologists reviewed the 166 post-chemoradiation presurgical MRIs in consensus. Nodal size and morphology (shape, margins, and signal intensity) were noted. The most accurate cut-off for size for predicting positive pN status was determined using the Youden index. RESULTS MRI understaged 30/166 (18%) and overstaged 40/166 (24%) patients using the SAR criteria. The most accurate cut-off for node size was 5.5 mm, with a sensitivity of 75%, specificity of 60.2%, PPV of 40.7%, NPV of 86.9% (95% CI:78-92.5%), accuracy of 64.2%, and area under the curve (AUC) 0.657 (95% CI-0.524-0.79). Morphological characteristics were not significant to determine involvement, with positive nodes including 42% of round and 31% of oval nodes, 40% of heterogeneous and 45% of homogeneous nodes, and 31% irregularly marginated and 46% nodes with regular margins being positive on pathology. MRI was accurate in predicting pathology for mucinous nodes in 9/29 (31%) cases. Seven cases which were yN2 on MRI and yN0 on pathology demonstrated mucinous changes on MRI and had acellular mucin on histopathology. CONCLUSIONS MRI has good negative predictive value, poor positive predictive value and moderate accuracy in nodal restaging. The cut-off of 5.5 mm demonstrated in our study is close to the SAR cut-off of 5 mm in the post-treatment setting. MRI accuracy is lower in patients with mucinous nodes.
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Javadrashid R, Mahmoudpour M, Akhavi Milani A, Jalili J, Hajalioghli P, Nezami N. Value of diffusion-weighted images in diagnosis of locoregionally recurrent rectal tumors. Radiography (Lond) 2021; 27:779-783. [PMID: 33386222 DOI: 10.1016/j.radi.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION To assess the value of referring to Diffusion-weighted images in evaluation of T2-weighted images of patients clinically suspicious of locoregional rectal cancer recurrence. METHODS After ethics committee approval and informed consent were obtained, 37 consecutive patients (male/female of 22/15; mean age 56 ± 13.5 SD) clinically suspicious of recurrent rectal tumor were prospectively included in the study over a two-year period. T2-weighted images of the patients were reviewed and the results were recorded. Right after that, the corresponding DWI images were provided for the radiologist and new ratings were given to the patients after taking into account the DWI findings. Finally, the patients underwent tissue biopsy. Receiver Operating Characteristic (ROC) analysis was performed, and Area Under the Curve (AUC) of the "T2-weighted alone" and "T2-weighted + DWI" methods were calculated and compared. RESULTS "T2-weighted alone" and "T2-weighted + DWI" methods had an AUC of 0.64 (95% CI 0.47 to 0.79) and 0.75 (95% CI 0.58 to 0.88), respectively. The Difference between the two AUCs was 0.11 (P = 0.16). In the subgroup of patients having equivocal ratings in T2-weighted images, DWI images correctly identified 81% (13/16) of patients with true tumor recurrence and 66% (8/12) of patients without recurrence. CONCLUSION Our results suggest that referring to DWI does not significantly change the overall diagnostic performance of T2-weighted images. However, DWI is of great value in evaluation of the subgroup of patients with equivocal findings in T2-weighted images. Studies with larger sample sizes are needed to confirm these findings. IMPLICATIONS FOR PRACTICE When T2-weighted images are equivocal, DWI images may be helpful in evaluation of patients with suspected locoregional recurrence of rectal tumor.
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Affiliation(s)
- R Javadrashid
- Radiology Department, Medical Radiation Sciences Research Group, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M Mahmoudpour
- Radiology Department, Medical Radiation Sciences Research Group, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - A Akhavi Milani
- Radiology Department, Medical Radiation Sciences Research Group, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - J Jalili
- Radiology Department, Medical Radiation Sciences Research Group, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - P Hajalioghli
- Radiology Department, Medical Radiation Sciences Research Group, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - N Nezami
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
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12
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Sukumaran R, Rajagopal R, Sivanandan C, Katoor J. Histopathological assessment of rectal carcinomas after neoadjuvant chemoradiotherapy. CLINICAL CANCER INVESTIGATION JOURNAL 2021. [DOI: 10.4103/ccij.ccij_135_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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13
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Suarez-Weiss KE, Jhaveri KS, Harisinghani MG. MRI Evaluation of Rectal Cancer Following Preoperative Chemoradiotherapy. Semin Roentgenol 2020; 56:177-185. [PMID: 33858644 DOI: 10.1053/j.ro.2020.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Kartik S Jhaveri
- Division of Diagnostic Radiology, University of Toronto University Health Network, Mt. Sinai and WCH, Toronto, Canada
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14
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The Diagnostic Accuracy of Magnetic Resonance Imaging in Restaging of Rectal Cancer After Preoperative Chemoradiotherapy. J Comput Assist Tomogr 2020; 44:102-110. [DOI: 10.1097/rct.0000000000000964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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15
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Cao W, Li Z, Mohamoud A, Gong J, Wang X, Zhou J, Hu H, Huang Y, Li W, Li F, Liu D, Liang C, Zhou Z. Quantitative MRI assessment of mucinous rectal adenocarcinoma to predict tumour response after neoadjuvant therapy. Clin Radiol 2019; 74:278-286. [DOI: 10.1016/j.crad.2018.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023]
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16
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Chung E, Kang D, Lee HS, Cho ES, Kim JH, Park EJ, Baik SH, Lee KY, Kang J. Accuracy of pelvic MRI in measuring tumor height in rectal cancer patients with or without preoperative chemoradiotherapy. Eur J Surg Oncol 2019; 45:324-330. [DOI: 10.1016/j.ejso.2018.08.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 06/24/2018] [Accepted: 08/30/2018] [Indexed: 01/23/2023] Open
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Ngu JCY, Kuo LJ, Kung CH, Chen CL, Kuo CC, Chang SW, Chen CC. Robotic transanal minimally invasive surgery for rectal cancer after clinical complete response to neoadjuvant chemoradiation. Int J Med Robot 2018; 14:e1948. [PMID: 30073747 DOI: 10.1002/rcs.1948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 07/08/2018] [Accepted: 07/10/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Full-thickness local excision (FTLE) for rectal cancer showing clinical complete remission (cCR) after neoadjuvant chemoradiation therapy (NCRT) is associated with good oncological results. The purpose of this study was to report the results of robotic transanal minimally invasive surgery for such patients. METHODS Patients were treated with a 5-fluorouracil-based NCRT regimen. The determination of cCR was based on digital rectal examination, colonoscopy, and magnetic resonance imaging. RESULTS Six patients underwent transanal FTLE using the da Vinci Xi surgical system. The median operative time was 106.5 minutes, and the estimated blood loss was minimal. The mean length of hospital stay was 4.2 days. After 18.2 months of follow-up, none of the patients developed local recurrences or distant disease. CONCLUSIONS With the use of robotic technology, FTLE can be performed with relative ease and can be considered as a viable alternative to radical resection or a "Watch and Wait" strategy.
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Affiliation(s)
| | - Li-Jen Kuo
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Huei Kung
- Department of Diagnostic Radiology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chi-Long Chen
- Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chia-Chun Kuo
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sheng-Wei Chang
- Division of Acute Care Surgery and Traumatology, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chia-Che Chen
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
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Gollub MJ, Hotker AM, Woo KM, Mazaheri Y, Gonen M. Quantitating whole lesion tumor biology in rectal cancer MRI: taking a lesson from FDG-PET tumor metrics. Abdom Radiol (NY) 2018; 43:1575-1582. [PMID: 29159523 PMCID: PMC5960599 DOI: 10.1007/s00261-017-1389-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine the value of novel whole tumor metrics in DWI-MRI and DCE-MRI of rectal cancer treatment assessment. MATERIALS AND METHODS This retrospective study included 24 uniformly treated patients with rectal adenocarcinoma who underwent MRI including diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) sequences, before and after chemoradiotherapy. Two experienced readers independently measured tumor volume and apparent diffusion coefficient (ADC) on DWI-MRI and tumor volume and transfer constant K trans on DCE-MRI. In addition, we explored and defined Total Lesion Diffusion (TLD) as Total DWI tumor volume multiplied by mean volumetric ADC and Total Lesion Perfusion (TLP) as the total DCE tumor volume multiplied by the mean volumetric K trans. These metrics were correlated with histopathologic percent tumor regression in the resected specimen (%TR). Inter-reader agreement was assessed using the concordance correlation coefficient (CCC). RESULTS For both readers, post-treatment TLP revealed comparable correlations with %TR compared with K trans (reader 1; Spearman's rho = - 0.36 vs. - 0.32, reader 2; Spearman's rho = - 0.32 vs. - 0.28). In addition, TLP afforded the highest inter-reader agreement at post-treatment among TLP, DCE vol, and K trans (CCC: 0.64 vs. 0.36 vs. 0.35). Post-treatment TLD showed similar correlation with %TR as DWI volume in reader 1 and superior correlation with %TR for reader 2 (reader 1; Spearman's rho - 0.56 vs. - 0.57, reader 2; Spearman's rho - 0.59 vs. - 0.45). CONCLUSION The novel tumor metrics TLD and TLP revealed similar results to established metrics for correlation with tumor response with equivalent or superior inter-reader agreements and we recommend that these be studied in larger trials.
