1
|
Stanietzky N, Morani A, Surabhi V, Jensen C, Horvat N, Vikram R. Mucinous Rectal Adenocarcinoma-Challenges in Magnetic Resonance Imaging Interpretation. J Comput Assist Tomogr 2024:00004728-990000000-00296. [PMID: 38446711 DOI: 10.1097/rct.0000000000001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
ABSTRACT Mucinous rectal cancer (MRC) is defined by the World Health Organization as an adenocarcinoma with greater than 50% mucin content. Classic teaching suggests that it carries a poorer prognosis than conventional rectal adenocarcinoma. This poorer prognosis is thought to be related to mucin dissecting through tissue planes at a higher rate, thus increasing the stage of disease at presentation. Developments in immunotherapy have bridged much of this prognostic gap in recent years. Magnetic resonance imaging is the leading modality in assessing the locoregional spread of rectal cancer. Mucinous rectal cancer carries unique imaging challenges when using this modality. Much of the difficulty lies in the inherent increased T2-weighted signal of mucin on magnetic resonance imaging. This creates difficulty in differentiating mucin from the adjacent background fat, making the detection of both the primary disease process as well as the locoregional spread challenging. Computed tomography scan can act as a valuable companion modality as mucin tends to be more apparent in the background fat. After therapy, diagnostic challenges remain. Mucin is frequently present, and distinguishing cellular from acellular mucin can be difficult. In this article, we will discuss each of these challenges and present examples of such situations and strategies that can be used to overcome them.
Collapse
Affiliation(s)
- Nir Stanietzky
- From the Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ajaykumar Morani
- From the Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Venkateswar Surabhi
- From the Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Corey Jensen
- From the Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Raghu Vikram
- From the Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
2
|
Marjasuo S, Koskenvuo L, Lepistö A. Findings in magnetic resonance imaging for restaging locally advanced rectal cancer. Int J Colorectal Dis 2024; 39:23. [PMID: 38289485 PMCID: PMC10827956 DOI: 10.1007/s00384-024-04595-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE We aimed to assess the prognostic value of restaging magnetic resonance imaging (MRI) in rectal cancer after neoadjuvant therapy and compare long-course chemoradiotherapy (LC-CRT) to short-course radiotherapy with delayed surgery (SCRT-delay). METHODS This retrospective study included 267 patients with locally advanced rectal cancer (LARC) operated on between January 2016 and April 2019, all of whom received either LC-CRT or SCRT-delay in the neoadjuvant setting. The primary outcomes were overall survival (OS) and cancer-specific survival (CSS) based on radiological response assessed using the magnetic resonance tumor regression grade (mrTRG). RESULTS In the LC-CRT group, cumulative 1-, 3-, and 5-year OS rates were 94.8%, 86.4%, and 79.0%, while in the SCRT-delay group, they were 83.3%, 68.9%, and 68.9% (P = 0.017). For CSS in the LC-CRT group, cumulative rates were 96.9%, 90.3%, and 85.0%, and in the SCRT-delay group, they were 88.6%, 81.4%, and 81.4% (P = 0.222). There were no significant differences in total histological response rates or local recurrence rates between the treatment groups. The good and moderate response group (mrTRG 1-3) had significantly better cumulative 1-, 3-, and 5-year OS and CSS compared to the poorer response group (mrTRG 4-5) (P = 0.023 for OS and P = 0.048 for CSS). CONCLUSION Unfavorable MRI response is a sign of poor prognosis in LARC. SCRT-delay is comparable to LC-CRT concerning the oncological outcome.
Collapse
Affiliation(s)
- Suvi Marjasuo
- Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
- Tays Central Hospital, Imaging Services, PL 2000, 33521, Tampere, Finland.