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Affiliation(s)
- Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Andreas M Hotker
- Department of Diagnostic and Interventional Radiology, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Radiology, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Kaitlin M Woo
- Department of Biostatistics and Medical Informatics, University of Wisconsin, K6/446 Clinical Sciences Center 600 Highland Avenue, Madison, WI, 53792-4675, USA
| | - Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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von den Grün JM, Hartmann A, Fietkau R, Ghadimi M, Liersch T, Hohenberger W, Weitz J, Sauer R, Wittekind C, Ströbel P, Rödel C, Fokas E. Can clinicopathological parameters predict for lymph node metastases in ypT0-2 rectal carcinoma? Results of the CAO/ARO/AIO-94 and CAO/ARO/AIO-04 phase 3 trials. Radiother Oncol 2018; 128:557-563. [PMID: 29929861 DOI: 10.1016/j.radonc.2018.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The advent of less radical surgical approaches has generated concern about leaving locoregional lymph node metastases (LNM) unresected that could lead to adverse outcome. We examined the prognostic role of clinicopathological factors for ypN-positivity in patients with ypT0-2 rectal carcinoma treated within the CAO/ARO/AIO-94 and CAO/ARO/AIO-04 randomized phase 3 trials. METHODS The correlation of clinicopathological factors with ypN-status (ypN0 vs ypN1/2) was examined in n = 776 patients with ypT0-2 rectal carcinoma after preoperative CRT and total mesorectal excision surgery using Pearson's Chi-squared test for categorical variables and Kruskal-Wallis' test for continuous variables. Multivariable analysis was performed using binary logistic regression to identify independent prognosticators for ypN-positivity. RESULTS Residual LNM (ypN+) were found in 6%, 20.8% and 21.4% of patients with ypT0, ypT1 and ypT2 carcinomas, respectively. Independent prognosticators for LNM were advanced ypT category (p = 0.002) and lymphatic invasion (p = 0.020). In a separate multivariable analysis performed upon exclusion of ypT-category due to multicollinearity with residual tumor diameter (RTD), lymphatic invasion (p = 0.015) and RTD ≥10 mm (p = 0.005) demonstrated strong correlation with LNM. CONCLUSION Advanced ypT-stage, lymphatic invasion and RTD ≥10 mm were prognostic factors for LNM in patients ypT0-2 rectal carcinoma treated with CRT and surgery within both phase 3 trials. The high incidence of LNM in the ypT1-2 group needs to be taken into consideration in the context of oncological safety and indicate that LE should be advocated with great caution in this patient subgroup. The prognostic pathological factor identified here could help guide decision of LE vs TME after standard CRT.
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Affiliation(s)
| | - Arndt Hartmann
- Institute of Pathology, University of Erlangen, Nürnberg, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology and Radiotherapy, University of Erlangen, Nürnberg, Germany
| | - Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Torsten Liersch
- Department of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany
| | - Werner Hohenberger
- Department of General and Visceral and Pediatric Surgery, University of Erlangen, Nürnberg, Germany
| | - Jürgen Weitz
- Department of General and Visceral and Pediatric Surgery, University of Dresden, Germany
| | - Rolf Sauer
- Department of Radiation Oncology and Radiotherapy, University of Erlangen, Nürnberg, Germany
| | | | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, Germany.
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Could early tumour volume changes assessed on morphological MRI predict the response to chemoradiation therapy in locally-advanced rectal cancer? Clin Radiol 2018; 73:555-563. [DOI: 10.1016/j.crad.2018.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 01/11/2018] [Indexed: 01/14/2023]
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21
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Prediction of lateral pelvic lymph node metastasis in patients with locally advanced rectal cancer with preoperative chemoradiotherapy: Focus on MR imaging findings. PLoS One 2018; 13:e0195815. [PMID: 29649321 PMCID: PMC5897011 DOI: 10.1371/journal.pone.0195815] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 03/31/2018] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To investigate the predictive factors for lateral pelvic lymph node (LPLN) metastasis in patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy (CRT). MATERIALS AND METHODS Fifty-seven patients with locally advanced rectal cancer and LPLNs larger than 5 mm underwent LPLN dissection (LPLD) after preoperative CRT. The MRI findings, including the apparent diffusion coefficient value and LPLN size reduction rate before/after CRT; clinical factors; and pathologic results were evaluated to identify the predictive factors associated with LPLN metastasis. RESULTS LPLN metastasis was confirmed in 23 patients (40.4%). Metastasis was significantly higher in LPLNs with multiplicity, short-axis diameter ≥8 mm before CRT, short-axis diameter >5 mm after CRT, size reduction rate ≤33.3%, heterogeneous signal intensity, and irregular margin (P<0.05) on MR. Multivariable analysis showed that pre-CRT short-axis diameter of LPLNs ≥8 mm, size reduction rate ≤33.3%, and heterogeneous signal intensity were independently associated with LPLN metastasis. CONCLUSIONS The size and signal intensity of LPLN before and after CRT are useful MRI findings to predict LPLN metastasis and are helpful to determine the indications for LPLD.
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Räsänen M, Ristimäki A, Savolainen R, Renkonen-Sinisalo L, Lepistö A. Oncological results of extended resection for locally advanced rectal cancer: the value of postirradiation MRI in predicting local recurrence. Colorectal Dis 2017; 19:339-348. [PMID: 27620502 DOI: 10.1111/codi.13513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/23/2016] [Indexed: 02/08/2023]
Abstract
AIM The primary purpose of this study was to analyse the overall survival and local recurrence rate after extended resection of locally advanced rectal cancer. The second aim was to determine the ability of the response to radiological irradiation to predict R0 resection. METHOD A retrospective study was performed of 94 consecutive patients with locally advanced rectal cancer operated on at the Helsinki University Hospital, Helsinki, Finland between 2005 and 2013. Data were collected from patient records. All patients were treated with an en bloc resection. Sixty-two patients received preoperative long-term chemoradiotherapy. RESULTS The 30-day mortality was 3.2%. Local recurrence occurred in 10 (10.6%) patients. The cumulative 1-, 3- and 5-year overall survival to each year was 89.4%, 68.3% and 51.8%. The most important prognostic factor for both local recurrence (P = 0.006) and survival (P = 0.003) was an R0 resection. A poor or no response seen on posttreatment MRI predicted local recurrence (P = 0.045) and decreased disease-free survival in patients treated curatively (P = 0.052). The histological tumour regression grade was not associated with local recurrence or survival. CONCLUSION Multivisceral resection offers a 5-year survival of over 50% and local control of advanced rectal cancer in nearly 90% of carefully selected patients.
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Affiliation(s)
- M Räsänen
- Colorectal Surgery, Abdominal Centre, Helsinki University Hospital, Helsinki, Finland.,Department of Medicine, University of Helsinki, Helsinki, Finland
| | - A Ristimäki
- Department of Pathology, Research Programs Unit and HUSLAB, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - R Savolainen
- HUS Medical Imaging Centre, Meilahti Hospital, Helsinki University Hospital, Helsinki, Finland
| | - L Renkonen-Sinisalo
- Colorectal Surgery, Abdominal Centre, Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Genome-Scale Biology, University of Helsinki, Helsinki, Finland
| | - A Lepistö
- Colorectal Surgery, Abdominal Centre, Helsinki University Hospital, Helsinki, Finland
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Lee CC, Chen PC, Chen HH, Huang CC, Lin LH, Ng SH, Chen MC, Ko SF. Effectiveness of a Tailored Anterior Saturation Band in the Improvement of the Image Quality of Pelvic Magnetic Resonance for Assessing Rectal Cancer. Clin Colorectal Cancer 2017; 16:187-194. [PMID: 28209482 DOI: 10.1016/j.clcc.2017.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 01/13/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE We sought to test the effectiveness of the application of a tailored anterior saturation band (ASB) to improve the image quality of pelvic magnetic resonance imaging (MRI) for assessing rectal cancer. METHODS A total of 165 patients with MRI assessment of rectal cancer between 2013 and 2015 were included. The image quality scores (4-point scale: 1, nondiagnostic through 4, excellent) of MRI without and with tailored ASBs were compared. Sensitivity, specificity, positive and negative predictive values, and accuracy of pelvic MRIs with and without a tailored ASB for T-staging in 65 patients with direct surgery and 67 patients with chemoradiotherapy before surgery were evaluated. RESULTS Two independent raters exhibited moderate-to-excellent interobserver agreements (κ = 0.529-0.879) in the grading of MRI image quality. Overall, the quality scores of sagittal and axial T2-weighted images with tailored ASBs were significantly improved compared with MRIs without ASBs (3.5 ± 0.3 vs. 2.7 ± 0.8 [mean ± SD]; P < .001, and 3.6 ± 0.3 vs. 2.8 ± 0.8; P < .001, respectively). The application of tailored ASBs in MRIs improved the averaged accuracies for staging of ≤ T2, T3, and T4 tumors from 87.7%, 78.5%, and 90.8% to 93.1%, 86.9%, and 97.7%, respectively. In post-chemoradiotherapy MRI follow-ups, the use of tailored ASBs also improved the average accuracies for staging of yT0, yT1-2, yT3, and yT4 tumors from 80.6%, 73.1%, 73.9%, and 91.0%, to 85.8%, 82.9%, 85.1%, and 94.0%, respectively. CONCLUSIONS Application of a tailored ASB in pelvic MRI is effective in substantially reducing motion artifacts, significantly upgrading image quality, and improving accuracies of rectal tumor staging.
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Affiliation(s)
- Chen-Chang Lee
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Po-Chou Chen
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hong-Hwa Chen
- Department of Colorectal Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Cheng Huang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Li-Han Lin
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Hang Ng
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Min-Chi Chen
- Biostatistics Consulting Center and Department of Public Health, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheung-Fat Ko
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Cao W, Lian Y, Liu D, Li F, Zhu P, Zhou Z. Rectal cancer restaging using 3D CUBE vs. 2D T2-weighted technique after neoadjuvant therapy: a diagnostic study. Gastroenterol Rep (Oxf) 2016; 5:226-231. [PMID: 28025227 PMCID: PMC5554381 DOI: 10.1093/gastro/gow039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/26/2016] [Accepted: 10/10/2016] [Indexed: 12/18/2022] Open
Abstract
Objective. This study aimed to compare the accuracy of rectal cancer restaging after neoadjuvant therapy with 3D CUBE sequence with 2D T2-weighted fast spin-echo (FSE) sequence. Methods. This retrospective study comprised 72 patients with rectal cancer confirmed by colonoscopy and biopsy. After neoadjuvant therapy, all patients underwent pelvic magnetic resonance imaging (MRI) examination at 1.5T MRI sequences including a single coronal 3D CUBE T2-weighted FSE sequence with 1.4 mm thickness and a 2D T2-weighted FSE sequence in the sagittal, coronal and axial planes with 5 mm thickness. The total acquisition time of the two sequences was recorded. Results were compared with postsurgical pathology (gold standard). The diagnostic accuracy was evaluated; and receiver operating characteristic (ROC) curves and the area under the curves (AUC) were calculated. Results. The T category staging accuracy of 3D T2WI and 2D T2WI was 81.9% and 72.2%, respectively, for reviewer 1 and 86.1% and 75.0% for reviewer 2. The AUC of 3D was higher than that of 2D (0.878 vs. 0.783 for reader 1 and 0.905 vs. 0.796 for reader 2; both P < 0.05) when judging whether the tumor broke through the muscle layer. There was no significant difference between 3D and 2D in judging whether lymph nodes were malignant (AUC 0.719 vs. 0.698 for reader 1 and 0.740 vs. 0.698 for reader 2; both P > 0.05). There were no significant differences in the visibility of the rectal wall layer, tumor lesion and the overall image quality (all P > 0.05). Compared with 2D sequences, the 3D sequence had shorter acquisition time and higher signal intensity ratio (both P < 0.05). Conclusion. 3D CUBE T2-weighted sequences offer better diagnostic accuracy in rectal cancer restaging after neoadjuvant therapy when compared with 2D T2-weighted FSE sequences; it has a shorter scanning time and more versatility of orientation reconstruction.
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Affiliation(s)
- Wuteng Cao
- Department of Radiology, Sixth Affiliated Hospital (Gastrointestinal Hospital) of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanbang Lian
- Department of Radiology, Sixth Affiliated Hospital (Gastrointestinal Hospital) of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Dechao Liu
- Department of Radiology, Sixth Affiliated Hospital (Gastrointestinal Hospital) of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fangqian Li
- Department of Radiology, Sixth Affiliated Hospital (Gastrointestinal Hospital) of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Pan Zhu
- Department of Radiology, Sixth Affiliated Hospital (Gastrointestinal Hospital) of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhiyang Zhou
- Department of Radiology, Sixth Affiliated Hospital (Gastrointestinal Hospital) of Sun Yat-sen University, Guangzhou, Guangdong, China
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Han Y, Oh S, Choi M, Lee S, Jang H, Lee M, Kim JG. Clinical impact of tumor volume reduction in rectal cancer following preoperative chemoradiation. Diagn Interv Imaging 2016; 97:843-50. [DOI: 10.1016/j.diii.2016.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/03/2016] [Accepted: 05/17/2016] [Indexed: 01/01/2023]
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26
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Li QW, Zheng RL, Ling YH, Wang QX, Xiao WW, Zeng ZF, Fan W, Li LR, Gao YH. Prediction of tumor response after neoadjuvant chemoradiotherapy in rectal cancer using (18)fluorine-2-deoxy-D-glucose positron emission tomography-computed tomography and serum carcinoembryonic antigen: a prospective study. Abdom Radiol (NY) 2016; 41:1448-55. [PMID: 27116012 DOI: 10.1007/s00261-016-0698-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To investigate the association between (18)fluorine-2-deoxy-D-glucose positron emission tomography-computed tomography ((18)F-FDG PET/CT) parameters, serum carcinoembryonic antigen (CEA), and tumor response in patients with rectal cancer receiving neoadjuvant chemoradiotherapy (nCRT). METHODS Sixty-four patients with T3-4 and/or node-positive rectal cancer receiving nCRT followed by surgery were prospectively studied. PET/CT was performed before, and in 28 patients, both before and after nCRT. The pre-/post-nCRT maximum standardized uptake (SUVmax) values, differences between pre-/post-nCRT SUVmax (∆SUVmax), response index of SUVmax (RI-SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and CEA were measured. The ability of PET/CT parameters and CEA to predict Mandard's tumor regression grade (TRG) and pathological complete remission (pCR) were evaluated. RESULTS 31 patients were identified as responders (TRG 1-2), and 19 exhibited pCR. For responders, significant differences were found for ΔSUVmax (24.88 vs. 15.39 g/ml, p = 0.037), RI-SUVmax (0.76 vs. 0.63, p = 0.025), ΔSUVmean (14.43 vs. 8.65 g/ml, p = 0.029), RI-SUVmean (0.77 vs. 0.63, p = 0.011), CEA-pre (6.30 vs. 27.86 μg/L, p < 0.001), CEA-post (2.22 vs. 5.49 μg/L, p = 0.002), ΔCEA (4.08 vs. 23.13 μg/L, p < 0.001), and RI-CEA (0.25 vs. 0.55, p = 0.002). Differences between pCR and non-pCR patients were noted as RI-SUVmean (0.77 vs. 0.65, p = 0.043), MTV-pre (9.87 vs. 14.62 cm(3), p = 0.045), CEA-pre (5.62 vs. 22.27 μg/L, p = 0.002), CEA-post (1.95 vs. 4.72 μg/L, p = 0.001), and ΔCEA (3.68 vs. 17.99 μg/L, p = 0.013). Receiver operating characteristic analysis revealed that RI-SUVmean exhibited the greatest accuracy in predicting responders, whereas CEA-post and ΔCEA exhibited the greatest accuracy in predicting pCR. CONCLUSIONS (18)F-FDG PET/CT parameters and CEA are accurate tools for predicting tumor response to nCRT in rectal cancer.