| | - Laura Koskenvuo
- Gastroenterological Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Anna Lepistö
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Applied Tumor Genomics, Research Programs Unit Organization, University of Helsinki, Helsinki, Finland
| |
Collapse
|
3
|
Stanojevic A, Spasic J, Marinkovic M, Stojanovic-Rundic S, Jankovic R, Djuric A, Zoidakis J, Fijneman RJA, Castellvi-Bel S, Cavic M. Methylenetetrahydrofolate reductase polymorphic variants C677T and A1298C in rectal cancer in Slavic population: significance for cancer risk and response to chemoradiotherapy. Front Genet 2024; 14:1299599. [PMID: 38288161 PMCID: PMC10822895 DOI: 10.3389/fgene.2023.1299599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/31/2023] [Indexed: 01/31/2024] Open
Abstract
Background: Methylenetetrahydrofolate reductase (MTHFR) single nucleotide polymorphisms (SNPs) have been suggested as risk, prognostic, and predictive factors for colorectal cancer in various populations, but have not been validated so far. The aim of this study was to examine the association of MTHFR C677T (rs1801133) and A1298C (rs1801131) single nucleotide polymorphisms with the risk of rectal cancer as well as the response to neoadjuvant chemoradiotherapy (nCRT) based on 5-Fluorouracil (5-FU)/leucovorin (LV) in the locally advanced setting. Patients and methods: This case-control study included 119 healthy controls and 97 patients with locally advanced rectal cancer (LARC). For MTHFR genotyping, restriction fragment length polymorphism analysis (PCR-RFLP) was employed. Results: In silico analysis highlighted that SNPs C677T and A1298T correlate with MTHFR gene expression, and that gene expression profile correlates with cancer risk and stage. Using dominant and recessive models, it was found that the MTHFR 677CC vs. 677CT+677TT have increased risk of cancer development (odds ratio (OR): 2.27; 95% confidence interval (CI): 1.30-3.95, p = 0.002) as well as 677CC+677CT compared to 677TT (OR: 4.18, 95% CI: 1.16-14.99, p = 0.014). MTHFR 1298AA also shown increased risk for cancer development compared to 1298AC+1298CC (OR:2.0, 95% CI: 1.20-3.59, p = 0.035) Statistical analysis of combined genotypes highlighted the protective role of CT/AC combined genotype (OR: 3.15 95% CI: 1.576-6.279, p = 0.002) while the CC/AA genotype showed an increased risk for rectal cancer development (OR: 2.499, 95% CI: 1.246-5.081, p = 0.016) The carriers of the 677C/1298A haplotype had the highest risk for developing rectal cancer (OR: 1.74; 95% CI: 1.198-2.530, p = 0.002) while the 677T/1298C haplotype seems to provide a protective effect. (OR: 0.44; 95%CI 0.248-0.795, p = 0.003). No significant association with response to chemoradiotherapy was found. Conclusion: Our data point to MTHFR 667C allele and 1298A alleles as low-penetrance risk factors for rectal cancer in our population. To the best of our knowledge, this is the first study of this type performed on the Slavic population in the Western Balkan, as various population-based factors might also be significant our findings can be used for future meta-analyses and the construction of genetic cancer risk prediction panels.
Collapse
Affiliation(s)
- Aleksandra Stanojevic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Jelena Spasic
- Clinic for Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Mladen Marinkovic
- Clinic for Radiation Oncology and Diagnostics, Department of Radiation Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Suzana Stojanovic-Rundic
- Clinic for Radiation Oncology and Diagnostics, Department of Radiation Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Radmila Jankovic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Ana Djuric
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Jerome Zoidakis
- Department of Biotechnology, Biomedical Research Foundation, Academy of Athens, Athens, Greece
- Department of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Sergi Castellvi-Bel
- Gastroenterology Department, Fundació Recerca Clínic Barcelona-Institutd’Investigacions Biomèdiques August Pi iSunyer, Centro de Investigación Biomédicaen Red de Enfermedades Hepáticas y Digestivas, Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Milena Cavic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| |
Collapse
|
4
|
Katdare AN, Baheti AD, Pangarkar SY, Mistry KA, Ankathi SK, Haria PD, Choudhari AJ, Guha A, Gala K, Shetty N, Kulkarni S, Ramadwar M, Bal M. Evaluation of an Objective MRI-Based Tumor Regression Grade (mrTRG) Score and a Subjective Likert Score for Assessing Treatment Response in Locally Advanced Rectal Cancers-A Retrospective Study. Indian J Radiol Imaging 2024; 34:69-75. [PMID: 38106857 PMCID: PMC10723953 DOI: 10.1055/s-0043-1772695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Purpose: Magnetic resonance imaging (MRI) with the help of MRI-based tumor regression grade (mrTRG) score has been used as a tool to predict pathological tumor regression grade (pTRG) in patients of rectal cancer post-neoadjuvant chemoradiation. Our study aims to evaluate the ability of MRI in assessing treatment response comparing an objective mrTRG score and a subjective Likert score, with a focus on the ability to predict pathologic complete response (pCR). Methods: Post-treatment MRI studies were retrospectively reviewed for 170 consecutive cases of histopathologically proven rectal cancer after receiving neoadjuvant chemoradiation and prior to surgery by two oncoradiologists blinded to the eventual postoperative histopathology findings. An objective (mrTRG) and a subjective Likert score were assigned to all the cases. Receiver operating characteristic curves were constructed to determine the ability of Likert scale and mrTRG to predict pCR, with postoperative histopathology being the gold standard. The optimal cutoff points on the scale of 1 to 5 were obtained for mrTRG and Likert scale with the greatest sum of sensitivity and specificity using the Youden Index. Results: The most accurate cutoff point for the mrTRG to predict complete response was 2.5 (using Youden index), with a sensitivity of 69.2%, specificity of 69.6%, positive predictive value (PPV) of 85.6%, negative predictive value (NPV) of 46.4%, and accuracy of 69.3%. The most accurate cutoff for the Likert scale to predict complete response was 3.5, with a sensitivity of 47.5%, specificity of 89.1%, PPV of 91.9%, NPV of 39.4%, and accuracy of 59%. mrTRG had a lower cutoff and was more accurate in predicting pCR compared to Likert score. Conclusion: An objective mrTRG was more accurate than a subjective Likert scale to predict complete response in our study.