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Moreno CC, Sullivan PS, Kalb BT, Tipton RG, Hanley KZ, Kitajima HD, Dixon WT, Votaw JR, Oshinski JN, Mittal PK. Magnetic resonance imaging of rectal cancer: staging and restaging evaluation. ACTA ACUST UNITED AC 2016; 40:2613-29. [PMID: 25759246 DOI: 10.1007/s00261-015-0394-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Magnetic resonance imaging is used to non-invasively stage and restage rectal adenocarcinomas. Accurate staging is important as the depth of tumor extension and the presence or absence of lymph node metastases determines if an individual will undergo preoperative neoadjuvant chemoradiation. Accurate description of tumor location is important for presurgical planning. The relationship of the tumor to the anal sphincter in addition to the depth of local invasion determines the surgical approach used for resection. High-resolution T2-weighted imaging is the primary sequence used for initial staging. The addition of diffusion-weighted imaging improves accuracy in the assessment of treatment response on restaging scans. Approximately 10%-30% of individuals will experience a complete pathologic response following chemoradiation with no residual viable tumor found in the resected specimen at histopathologic assessment. In some centers, individuals with no residual tumor visible on restaging MR who are thought to be at high operative risk are monitored with serial imaging and a "watch and wait" approach in lieu of resection. Normal rectal anatomy, MR technique utilized for staging and restaging scans, and TMN staging are reviewed. An overview of surgical techniques used for resection including newer, minimally invasive endoluminal techniques is included.
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Affiliation(s)
- Courtney C Moreno
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA.
| | - Patrick S Sullivan
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Bobby T Kalb
- Department of Medical Imaging, The University of Arizona School of Medicine, Tucson, AZ, 85724, USA
| | - Russell G Tipton
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Krisztina Z Hanley
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Hiroumi D Kitajima
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - W Thomas Dixon
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - John R Votaw
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - John N Oshinski
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Pardeep K Mittal
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
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Siddiqui MRS, Gormly KL, Bhoday J, Balyansikova S, Battersby NJ, Chand M, Rao S, Tekkis P, Abulafi AM, Brown G. Interobserver agreement of radiologists assessing the response of rectal cancers to preoperative chemoradiation using the MRI tumour regression grading (mrTRG). Clin Radiol 2016; 71:854-62. [PMID: 27381221 DOI: 10.1016/j.crad.2016.05.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/13/2016] [Accepted: 05/03/2016] [Indexed: 02/07/2023]
Abstract
AIM To investigate whether the magnetic resonance imaging (MRI) tumour regression grading (mrTRG) scale can be taught effectively resulting in a clinically reasonable interobserver agreement (>0.4; moderate to near perfect agreement). MATERIALS AND METHODS This study examines the interobserver agreement of mrTRG, between 35 radiologists and a central reviewer. Two workshops were organised for radiologists to assess regression of rectal cancers on MRI staging scans. A range of mrTRGs on 12 patient scans were used for assessment. RESULTS Kappa agreement ranged from 0.14-0.82 with a median value of 0.57 (95% CI: 0.37-0.77) indicating good overall agreement. Eight (26%) radiologists had very good/near perfect agreement (κ>0.8). Six (19%) radiologists had good agreement (0.8≥κ>0.6) and a further 12 (39%) had moderate agreement (0.6≥κ>0.4). Five (16%) radiologists had a fair agreement (0.4≥κ>0.2) and two had poor agreement (0.2>κ). There was a tendency towards good agreement (skewness: 0.92). In 65.9% and 90% of cases the radiologists were able to correctly highlight good and poor responders, respectively. CONCLUSIONS The assessment of the response of rectal cancers to chemoradiation therapy may be performed effectively using mrTRG. Radiologists can be taught the mrTRG scale. Even with minimal training, good agreement with the central reviewer along with effective differentiation between good and intermediate/poor responders can be achieved. Focus should be on facilitating the identification of good responders. It is predicted that with more intensive interactive case-based learning a κ>0.8 is likely to be achieved. Testing and retesting is recommended.
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Affiliation(s)
- M R S Siddiqui
- Department of Colorectal Surgery, Croydon University Hospital, Croydon CR7 7YE, UK; Department of Radiology, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK; Imperial College London, London, UK
| | - K L Gormly
- Dr Jones and Partners, Adelaide, South Australia, Australia
| | - J Bhoday
- Department of Colorectal Surgery, Croydon University Hospital, Croydon CR7 7YE, UK; Department of Radiology, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK; Imperial College London, London, UK
| | - S Balyansikova
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK
| | - N J Battersby
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK
| | - M Chand
- Department of Surgery, University College London, London, UK
| | - S Rao
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK
| | - P Tekkis
- Department of Surgery, Royal Marsden Hospital, Fulham Rd, London SW3 6JJ, UK; Imperial College London, London, UK
| | - A M Abulafi
- Department of Colorectal Surgery, Croydon University Hospital, Croydon CR7 7YE, UK
| | - G Brown
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK; Imperial College London, London, UK.
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Helewa RM, Park J. Surgery for Locally Advanced T4 Rectal Cancer: Strategies and Techniques. Clin Colon Rectal Surg 2016; 29:106-13. [PMID: 27247535 PMCID: PMC4882171 DOI: 10.1055/s-0036-1580722] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Locally advanced T4 rectal cancer represents a complex clinical condition that requires a well thought-out treatment plan and expertise from multiple specialists. Paramount in the management of patients with locally advanced rectal cancer are accurate preoperative staging, appropriate application of neoadjuvant and adjuvant treatments, and, above all, the provision of high-quality, complete surgical resection in potentially curable cases. Despite the advanced nature of this disease, extended and multivisceral resections with clear margins have been shown to result in good oncological outcomes and offer patients a real chance of cure. In this article, we describe the assessment, classification, and multimodality treatment of primary locally advanced T4 rectal cancer, with a focus on surgical planning, approaches, and outcomes.
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Affiliation(s)
- Ramzi M. Helewa
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason Park
- Section of Surgical Oncology, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Quaia E, Gennari AG, Ricciardi MC, Ulcigrai V, Angileri R, Cova MA. Value of percent change in tumoral volume measured at T 2 -weighted and diffusion-weighted MRI to identify responders after neoadjuvant chemoradiation therapy in patients with locally advanced rectal carcinoma. J Magn Reson Imaging 2016; 44:1415-1424. [PMID: 27219471 DOI: 10.1002/jmri.25310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/27/2016] [Accepted: 04/27/2016] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To evaluate the percent change in tumoral volume measured at T2 -weighted magnetic resonance imaging (T2 WMRI) and diffusion-weighted (DWI) as a method to identify responders after chemo- and radiation therapy (CRT) in patients with locally advanced rectal carcinoma. MATERIALS AND METHODS Forty-five consecutive patients (mean age ± SD: 72 years ± 9.7; male/female = 24/21) with locally advanced rectal carcinoma underwent CRT followed by surgery. Each patient underwent T2 WMRI and DWI at 1.5T before and 6 weeks after the completion of CRT. The percent change in tumoral volume before and 6 weeks after CRT was compared in patients classified as responders and nonresponders according to rectal cancer regression grade. RESULTS Twenty-five patients were classified as responders with either partial (n = 20) or complete response (n = 5), while 20 patients were classified as nonresponders due to stable disease (n = 18) or disease progression (n = 2). Responders vs. nonresponders differed in the percent change of tumoral volume at T2 WMRI (-67% ± 26% vs. -29% ± 26%; P < 0.05) and DWI images (-72% ± 24% vs. -33% ± 28%; P < 0.05) with a cutoff ≤ -70% for T2 WMRI (sensitivity = 69%, 95% confidence interval [CI]: 48-85%; specificity = 100%, 95% CI 81-100%) and ≤66% for DWI (sensitivity = 73%, 95% CI: 52-88%; specificity = 100%, 95% CI 81-100%). CONCLUSION The percent change in tumoral volume at T2 WMRI and DWI images can differentiate responders from nonresponders in patients with locally advanced rectal carcinoma after neoadjuvant CRT. J. Magn. Reson. Imaging 2016;44:1415-1424.
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Affiliation(s)
- Emilio Quaia
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | | | | | - Veronica Ulcigrai
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Roberta Angileri
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
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Pathologic Complete Response in Rectal Cancer: Can We Detect It? Lessons Learned From a Proposed Randomized Trial of Watch-and-Wait Treatment of Rectal Cancer. Dis Colon Rectum 2016; 59:255-63. [PMID: 26953983 DOI: 10.1097/dcr.0000000000000558] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chemoradiotherapy has the potential to downsize and downstage tumors before surgery, decrease locoregional recurrence, and induce a complete sterilization of tumor cells for middle and low locally advanced rectal cancer. A watch-and-wait tactic has been proposed for patients with clinical complete response. OBJECTIVE The purpose of this study was to verify our ability to identify complete clinical response in patients with rectal cancer based on clinical and radiologic criteria. DESIGN This was a prospective study. SETTINGS The study was conducted at a single institution, in the setting of a watch-and-wait randomized trial. PATIENTS Consecutive patients with stage T3 to T4N0M0 or T(any)N+M0 cancer located within 10 cm from anal verge or T2N0 within 7 cm from anal verge were included in the study. Patients were staged and restaged 8 weeks after completion of chemoradiation (5-fluorouracil, 5040 cGy) by digital examination, colonoscopy, pelvic MRI, and thorax and abdominal CT scans. MAIN OUTCOME MEASURES Clinical and radiologic judgments of tumor response were compared with pathologic response of patients treated by total mesorectal excision or clinical follow-up of patients selected for nonoperative treatment. RESULTS A total of 118 patients were treated. Six patients were considered clinic complete responders (2 randomly assigned for surgery (1 ypT0N0 and 1 ypT2N0) and 4 patients randomly assigned for observation (3 sustained clinic complete response and 1 had tumor regrowth)). The 112 clinic incomplete responders underwent total mesorectal excision, and 18 revealed pathologic complete response. These 18 patients were not considered complete responders at restaging because they presented at least 1 of the following conditions: mucosal ulceration and/or deformity and/or substenosis of rectal lumen at digital rectal examination and colonoscopy (n = 16), ymrT1 to T4 (n = 16), ymrN+ (n = 2), involvement of circumferential resection margin on MRI (n = 3), extramural vascular invasion on MRI (n = 4), MRI tumor response grade 2 to 4 (n = 15), and pelvic side wall lymph node involvement on MRI (n = 1). Sensitivity for identification of ypT0N0 or sustained clinic complete response was 18.2%. LIMITATIONS This study has a short follow-up and small sample size. Radiologists who reviewed the restaging examination were not blinded to the pretreatment stage. Only 1 radiologist read the images of each patient. CONCLUSIONS Evaluation of clinic complete response according to current adopted criteria has low sensitivity because pathologic complete response more frequently presented as clinic incomplete response (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A221).
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Multiparametric MRI in the assessment of response of rectal cancer to neoadjuvant chemoradiotherapy: A comparison of morphological, volumetric and functional MRI parameters. Eur Radiol 2016; 26:4303-4312. [PMID: 26945761 DOI: 10.1007/s00330-016-4283-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 02/07/2016] [Accepted: 02/11/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare morphological and functional MRI metrics and determine which ones perform best in assessing response to neoadjuvant chemoradiotherapy (CRT) in rectal cancer. MATERIALS AND METHODS This retrospective study included 24 uniformly-treated patients with biopsy-proven rectal adenocarcinoma who underwent MRI, including diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) sequences, before and after completion of CRT. On all MRI exams, two experienced readers independently measured longest and perpendicular tumour diameters, tumour volume, tumour regression grade (TRG) and tumour signal intensity ratio on T2-weighted imaging, as well as tumour volume and apparent diffusion coefficient on DW-MRI and tumour volume and transfer constant Ktrans on DCE-MRI. These metrics were correlated with histopathological percent tumour regression in the resected specimen (%TR). Inter-reader agreement was assessed using the concordance correlation coefficient (CCC). RESULTS For both readers, post-treatment DW-MRI and DCE-MRI volumetric tumour assessments were significantly associated with %TR; DCE-MRI volumetry showed better inter-reader agreement (CCC=0.700) than DW-MRI volumetry (CCC=0.292). For one reader, mrTRG, post-treatment T2 tumour volumetry and assessments of volume change made with T2, DW-MRI and DCE-MRI were also significantly associated with %TR. CONCLUSION Tumour volumetry on post-treatment DCE-MRI and DW-MRI correlated well with %TR, with DCE-MRI volumetry demonstrating better inter-reader agreement. KEY POINTS • Volumetry on post-treatment DCE-/DW-MRI sequences correlated well with histopathological tumour regression. • DCE-MRI volumetry demonstrated good inter-reader agreement. • Inter-reader agreement was higher for DCE-MRI volumetry than for DW-MRI volumetry. • DCE-MRI volumetry merits further investigation as a metric for evaluating treatment response.
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Choi MH, Oh SN, Rha SE, Choi JI, Lee SH, Jang HS, Kim JG, Grimm R, Son Y. Diffusion-weighted imaging: Apparent diffusion coefficient histogram analysis for detecting pathologic complete response to chemoradiotherapy in locally advanced rectal cancer. J Magn Reson Imaging 2015; 44:212-20. [PMID: 26666560 DOI: 10.1002/jmri.25117] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 11/25/2015] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To investigate the usefulness of apparent diffusion coefficient (ADC) values derived from histogram analysis of the whole rectal cancer as a quantitative parameter to evaluate pathologic complete response (pCR) on preoperative magnetic resonance imaging (MRI). MATERIALS AND METHODS We enrolled a total of 86 consecutive patients who had undergone surgery for rectal cancer after neoadjuvant chemoradiotherapy (CRT) at our institution between July 2012 and November 2014. Two radiologists who were blinded to the final pathological results reviewed post-CRT MRI to evaluate tumor stage. Quantitative image analysis was performed using T2 -weighted and diffusion-weighted images independently by two radiologists using dedicated software that performed histogram analysis to assess the distribution of ADC in the whole tumor. RESULTS After surgery, 16 patients were confirmed to have achieved pCR (18.6%). All parameters from pre- and post-CRT ADC histogram showed good or excellent agreement between two readers. The minimum, 10th, 25th, 50th, and 75th percentile and mean ADC from post-CRT ADC histogram were significantly higher in the pCR group than in the non-pCR group for both readers. The 25th percentile value from ADC histogram in post-CRT MRI had the best diagnostic performance for detecting pCR, with an area under the receiver operating characteristic curve of 0.796. CONCLUSION Low percentile values derived from the ADC histogram analysis of rectal cancer on MRI after CRT showed a significant difference between pCR and non-pCR groups, demonstrating the utility of the ADC value as a quantitative and objective marker to evaluate complete pathologic response to preoperative CRT in rectal cancer. J. Magn. Reson. Imaging 2016;44:212-220.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Soon Nam Oh
- Department of Radiology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Eun Rha
- Department of Radiology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Il Choi
- Department of Radiology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Hong Seok Jang
- Department of Radiation Oncology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Jun-Gi Kim
- Department of Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | | | - Yohan Son
- Siemens Healthcare, Seoul, Republic of Korea
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The accuracy of MRI, endorectal ultrasonography, and computed tomography in predicting the response of locally advanced rectal cancer after preoperative therapy: A metaanalysis. Surgery 2015; 159:688-99. [PMID: 26619929 DOI: 10.1016/j.surg.2015.10.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/07/2015] [Accepted: 10/16/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND To perform a metaanalysis to determine and compare the diagnostic performance of MRI, endorectal ultrasonography (ERUS), and computed tomography (CT) in predicting the response of locally advanced rectal cancer after preoperative therapy. METHODS All previously published articles on the role of MRI, CT, and/or ERUS in predicting the response of rectal cancer to preoperative therapy were collected. We divided the objective in 3 parts: the accuracy to assess (i) complete response, (ii) to detect T4 tumors with invasion to the circumferential resection margin (CRM), and (iii) to predict the presence of lymph node metastasis. The pooled estimates of, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated using a bivariate mixed effect analysis. RESULTS Forty-six studies comprising 2,224 patients were included. (i) The pooled accuracy to assess complete tumor response were (a) 75% for MRI, (b) 82% for ERUS, (c) and 83% for CT. (ii) Pooled accuracy to detect T4 tumors with invasion to the CRM were (a) 88% and (b) 94% for ERUS. (iii) Pooled accuracy to predict the presence of lymph node metastasis was (a) 72% for MRI, (b) 72% for ERUS, (c) and 65% for CT. CONCLUSION MRI, CT, and ERUS cannot be used to predict complete response of locally advanced rectal cancer after CRT. In addition, the positive predictive value for these imaging techniques is low for the assessment of tumor invasion in the CRM. The accuracy of the modalities to predict the presence of metastatic lymph node disease is also low.