Collapse
Affiliation(s)
- Aparna N Katdare
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Akshay D Baheti
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sayali Y Pangarkar
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kunal A Mistry
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Suman K Ankathi
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Purvi D Haria
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit J Choudhari
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amrita Guha
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kunal Gala
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nitin Shetty
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Suyash Kulkarni
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mukta Ramadwar
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Munita Bal
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
5
|
Nougaret S, Rousset P, Lambregts DMJ, Maas M, Gormly K, Lucidarme O, Brunelle S, Milot L, Arrivé L, Salut C, Pilleul F, Hordonneau C, Baudin G, Soyer P, Brun V, Laurent V, Savoye-Collet C, Petkovska I, Gerard JP, Cotte E, Rouanet P, Catalano O, Denost Q, Tan RB, Frulio N, Hoeffel C. MRI restaging of rectal cancer: The RAC (Response-Anal canal-CRM) analysis joint consensus guidelines of the GRERCAR and GRECCAR groups. Diagn Interv Imaging 2023; 104:311-322. [PMID: 36949002 DOI: 10.1016/j.diii.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/09/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To develop guidelines by international experts to standardize data acquisition, image interpretation, and reporting in rectal cancer restaging with magnetic resonance imaging (MRI). MATERIALS AND METHODS Evidence-based data and experts' opinions were combined using the RAND-UCLA Appropriateness Method to attain consensus guidelines. Experts provided recommendations for reporting template and protocol for data acquisition were collected; responses were analysed and classified as "RECOMMENDED" versus "NOT RECOMMENDED" (if ≥ 80% consensus among experts) or uncertain (if < 80% consensus among experts). RESULTS Consensus regarding patient preparation, MRI sequences, staging and reporting was attained using the RAND-UCLA Appropriateness Method. A consensus was reached for each reporting template item among the experts. Tailored MRI protocol and standardized report were proposed. CONCLUSION These consensus recommendations should be used as a guide for rectal cancer restaging with MRI.
Collapse
Affiliation(s)
- Stephanie Nougaret
- Department of Radiology IRCM, Montpellier Cancer Research Institute, 34000 Montpellier, France; INSERM, U1194, University of Montpellier, 34295, Montpellier, France.
| | - Pascal Rousset
- Department of Radiology, CHU Lyon-Sud, EMR 3738 CICLY, Université Claude-Bernard Lyon 1, 69495 Pierre-Benite, France
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Kirsten Gormly
- Jones Radiology, Kurralta Park, 5037, Australia; University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - Oliver Lucidarme
- Department of Radiology, Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, Sorbonne Université, 75013 Paris, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Laurent Milot
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Lionel Arrivé
- Department of Radiology, Hôpital Saint-Antoine, AP-HP, 75012 Paris, France; Sorbonne Université, 75013 Paris, France
| | - Celine Salut
- CHU de Bordeaux, Department of Radiology, Université de Bordeaux, 33000 Bordeaux, France
| | - Franck Pilleul
- Department of Radiology, Centre Léon Bérard, Lyon, France Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621, Lyon, France
| | | | - Guillaume Baudin
- Department of Radiology, Centre Antoine Lacassagne, 06100 Nice, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Vanessa Brun
- Department of Radiology, CHU Hôpital Pontchaillou, 35000 Rennes, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jean-Pierre Gerard
- Department of Radiotherapy, Centre Antoine Lacassagne, 06000 Nice, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hospices Civils de Lyon, Lyon Sud University Hospital, 69310 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Philippe Rouanet
- Department of Surgery, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France
| | - Onofrio Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Quentin Denost
- Department of Digestive Surgery, Hôpital Haut-Lévèque, Université de Bordeaux, 33000 Bordeaux, France
| | - Regina Beets Tan
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Nora Frulio
- CHU de Bordeaux, Department of Radiology, Université de Bordeaux, 33000 Bordeaux, France
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré & CRESTIC, URCA, 51092 Reims, France
| |
Collapse
|
6
|
Boughriba R, Sahraoui G, Chaar I, Weslati M, Ayed K, Ounissi D, Hazgui M, Bouraoui S, Gati A. Significant association of MCP1 rs1024611 and CCR2 rs1799864 polymorphisms with colorectal cancer and liver metastases susceptibility and aggressiveness: A case-control study. Cytokine 2023; 167:156193. [PMID: 37149962 DOI: 10.1016/j.cyto.2023.156193] [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: 04/13/2022] [Revised: 02/07/2023] [Accepted: 03/26/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND The MCP-1/CCR2 axis is one of the major chemokine signaling pathways that play a crucial role in the tumor microenvironment and has been involved in triggering various tumor progression mechanisms, such as increasing the immunosuppressive cells recruitment and promoting tumor cell proliferation and invasiveness. AIM The current study investigated the association of MCP1 (rs1024611) and CCR2 (rs1799864) genes variants with the risk as well as prognosis of colorectal cancer (CRC) and colorectal liver metastases (CRLM). SUBJECTS AND METHODS A retrospective cohort study involved 408 patients (284 CRC and 124 CRLM), and 284 healthy control was conducted. Genotyping of selected polymorphisms was performed by PCR-RFLP assays and confirmed by microchip and capillary electrophoresis. RESULTS The results highlighted a positive association between MCP1 rs1024611 (non-AA) and CCR2 rs1799864 (GA) genotypes with increased CRC and CRLM risk. Correlation between SNPs and clinicopathological characteristics revealed a positive association between MCP1 rs1024611 and CCR2 rs1799864 (dominant model) and CRC poor prognosis features. Kaplan-Meier survival analysis revealed a significant association between MCP1 rs1024611 non-AA carriers and decreased survival rate. Neoadjuvant treatment showed an improvement in CRC and CRLM survival rates among carriers of MCP1 and CCR2 wild-type genotype. FOLFIRI chemotherapy exhibits reduced survival rates for patients who carried mutated genotypes of MCP1 and CCR2 polymorphisms. CONCLUSION Considering our results, we suggest That both MCP1 and CCR2 polymorphisms may constitute independent factors for CRC and CRLM occurrence and can be helpful targets for an efficient therapeutic approach.