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Patel PM, Harris K, Huerta S. Clinical and molecular diagnosis of pathologic complete response in rectal cancer. Expert Rev Mol Diagn 2015; 15:1505-16. [DOI: 10.1586/14737159.2015.1091728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Marouf RA, Tadros MY, Ahmed TY. Value of diffusion-weighted MR imaging in assessing response of neoadjuvant chemo and radiation therapy in locally advanced rectal cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Memon S, Lynch AC, Bressel M, Wise AG, Heriot AG. Systematic review and meta-analysis of the accuracy of MRI and endorectal ultrasound in the restaging and response assessment of rectal cancer following neoadjuvant therapy. Colorectal Dis 2015; 17:748-61. [PMID: 25891148 DOI: 10.1111/codi.12976] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 02/26/2015] [Indexed: 12/14/2022]
Abstract
AIM Restaging imaging by MRI or endorectal ultrasound (ERUS) following neoadjuvant chemoradiotherapy is not routinely performed, but the assessment of response is becoming increasingly important to facilitate individualization of management. METHOD A search of the MEDLINE and Scopus databases was performed for studies that evaluated the accuracy of restaging of rectal cancer following neoadjuvant chemoradiotherapy with MRI or ERUS against the histopathological outcome. A systematic review of selected studies was performed. The methodological quality of studies that qualified for meta-analysis was critically assessed to identify studies suitable for inclusion in the meta-analysis. RESULTS Sixty-three articles were included in the systematic review. Twelve restaging MRI studies and 18 restaging ERUS studies were eligible for meta-analysis of T-stage restaging accuracy. Overall, ERUS T-stage restaging accuracy (mean [95% CI]: 65% [56-72%]) was nonsignificantly higher than MRI T-stage accuracy (52% [44-59%]). Restaging MRI is accurate at excluding circumferential resection margin involvement. Restaging MRI and ERUS were equivalent for prediction of nodal status: the accuracy of both investigations was 72% with over-staging and under-staging occurring in 10-15%. CONCLUSION The heterogeneity amongst restaging studies is high, limiting conclusive findings regarding their accuracies. The accuracy of restaging imaging is different for different pathological T stages and highest for T3 tumours. Morphological assessment of T- or N-stage by MRI or ERUS is currently not accurate or consistent enough for clinical application. Restaging MRI appears to have a role in excluding circumferential resection margin involvement.
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Affiliation(s)
- S Memon
- Division of Cancer Surgery, Colorectal Surgery Department, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - A C Lynch
- Division of Cancer Surgery, Colorectal Surgery Department, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - M Bressel
- Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - A G Wise
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - A G Heriot
- Division of Cancer Surgery, Colorectal Surgery Department, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Issa N, Murninkas A, Schmilovitz-Weiss H, Agbarya A, Powsner E. Transanal Endoscopic Microsurgery After Neoadjuvant Chemoradiotherapy for Rectal Cancer. J Laparoendosc Adv Surg Tech A 2015; 25:617-24. [PMID: 26258267 DOI: 10.1089/lap.2014.0647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Radical rectal resection following neoadjuvant chemoradiation therapy (CRT) for locally advanced rectal cancer is accompanied by relatively high morbidity. Local excision of rectal cancer may be more appropriate for some frail patients with severe comorbidities. Transanal endoscopic microsurgery (TEM), consisting of local excision of selected rectal cancers, has been associated with low rates of postoperative complications. Because neoadjuvant CRT for rectal cancer may be associated with increased complications, the suitability of TEM following CRT is still unclear. In this study we aimed to assess the clinical outcomes of patients undergoing TEM following neoadjuvant CRT. PATIENTS AND METHODS This study retrospectively analyzed all patients undergoing TEM for malignant rectal tumor in our institution between 2004 and 2010. They were divided into those who received CRT (CRT group) and those without CRT (non-CRT group). Demographics and clinical data were compared. RESULTS Forty-four of 97 patients who underwent TEM were included: 13 CRT and 31 non-CRT. Age, comorbidities, and the duration of the procedure were similar for both groups. There were no significant group differences in tumor diameter (2.1 cm [range, 0.5-3.5 cm] and 2.9 cm [range, 0.5-4.2 cm], respectively; P=.125) or distance of the lower part of the tumor from the anal verge (6.7 cm [range, 5-10 cm] and 7.7 cm [range, 5-15 cm], respectively; P=.285). Two non-CRT patients had peritoneal entry, and 1 of them underwent protective ileostomy because of insecure rectal defect closure. One non-CRT patient underwent a re-operation for postoperative bleeding. The other perioperative complications were minor and included urinary retention requiring catheter placement (2 patients in each group), pulmonary edema (1 non-CRT patient), and pneumonia (1 non-CRT patient). All complications were managed conservatively. There was no wound disruption, major complication, or mortality in either group. CONCLUSIONS With proper patient selection, TEM can be performed safely following CRT, without major complication or increased postoperative morbidity.
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Affiliation(s)
- Nidal Issa
- 1 Department of Surgery B, Rabin Medical Center , Petah-Tikva, Israel .,2 Sackler School of Medicine, Tel-Aviv University , Tel Aviv, Israel
| | - Alejandro Murninkas
- 1 Department of Surgery B, Rabin Medical Center , Petah-Tikva, Israel .,2 Sackler School of Medicine, Tel-Aviv University , Tel Aviv, Israel
| | - Hemda Schmilovitz-Weiss
- 2 Sackler School of Medicine, Tel-Aviv University , Tel Aviv, Israel .,3 Department of Gastroenterology, Hasharon Hospital, Rabin Medical Center , Petah-Tikva, Israel
| | - Abed Agbarya
- 4 Oncology Community Unit, Northern District, Clalit Health Services , Nazareth, Israel
| | - Eldad Powsner
- 1 Department of Surgery B, Rabin Medical Center , Petah-Tikva, Israel .,2 Sackler School of Medicine, Tel-Aviv University , Tel Aviv, Israel
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Xiao J, Cai Z, Li W, Yang Z, Gong J, Huang Y, Deng Y, Wu X, Wang L, Peng J, Ren D, Lan P, Wang J. Tumor Volume Reduction Rate Predicts Pathologic Tumor Response of Locally Advanced Rectal Cancer Treated with Neoadjuvant Chemotherapy alone: Results from a Prospective Trial. J Cancer 2015; 6:636-42. [PMID: 26078794 PMCID: PMC4466413 DOI: 10.7150/jca.11738] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/15/2015] [Indexed: 01/30/2023] Open
Abstract
Purpose: To evaluate tumor volume reduction rate (TVRR) measured by three-dimensional region-of-interest (3D-ROI) magnetic resonance (MR) volumetry in predicting pathological tumor response of preoperative chemotherapy alone for locally advanced rectal cancer (LARC). Methods: LARC patients who received neoadjuvant chemotherapy only from a prospective and randomized trial were recruited. Tumor volumes were measured with 3D-ROI MR volumetry. TVRR was determined using the equation TVRR = (VPre-Therapy - VPost-Therapy) / VPre-Therapy ×100%. Correlation between TVRR and clinical or pathological characteristics and predictive value of TVRR for pathological tumor response in terms of Tumor Regression Grade (TRG), T downstage, N downstage and overall downstage were analyzed. Results: 80 eligible cases of LARC were included in our study with TVRR of (51.7±25.1) %. TVRR was higher in well-differentiated tumors compared with poor-differentiated tumors (P=0.040). TVRR was found to be related with TRG (P<0.001), T downstage (P<0.001) and overall downstage (P<0.001). Risk of achieving TRG 2/3 decreased to 57.5% (P=0.002) and odds of achieving overall downstage increase to 179.3% (P<0.001) when TVRR increased by every 10%. A sensitivity of 0.704 and specificity of 0.804 were calculated when ROC curve was constructed to predict TRG using TVRR with a cutoff of 65%. Conclusion: TVRR is correlated with TRG and overall downstage significantly in LARC patients treated with preoperative chemotherapy alone and shows great value in predicting favorable TRG and overall downstage with good sensitivity and specificity. It could be considered as a promising parameter candidate for efficacy evaluation.
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Affiliation(s)
- Jian Xiao
- 1. Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, P.R. China
| | - Zerong Cai
- 2. Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, P.R. China
| | - Wenyun Li
- 3. Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, National University of Singapore, 169856, Singapore
| | - Zuli Yang
- 2. Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, P.R. China
| | - Jiaying Gong
- 4. Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, P.R. China
| | - Yan Huang
- 5. Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, P.R. China
| | - Yanhong Deng
- 1. Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, P.R. China
| | - Xiaojian Wu
- 2. Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, P.R. China
| | - Lei Wang
- 2. Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, P.R. China
| | - Junsheng Peng
- 2. Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, P.R. China
| | - Donglin Ren
- 2. Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, P.R. China
| | - Ping Lan
- 2. Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, P.R. China
| | - Jianping Wang
- 2. Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, P.R. China
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Kim IY, Cha SW, Ahn JH, Kim YW. Factors affecting the restaging accuracy of magnetic resonance imaging after preoperative chemoradiation in patients with rectal cancer. Eur J Surg Oncol 2015; 41:493-8. [PMID: 25648465 DOI: 10.1016/j.ejso.2014.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/26/2014] [Indexed: 01/11/2023] Open
Abstract
PURPOSES We evaluated patient or tumor factors associated with the preoperative restaging accuracy of magnetic resonance imaging (MRI) for determining T and N stages as well as circumferential resection margin (CRM) involvement after chemoradiation (CRT) in patients with locally advanced rectal cancer. METHODS Seventy-seven patients with rectal cancer that were treated with preoperative CRT (50.4 Gy) followed by radical resection were included. Post-CRT MRI was performed approximately 4 weeks after preoperative CRT. RESULTS The median tumor distance from the anal verge was 6 cm, 48 (62%) of which were anterior and 29 (38%) posterior. The median tumor diameter was 3 cm. A stage-by-stage comparison showed that correct staging occurred in 62%, 43%, and 86% of patients for T staging, N staging, and CRM prediction, respectively. Shorter distance to the anal verge (<5 cm), smaller tumor diameter (<1 cm), and anterior tumor location were associated with incorrect T staging. There were no significant variables in terms of N staging accuracy. Shorter tumor distance and anterior tumor location were associated with incorrect CRM prediction. CONCLUSIONS Our findings suggest that specific tumor factors such as small, distal, or anterior rectal tumors are closely associated with the accuracy of MRI after preoperative CRT.
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Affiliation(s)
- I Y Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - S W Cha
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - J H Ahn
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Y W Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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Sheth RA, Bittencourt LK, Guimaraes AR. Diffusion-weighted imaging of the male pelvis. Magn Reson Imaging Clin N Am 2015; 22:145-63, v. [PMID: 24792675 DOI: 10.1016/j.mric.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diffusion-weighted (DW) imaging is playing an increasingly important role in disease detection, prognostication, and monitoring of treatment response. Particularly in the realm of oncology, the potential applications for DW imaging continue to expand. In this article, the authors detail the role of DW imaging for pathologic processes involving the male pelvis. The authors describe the current data, new insights, and ongoing controversies regarding DW imaging of the male pelvis with a particular emphasis on oncologic applications. The authors also discuss imaging techniques and common pitfalls for DW imaging in this anatomic region.
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Affiliation(s)
- Rahul A Sheth
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Leonardo K Bittencourt
- Abdominal and Pelvic Imaging, Clinica de Diagnostico por Imagem (CDPI), Department of Radiology, Rio de Janeiro Federal University, Av das Americas 4666, Sala 325, Rio de Janeiro 22640902, Brazil
| | - Alexander R Guimaraes
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA.
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Abstract
BACKGROUND Local excision, as an alternative to radical resection for patients with pathological complete response (ypT0) after preoperative chemoradiation, is under investigation. OBJECTIVE The aim of the present study was to evaluate the long-term clinical outcome of a selected group of patients with ypT0 rectal cancer who underwent local excision with transanal endoscopic microsurgery as a definitive treatment. PATIENTS Between 1993 and 2013, 43 patients with rectal adenocarcinoma underwent complete full-thickness local excision with a transanal endoscopic microsurgery procedure after a regimen of chemoradiation. In all patients, rectal wall penetration was preoperatively assessed by endorectal ultrasound and/or magnetic resonance. Chemoradiation and transanal endoscopic microsurgery were indicated in patients refusing radical procedures or patients unfit for major abdominal procedures. MAIN OUTCOME MEASURES Patient characteristics, operative record, pathology report, and tumor recurrence were analyzed at a median follow-up of 81 months. The potential prognostic factors for recurrence, screened in univariate analysis, were analyzed by multivariate analysis by using the Cox regression model. RESULTS Thirteen patients (30.2%), without residual tumor in the surgical specimen (ypT0), were treated with transanal endoscopic microsurgery only. In this ypT0 group, 2 patients (15.4%) had postoperative complications: 1 bleeding and 1 suture dehiscence. Postoperative mortality was nil. No local and distal recurrences were observed, and no tumor-related mortality occurred. In 30 patients (69.8%), partial tumor chemoradiation response or the absence of tumor chemoradiation response was observed. In this group, recurrence occurred in 17 patients (56.7%). LIMITATIONS The study was limited by its retrospective nature, different protocols of chemoradiation and preoperative staging over time, and the small sample size. CONCLUSIONS Local excision with transanal endoscopic microsurgery can be considered a definitive therapeutic option in patients with rectal cancer treated with preoperative chemoradiation, when no residual tumor is found in the specimen. In this selected group, local excision offers excellent results in terms of survival and recurrence rates. In the presence of residual tumor, transanal endoscopic microsurgery should be considered as a large excisional biopsy (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A157).
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Prediction of pathologic staging with magnetic resonance imaging after preoperative chemoradiotherapy in rectal cancer: pooled analysis of KROG 10-01 and 11-02. Radiother Oncol 2014; 113:18-23. [PMID: 25245559 DOI: 10.1016/j.radonc.2014.08.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/06/2014] [Accepted: 08/24/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE The reported overall accuracy of MRI in predicting the pathologic stage of nonirradiated rectal cancer is high. However, the role of MRI in restaging rectal tumors after neoadjuvant CRT is contentious. Thus, we evaluate the accuracy of restaging magnetic resonance imaging (MRI) for rectal cancer patients who receive preoperative chemoradiotherapy (CRT). METHODS AND MATERIALS We analyzed 150 patients with locally advanced rectal cancer (T3-4N0-2) who had received preoperative CRT. Pre-CRT MRI was performed for local tumor and nodal staging. All patients underwent restaging MRI followed by total mesorectal excision after the end of radiotherapy. The primary endpoint of the present study was to estimate the accuracy of post-CRT MRI as compared with pathologic staging. RESULTS Pathologic T classification matched the post-CRT MRI findings in 97 (64.7%) of 150 patients. 36 (24.0%) of 150 patients were overstaged in T classification, and the concordance degree was moderate (k=0.33, p<0.01). Pathologic N classification matched the post-CRI MRI findings in 85 (56.6%) of 150 patients. 54 (36.0%) of 150 patients were overstaged in N classification. 26 patients achieved downstaging (ycT0-2N0) on restaging MRI after CRT. 23 (88.5%) of 26 patients who had been downstaged on MRI after CRT were confirmed on the pathological staging, and the concordance degree was good (k=0.72, p<0.01). CONCLUSIONS Restaging MRI has low accuracy for the prediction of the pathologic T and N classifications in rectal cancer patients who received preoperative CRT. The diagnostic accuracy of restaging MRI is relatively high in rectal cancer patients who achieved clinical downstaging after CRT.
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Vignali A, Nardi PD. Multidisciplinary treatment of rectal cancer in 2014: Where are we going? World J Gastroenterol 2014; 20:11249-11261. [PMID: 25170209 PMCID: PMC4145763 DOI: 10.3748/wjg.v20.i32.11249] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 05/08/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023] Open
Abstract
In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of neoadjuvant chemo-radiation and to the conservative and more limited surgical approaches based on tumour response after neoadjuvant combined therapy. When initial tumor staging is considered a high accuracy has been reported for T pre-treatment staging, while preoperative lymph node mapping is still suboptimal. With respect to tumour re-staging, all the current available modalities still present a limited accuracy, in particular in defining a complete response. The role of short vs long-course radiotherapy regimens as well as the optimal time of surgery are still unclear and under investigation by means of ongoing randomized trials. Observational management or local excision following tumour complete response are promising alternatives to total mesorectal excision, but need further evaluation, and their use outside of a clinical trial is not recommended. The preoperative selection of patients who will benefit from neoadjuvant radiotherapy or not, as well as the proper identification of a clinical complete tumour response after combined treatment modalities,will influence the future directions in the treatment of locally advanced rectal cancer.
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Park J, Chang KJ, Seo YS, Byun BH, Choi JH, Moon H, Lim I, Kim BI, Choi CW, Lim SM. Tumor SUVmax Normalized to Liver Uptake on (18)F-FDG PET/CT Predicts the Pathologic Complete Response After Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer. Nucl Med Mol Imaging 2014; 48:295-302. [PMID: 26396634 DOI: 10.1007/s13139-014-0289-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/08/2014] [Accepted: 07/16/2014] [Indexed: 01/11/2023] Open
Abstract
PURPOSE This study investigates the feasibility of using (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) to predict the pCR (pathologic complete response) rate after neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer. METHODS A total of 88 patients with locally advanced rectal cancer were retrospectively analyzed. All patients were treated with NCRT, followed by radical surgery, and (18)F-FDG PET/CT was performed before and after NCRT. For a semiquantitative assessment, a volume of interest was drawn, including the whole tumor region, and the maximum SUV (SUVmax), SUVmax normalized to liver uptake (SLR), SUVmax normalized to blood pool uptake (SBR), the metabolic tumor volume at SUV 2.0 (MTV[2.0]), SUV 2.5 (MTV[2.5]), and SUV 3.0 (MTV[3.0]) were measured. In addition, their percentage changes after NCRT were assessed. The pCR was verified through a histologic examination of postsurgical specimens. A receiver operating characteristic curve analysis was conducted to predict the pCR by using these PET parameters. RESULTS The pCR was predicted in 17 patients (19 %). The values of the area under the curve (AUC) for predicting the pCR were 0.774 for SUVmax after NCRT, 0.826 for SLR after NCRT, 0.815 for SBR after NCRT, 0.724 for MTV(2.5) after NCRT, 0.729 for the percentage change in SUVmax, 0.700 for the percentage change in SLR, and 0.749 for the percentage change in MTV (2.5). Among these PET parameters, SLR after NCRT showed the highest AUC value. The optimal criterion, sensitivity, specificity, and accuracy of SLR after NCRT for predicting the pCR were ≤1.41, 88 %, 65 %, and 68 %, respectively. CONCLUSIONS F-FDG PET was found to be useful for predicting the pCR after NCRT in patients with locally advanced rectal cancer. Among various PET parameters, SUVmax normalized to liver uptake after NCRT was the best predictor of the pCR.