Collapse
Affiliation(s)
- Rahma Boughriba
- Laboratory of Genetic, Immunology and Human Pathology, Faculty of Sciences of Tunis, University of Tunis El Manar (UTM), 2092 Tunis, Tunisia; Unit of Colorectal Cancer Research UR12SP14, Mongi Slim Hospital, Sidi Daoud, La Marsa, 2046 Tunis, Tunisia
| | - Ghada Sahraoui
- Department of Pathological Anatomy and Cytology of Salah Azaiez Oncology Institute, Bab Saadoun 1029 Tunis, Tunisia; Medical School of Tunis, University of Tunis El Manar, 15 rue Djebel Lakhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Ines Chaar
- Unit of Colorectal Cancer Research UR12SP14, Mongi Slim Hospital, Sidi Daoud, La Marsa, 2046 Tunis, Tunisia
| | - Marwa Weslati
- Unit of Colorectal Cancer Research UR12SP14, Mongi Slim Hospital, Sidi Daoud, La Marsa, 2046 Tunis, Tunisia
| | - Khouloud Ayed
- Laboratory of Genetic, Immunology and Human Pathology, Faculty of Sciences of Tunis, University of Tunis El Manar (UTM), 2092 Tunis, Tunisia
| | - Donia Ounissi
- Unit of Colorectal Cancer Research UR12SP14, Mongi Slim Hospital, Sidi Daoud, La Marsa, 2046 Tunis, Tunisia
| | - Mariem Hazgui
- Unit of Colorectal Cancer Research UR12SP14, Mongi Slim Hospital, Sidi Daoud, La Marsa, 2046 Tunis, Tunisia
| | - Saadia Bouraoui
- Unit of Colorectal Cancer Research UR12SP14, Mongi Slim Hospital, Sidi Daoud, La Marsa, 2046 Tunis, Tunisia; Medical School of Tunis, University of Tunis El Manar, 15 rue Djebel Lakhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Asma Gati
- Laboratory of Genetic, Immunology and Human Pathology, Faculty of Sciences of Tunis, University of Tunis El Manar (UTM), 2092 Tunis, Tunisia.
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Boubaddi M, Fleming C, Vendrely V, Frulio N, Salut C, Rullier E, Denost Q. Feasibility study of a Response Surveillance Program in locally advanced mid and low rectal cancer to increase organ preservation. Eur J Surg Oncol 2023; 49:237-243. [PMID: 36114048 DOI: 10.1016/j.ejso.2022.08.031] [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: 06/13/2022] [Revised: 08/02/2022] [Accepted: 08/25/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Assessment of tumor response in rectal cancer after neoadjuvant treatment by MRI (Tumour Regression Grade, TRG 1-5) is well standardized. The overall timing and method of defining complete response (cCR) remain controversial. The aim of this work was to evaluate the feasibility of a defined Response Surveillance Program (RSP) to increase organ preservation for locally advanced rectal cancer after neoadjuvant treatment. METHODS A standardized program of clinical (CR), radiological (RR) and metabolic (MR) assessment of tumor response is defined over a 6 month period from completion of NACRT with formal assessment performed every 2 months (M). Patients with TRG1-3 at M2 and TRG1-2 at M4 continue in the program up to M6 assessment. Patients managed with this protocol from 2016 to 2020 were analyzed. The primary endpoint was rectal preservation rate. Secondary endpoints included disease-free survival and overall survival at 3 years. RESULT 314 potentially suitable patients were enrolled in the RSP and 50 patients completed the six month program and were successfully enrolled into watch and wait. Fourteen (28%) were T2 tumor stage, 27 (54%) T3 and nine (18%) were T4. During watch and wait, patients with locoregional recurrence (n = 11) were treated with local excision (n = 3), endocavitary radiotherapy (n = 1), TME (n = 5) and APR (n = 2). With a median follow-up of 32 months, the rectal preservation rate was 88%, with a 3-year disease-free survival of 67% and an overall survival of 98%. CONCLUSION This study validates the feasibility of the practical implementation of a Response Surveillance Program to increase organ preservation rates without compromising oncological outcomes in rectal cancer.