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Affiliation(s)
- Jihyun Park
- Department of Nuclear Medicine, Korea Cancer Center Hospital, 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Kyoung Jin Chang
- Department of Nuclear Medicine, Korea Cancer Center Hospital, 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Young Seok Seo
- Department of Radiation Oncology, Korea Cancer Center Hospital, 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Byung Hyun Byun
- Department of Nuclear Medicine, Korea Cancer Center Hospital, 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Joon Ho Choi
- Department of Nuclear Medicine, Korea Cancer Center Hospital, 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Hansol Moon
- Department of Nuclear Medicine, Korea Cancer Center Hospital, 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Ilhan Lim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Byung Il Kim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Chang Woon Choi
- Department of Nuclear Medicine, Korea Cancer Center Hospital, 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Sang Moo Lim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
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Evaluation of lateral pelvic nodes in patients with advanced rectal cancer. AJR Am J Roentgenol 2014; 202:1245-55. [PMID: 24848821 DOI: 10.2214/ajr.13.11228] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this article is to discuss the importance of lateral pelvic lymph node metastasis as a predictor of local recurrence and survival in patients with advanced rectal cancer. CONCLUSION Prediction of lateral pelvic nodal staging on MRI shows high accuracy compared with the other imaging modalities. Diffusion-weighted MRI or (18)F-FDG PET/CT may be helpful to assesses lateral pelvic lymph node metastasis.
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Prognostic stratification by extramural depth of tumor invasion of primary rectal cancer based on the Radiological Society of North America proposal. AJR Am J Roentgenol 2014; 202:1238-44. [PMID: 24848820 DOI: 10.2214/ajr.13.11311] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the diagnostic performance of MRI in stratifying tumors stage III (T3) in patients with rectal cancer by measuring the extramural depth of tumor invasion based on the Radiologic Society of North America (RSNA) proposal and to validate its role as a prognostic indicator. MATERIALS AND METHODS From January 2006 to July 2009, 146 patients with surgically and pathologically confirmed T3 rectal adenocarcinoma who underwent preoperative MRI were enrolled. Two blinded radiologists measured the maximum extramural depth of tumor invasion on T2-weighted images. To evaluate the diagnostic performance of MRI for stratifying subgroups, the study population was assigned into three subgroups (T3a, T3b, and T3c) according to extramural depth of tumor invasion (< 5, 5-10, and > 10 mm).To validate the role of extramural depth of tumor invasion as a prognostic indicator, Cox regression analysis was used for estimation of independent risk factors for postoperative recurrence. Three-year recurrence-free survival was evaluated by the Kaplan-Meier method with a log-rank test. Histopathologic reports were used as the reference standard. RESULTS The overall accuracy of MRI for stratifying subgroups was 71.2% (104/146) and 77.4% (113/146) for reviewers 1 and 2. Extramural depth of tumor invasion was an independent risk factor for 3-year recurrence-free survival (hazard ratio, 2.186; 95% CI, 1.336-3.577; p = 0.002). Kaplan-Meier curves revealed a significant difference in 3-year recurrence-free survival rates for each subgroup (86%, 69%, and 43% for T3a, T3b, and T3c; p < 0.03). CONCLUSION MRI can be used for prognostic stratification according to extramural depth of tumor invasion based on the RSNA proposal for patients with T3 rectal cancer.
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Heijnen LA, Maas M, Lahaye MJ, Lalji U, Lambregts DMJ, Martens MH, Riedl RG, Beets GL, Beets-Tan RGH. Value of gadofosveset-enhanced MRI and multiplanar reformatting for selecting good responders after chemoradiation for rectal cancer. Eur Radiol 2014; 24:1845-52. [PMID: 24898096 DOI: 10.1007/s00330-014-3231-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 04/23/2014] [Accepted: 05/08/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Our primary objective was to evaluate diagnostic performance of gadofosveset T1-weighted magnetic resonance imaging (T1W MRI) for discriminating between ypT0-2 and ypT3-4 tumours after chemoradiation therapy (CRT) for rectal cancer compared with T2W MRI for a general and expert reader. Second objectives included assessing the value of multiplanar reformatting (MPR) and interobserver agreement. METHODS A general and expert reader evaluated 49 patients for likelihood of ypT0-2 tumour after CRT on T2W, gadofosveset T1W MRI, and gadofosveset T1W MRI + T2W MRI. The general reader scored with and without MPR. Confidence level scores were used to construct receiver-operating characteristic (ROC) curves. Area under the curve (AUC) values and diagnostic parameters were calculated and compared. RESULTS Gadofosveset T1W MRI + T2W MRI showed slightly superior sensitivity than T2W MRI for the general but not the expert reader. Specificity was higher for the expert on gadofosveset T1W MRI only compared with T2W MRI only (100% vs. 82%). MPR did not increase diagnostic performance. Interobserver agreement was highest for the combination of gadofosveset-enhanced T1W imaging plus T2W MRI. CONCLUSIONS The sole use or addition of gadofosveset-enhanced T1W MRI to T2W MRI did not increase significantly diagnostic performance for assessing ypT0-2 tumours. Adding gadofosveset-enhanced T1W MRI slightly increased sensitivity for the general reader and specificity for the expert reader, but this increase was not significant for more accurate clinical decision making. MPR did not improve diagnostic performance. KEY POINTS • ycT restaging with MRI in rectal cancer is challenging. • Gadofosveset-enhanced T1W MRI has shown promise for nodal restaging. • Gadofosveset-enhanced T1W MRI did not significantly increase diagnostic performance for assessing ypT0-2-tumours. • Addition of the gadofosveset sequence to T2W MRI slightly increased sensitivity for the general reader. • MPR did not improve diagnostic performance of ycT staging.
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Affiliation(s)
- Luc A Heijnen
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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Abstract
BACKGROUND Conventional MRI is limited in the assessment of nodal status and T status after neoadjuvant chemoradiotherapy. Multiparametric MRI strives to overcome these issues by directly measuring the local microcirculation and cellular environment, thus possibly allowing for a more reliable evaluation of response to therapy. OBJECTIVE We assessed the available literature for the value of multiparametric MRI sequences (diffusion-weighted and dynamic contrast-enhanced imaging) in determining the response to neoadjuvant chemoradiotherapy in patients with rectal cancer. DATA SOURCES We conducted a systematic literature research in the PubMed database. STUDY SELECTION English-language publications of the years 2000-2013 that applied multiparametric MRI in the neoadjuvant setting were included in this study. INTERVENTION Patients received neoadjuvant chemoradiotherapy and MRI examinations for staging and assessment of response. MAIN OUTCOME MEASURES Accuracy, specificity, and sensitivity of MRI in prediction/assessment of response to therapy were the included measures. RESULTS Forty-three studies were included in this review; 30 of them included diffusion-weighted imaging sequences, and 13 included dynamic contrast-enhanced MRI. Conventional MRI is limited in the accuracy of both T and N stages and response assessment. Diffusion-weighted imaging and dynamic contrast-enhanced MRIs showed additional value in both the prediction and detection of (complete) response to therapy compared with conventional sequences alone, as well as in correct N staging along with new experimental contrast agents. LIMITATIONS The lack of standardization represents an important technical limitation. Most studies are conducted in an experimental setting; therefore, larger multicenter prospective studies are needed to verify the present findings. CONCLUSIONS Advanced, functional MRI techniques allow for the quantification of tumor biological processes, such as microcirculation, vascular permeability, and tissue cellularity. This new technology has begun to show potential advantages over standard morphologic imaging in the restaging of rectal cancer, allowing for more accurate prognostication of response and potentially introducing an era allowing earlier treatment alteration and more accurate noninvasive surveillance, which could improve patient outcomes.
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