Collapse
Affiliation(s)
| | | | | | - Nora Frulio
- Department of Radiology, CHU, Bordeaux, France
| | | | - Eric Rullier
- Department of Colorectal Surgery, CHU, Bordeaux, France
| | - Quentin Denost
- Department of Colorectal Surgery, CHU, Bordeaux, France.
| |
Collapse
|
9
|
Tan Z, Cheng L, Xie L, Zhang L, Lin Z, Han P, Li X. Comparison of the diagnostic performance of changes in signal intensity and volume from multiparametric MRI for assessing response of rectal cancer to neoadjuvant chemoradiotherapy. Asia Pac J Clin Oncol 2022; 19:327-336. [PMID: 36271652 DOI: 10.1111/ajco.13878] [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: 03/05/2022] [Revised: 07/05/2022] [Accepted: 09/25/2022] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the change in signal intensity (SI) and volume (V) from multiparametric magnetic resonance imaging (MRI) for assessing the response of locally advanced rectal cancer (LARC) to chemoradiotherapy (CRT). MATERIALS AND METHODS Eight-two LARC patients who underwent pre- and post-CRT T2-weighted (T2W), apparent diffusion coefficient (ADC), and contrast-enhanced T1-weighted (ceT1W) MRI were retrospectively analyzed. The change of volume (%△V) and relative SI ratio (%△SIR) from each sequence were determined. All LARCs were confirmed pathologically and classified as tumor regression grade (TRG) -0, 1, 2,or 3. Descriptive statistics and receiver operating characteristic (ROC) analysis, with calculation of area under the curve (AUC), were used to compare the diagnostic performances. RESULTS Sixteen patients had TRG-0, 15 had TRG-1, 35 had TRG-2, and 16 had TRG-3. Except for ADC-%△SIR, the remaining %△V and %△SIR values on MR sequences had significant differences among the four groups. The %△V and %△SIR (alone or together) did not distinguish TRG-1 from TRG-2, nor TRG-2 from TRG-3; however, differences between other TRGs were identified by %△V and %△SIR. The combined use of ADC-%△V and T2W-%△SIR provided the best diagnostic performance in distinguishing of TRG-0 from TRG-2 (AUC: 0.954) and from TRG-3 (AUC: 1.000). CONCLUSIONS Preoperative MRI of LARC patients after CRT has high diagnostic value for determination TRG, and may therefore improve the selection of patients most suitable for surgery.
Collapse
Affiliation(s)
- Zhengwu Tan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | - Lan Cheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | - Lingling Xie
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lan Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | - Zhenyu Lin
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | - Xin Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| |
Collapse
|
10
|
He L, Xiao J, Zheng P, Zhong L, Peng Q. Lymph node regression grading of locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. World J Gastrointest Oncol 2022; 14:1429-1445. [PMID: 36160739 PMCID: PMC9412927 DOI: 10.4251/wjgo.v14.i8.1429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/30/2022] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Abstract
Neoadjuvant chemoradiotherapy (nCRT) and total rectal mesenteric excision are the main standards of treatment for locally advanced rectal cancer (LARC). Lymph node regression grade (LRG) is an indicator of prognosis and response to preoperative nCRT based on postsurgical metastatic lymph node pathology. Common histopathological findings in metastatic lymph nodes after nCRT include necrosis, hemorrhage, nodular fibrosis, foamy histiocytes, cystic cell reactions, areas of hyalinosis, residual cancer cells, and pools of mucin. A number of LRG systems designed to classify the amount of lymph node regression after nCRT is mainly concerned with the relationship between residual cancer cells and regressive fibrosis and with estimating the number of lymph nodes existing with residual cancer cells. LRG offers significant prognostic information, and in most cases, LRG after nCRT correlates with patient outcomes. In this review, we describe the systematic classification of LRG after nCRT, patient prognosis, the correlation with tumor regression grade, and the typical histopathological findings of lymph nodes. This work may serve as a reference to help predict the clinical complete response and determine lymph node regression in patients based on preservation strategies, allowing for the formulation of more accurate treatment strategies for LARC patients, which has important clinical significance and scientific value.
Collapse
Affiliation(s)
- Lei He
- School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China
| | - Juan Xiao
- School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China
| | - Ping Zheng
- Department of Pathology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, Sichuan Province, China
| | - Lei Zhong
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China
| | - Qian Peng
- Radiation Therapy Center, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
11
|
Han J, Kim JH, Lee JW, Han SH, Kim H. Neoadjuvant therapy of metformin is associated with good tumor response after preoperative concurrent chemoradiotherapy for rectal cancer. Sci Rep 2022; 12:3716. [PMID: 35260687 PMCID: PMC8904786 DOI: 10.1038/s41598-022-07768-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
Metformin is associated with good tumor response in preoperative concurrent chemoradiotherapy (CCRT) for rectal cancer. This study aims to demonstrate that the timing of metformin is related to the tumor response on preoperative CCRT for rectal cancer. From January 2010 to December 2017, 232 patients who underwent curative resection after preoperative CCRT were reviewed. Patients were divided into groups with or without diabetes or metformin. The timing of metformin administration was divided based on before and from initiation of CCRT. Multivariate logistic regression analysis was used to identify predictors for tumor response. Tumor downstaging (p = 0.02) and good response rates of tumor regression grade (TRG) (p = 0.008) were significantly higher in the group administered metformin before CCRT than other groups. In the multivariate analysis, metformin administration before CCRT was a significant factor in predicting tumor downstaging [odds ratio (OR) 10.31, 95% confidence interval (CI) 1.76–102.08, p = 0.02] and good TRG (OR 12.55, 95% CI 2.38–80.24, p = 0.004). In patients with rectal cancer who underwent preoperative CCRT, neoadjuvant therapy of metformin before CCRT was significantly associated with good tumor response.
Collapse
Affiliation(s)
- Jeonghee Han
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, 24253, Republic of Korea.,Department of Pharmacology, Kangwon University College of Medicine, Chuncheon, Republic of Korea
| | - Jong Ho Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, 24253, Republic of Korea
| | - Jin-Won Lee
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, 24253, Republic of Korea
| | - Sang Hyup Han
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, 24253, Republic of Korea
| | - Haesung Kim
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, 24253, Republic of Korea.
| |
Collapse
|
12
|
Azamat S, Karaman Ş, Azamat IF, Ertaş G, Kulle CB, Keskin M, Sakin RND, Bakır B, Oral EN, Kartal MG. Complete Response Evaluation of Locally Advanced Rectal Cancer to Neoadjuvant Chemoradiotherapy Using Textural Features Obtained from T2 Weighted Imaging and ADC Maps. Curr Med Imaging 2022; 18:1061-1069. [PMID: 35240976 DOI: 10.2174/1573405618666220303111026] [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: 08/20/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The prediction of pathological responses for locally advanced rectal cancer using magnetic resonance imaging (MRI) after neoadjuvant chemoradiotherapy (CRT) is a challenging task for radiologists, as residual tumor cells can be mistaken for fibrosis. Texture analysis of MR images has been proposed to understand the underlying pathology. OBJECTIVE This study aimed to assess the responses of lesions to CRT in patients with locally advanced rectal cancer using the first-order textural features of MRI T2-weighted imaging (T2-WI) and apparent diffusion coefficient (ADC) maps. METHODS Forty-four patients with locally advanced rectal cancer (median age: 57 years) who underwent MRI before and after CRT were enrolled in this retrospective study. The first-order textural parameters of tumors on T2-WI and ADC maps were extracted. The textural features of lesions in pathologic complete responders were compared to partial responders using Student's t- or Mann-Whitney U tests. A comparison of textural features before and after CRT for each group was performed using the Wilcoxon rank sum test. Receiver operating characteristic curves were calculated to detect the diagnostic performance of the ADC. RESULTS Of the 44 patients evaluated, 22 (50%) were placed in a partial response group and 50% were placed in a complete response group. The ADC changes of the complete responders were statistically more significant than those of the partial responders (P = 0.002). Pathologic total response was predicted with an ADC cut-off of 1310 x 10-6 mm2/s, with a sensitivity of 72%, a specificity of 77%, and an accuracy of 78.1% after neoadjuvant CRT. The skewness of the T2-WI before and after neoadjuvant CRT showed a significant difference in the complete response group compared to the partial response group (P = 0.001 for complete responders vs. P = 0.482 for partial responders). Also, relative T2-WI signal intensity in the complete response group was statistically lower than that of the partial response group after neoadjuvant CRT (P = 0.006). CONCLUSION As a result of the conversion of tumor cells to fibrosis, the skewness of the T2-WI before and after neoadjuvant CRT was statistically different in the complete response group compared to the partial response group, and the complete response group showed statistically lower relative T2-WI signal intensity than the partial response group after neoadjuvant CRT. Additionally, the ADC cut-off value of 1310 × 10-6 mm2/s could be used as a marker for complete response along with absolute ADC value changes within this dataset.
Collapse
Affiliation(s)
- Sena Azamat
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
- Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Şule Karaman
- Department of Radiation Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ibrahim Fethi Azamat
- Department of General Surgery, Faculty of Medicine, Koc University, Istanbul, Turke
| | - Gokhan Ertaş
- Biomedical Engineering Department, Yeditepe University, Istanbul, Turkey
| | - Cemil Burak Kulle
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Metin Keskin
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Barış Bakır
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ethem Nezih Oral
- Department of Radiation Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Merve Gulbiz Kartal
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
13
|
Achilli P, Magistro C, Abd El Aziz MA, Calini G, Bertoglio CL, Ferrari G, Mari G, Maggioni D, Peros G, Tamburello S, Coppola E, Spinelli A, Grass F, Martin D, Hahnloser D, Salvatori A, De Simoni S, Sheedy SP, Fletcher JG, Larson DW. Modest agreement between magnetic resonance and pathological tumor regression after neoadjuvant therapy for rectal cancer in the real world. Int J Cancer 2022; 151:120-127. [PMID: 35191540 DOI: 10.1002/ijc.33975] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/12/2022]
Abstract
Magnetic Resonance Imaging (MRI) is routinely used for preoperative tumor staging and to assess response to therapy in rectal cancer patients. The aim of this study was to evaluate the accuracy of MRI based restaging after neoadjuvant CRT in predicting pathologic response. This multicenter cohort study included adult patients with histologically confirmed locally advanced rectal adenocarcinoma treated with neoadjuvant CRT followed by curative intent elective surgery between January 2014 and December 2019 at four academic high-volume institutions. Magnetic resonance tumor regression grade (mrTRG) and pathologic tumor regression grade (pTRG) were reviewed and compared for all the patients. The agreement between radiologist and pathologist was assessed with the weighted k test. Risk factors for poor agreement were investigated using logistic regression. A total of 309 patients were included. Modest agreement was found between mrTRG and pTRG when regression was classified according to standard five-tier systems (k=0.386). When only two categories were considered for each regression system, (pTRG 0-3 vs. pTRG 4; mrTRG 2-5 vs. mrTRG 1) an accuracy of 78% (IC 95% 0.73-0.83) was found between radiologic and pathologic assessment with a k value of 0.185.The logistic regression model revealed that "T3 greater than 5mm extent" was the only variable significantly impacting on disagreement (OR 0.33, 95% CI 0.15-0.68, p=0.0034). Modest agreement exhists between mrTRG and pTRG. The chances of appropriate assessment of the regression grade after neoadjuvant CRT appear to be higher in case of a T3 tumor with at least 5mm extension in the mesorectal fat at the pre-treatment MRI. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Pietro Achilli
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of mini-invasive surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carmelo Magistro
- Department of mini-invasive surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Giacomo Calini
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Camillo L Bertoglio
- Department of mini-invasive surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Ferrari
- Department of mini-invasive surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulio Mari
- Department of surgery, Desio Hospital, Desio, Italy
| | | | - Georgios Peros
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy
| | - Sara Tamburello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy
| | - Elisabetta Coppola
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano - Milan, Italy
| | - Fabian Grass
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - David Martin
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Dieter Hahnloser
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Andrea Salvatori
- Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Silvia De Simoni
- Department of Radiology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Joel G Fletcher
- Mayo Clinic Department of Radiology, Rochester, Minnesota, USA
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
14
|
Rectal cancer response to neoadjuvant chemoradiotherapy evaluated with MRI: Development and validation of a classification algorithm. Eur J Radiol 2022; 147:110146. [PMID: 34998098 DOI: 10.1016/j.ejrad.2021.110146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to develop and validate a decision support model using data mining algorithms, based on morphologic features derived from MRI images, to discriminate between complete responders (CR) and non-complete responders (NCR) patients after neoadjuvant chemoradiotherapy (CRT), in a population of patients with locally advanced rectal cancer (LARC). METHODS Two populations were retrospectively enrolled: group A (65 patients) was used to train a data mining decision tree algorithm whereas group B (30 patients) was used to validate it. All patients underwent surgery; according to the histology evaluation, patients were divided in CR and NCR. Staging and restaging MRI examinations were retrospectively analysed and seven parameters were considered for data mining classification. Five different classification methods were tested and evaluated in terms of sensitivity, specificity, accuracy and AUC in order to identify the classification model able to achieve the best performance. The best classification algorithm was subsequently applied to group B for validation: sensitivity, specificity, positive and negative predictive value, accuracy and ROC curve were calculated. Inter and intra-reader agreement were calculated. RESULTS Four features were selected for the development of the classification algorithm: MRI tumor regression grade (MR-TRG), staging volume (SV), tumor volume reduction rate (TVRR) and signal intensity reduction rate (SIRR). The decision tree J48 showed the highest efficiency: when applied to group B, all the CR and 18/21 NCR were correctly classified (sensitivity 85.71%, specificity 100%, PPV 100%, NPV 94.2%, accuracy 95.7%, AUC 0.833). Both inter- and intra-reader evaluation showed good agreement (κ > 0.6). CONCLUSIONS The proposed decision support model may help in distinguishing between CR and NCR patients with LARC after CRT.
Collapse
|
15
|
Wan L, Peng W, Zou S, Ye F, Geng Y, Ouyang H, Zhao X, Zhang H. MRI-based delta-radiomics are predictive of pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Acad Radiol 2021; 28 Suppl 1:S95-S104. [PMID: 33189550 DOI: 10.1016/j.acra.2020.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the capability of delta-radiomics to predict pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC). MATERIALS AND METHODS This retrospective study enrolled 165 consecutive patients with LARC (training set, n = 116; test set, n = 49) who received nCRT before surgery. All patients underwent pre- and post-nCRT MRI examination from which radiomics features were extracted. A delta-radiomics feature was defined as the percentage change in a radiomics feature from pre- to post-nCRT MRI. A data reduction and feature selection process including the least absolute shrinkage and selection operator algorithm was performed for building T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) delta-radiomics signature. Logistic regression was used to build a T2WI and DWI combined radiomics model. Receiver operating characteristic analysis was performed to assess diagnostic performance. Delong method was used to compare the performance of delta-radiomics model with that of magnetic resonance tumor regression grade (mrTRG). RESULTS Twenty-seven of 165 patients (16.4%) achieved pCR. T2WI and DWI delta-radiomics signature, and the combined model showed good predictive performance for pCR. The combined model achieved the highest areas under the receiver operating characteristic curves of 0.91 (95% confidence interval: 0.85-0.98) and 0.91 (95% confidence interval: 0.83-0.99) in the training and test sets, respectively (significantly greater than those for mrTRG; training set, p < 0.001; test set, p = 0.04). CONCLUSION MRI-based delta-radiomics can help predict pCR after nCRT in patients with LARC with better performance than mrTRG.
Collapse
|
16
|
Kokaine L, Gardovskis A, Gardovskis J. Evaluation and Predictive Factors of Complete Response in Rectal Cancer after Neoadjuvant Chemoradiation Therapy. ACTA ACUST UNITED AC 2021; 57:medicina57101044. [PMID: 34684080 PMCID: PMC8537499 DOI: 10.3390/medicina57101044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 12/18/2022]
Abstract
The response to neoadjuvant chemoradiation therapy is an important prognostic factor for locally advanced rectal cancer. Although the majority of the patients after neoadjuvant therapy are referred to following surgery, the clinical data show that complete clinical or pathological response is found in a significant proportion of the patients. Diagnostic accuracy of confirming the complete response has a crucial role in further management of a rectal cancer patient. As the rate of clinical complete response, unfortunately, is not always consistent with pathological complete response, accurate diagnostic parameters and predictive markers of tumor response may help to guide more personalized treatment strategies and identify potential candidates for nonoperative management more safely. The management of complete response demands interdisciplinary collaboration including oncologists, radiotherapists, radiologists, pathologists, endoscopists and surgeons, because the absence of a multidisciplinary approach may compromise the oncological outcome. Prediction and improvement of rectal cancer response to neoadjuvant therapy is still an active and challenging field of further research. This literature review is summarizing the main, currently known clinical information about the complete response that could be useful in case if encountering such condition in rectal cancer patients after neoadjuvant chemoradiation therapy, using as a source PubMed publications from 2010–2021 matching the search terms “rectal cancer”, “neoadjuvant therapy” and “response”.
Collapse
Affiliation(s)
- Linda Kokaine
- Department of Surgery, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; or
- Pauls Stradins Clinical University Hospital, Pilsoņu Street 13, LV-1002 Riga, Latvia
- Correspondence: (L.K.); (J.G.); Tel.: +371-2635-9472 (L.K.)
| | - Andris Gardovskis
- Department of Surgery, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; or
- Pauls Stradins Clinical University Hospital, Pilsoņu Street 13, LV-1002 Riga, Latvia
| | - Jānis Gardovskis
- Department of Surgery, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; or
- Pauls Stradins Clinical University Hospital, Pilsoņu Street 13, LV-1002 Riga, Latvia
- Correspondence: (L.K.); (J.G.); Tel.: +371-2635-9472 (L.K.)
| |
Collapse
|
17
|
Abstract
The management of rectal cancer is complex and continually evolving. With advancements in technology and the use of multidisciplinary teams to guide the treatment decision making, staging, oncologic, and functional outcomes are improving, and the management is moving toward personalized treatment strategies to optimize each individual patient's outcomes. Key in this evolution is imaging. Magnetic resonance imaging (MRI) has emerged as the dominant method of pelvic imaging in rectal cancer, and use of MRI for staging is best practice in multiple international guidelines. MRI allows a noninvasive assessment of the tumor site, relationship to surrounding structures, and provides highly accurate rectal cancer staging, which is necessary for determining the appropriate treatment strategy. However, the applications of MRI extend far beyond pretreatment staging. MRI can be used to predict outcomes in locally advanced rectal cancer and guide the surgical or nonsurgical plan, serving as a predictive and prognostic biomarker. With continued MRI hardware improvement and new sequence development, MRI may offer new perspectives in the assessment of treatment response and new innovations that could provide better insight into the staging, restaging, and outcomes with rectal cancer.
Collapse
Affiliation(s)
- Deborah S Keller
- Division of Colorectal Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
18
|
Guan Z, Sun RJ, Cao WT, Zhang HM, Yu T, Yu XP, Zhang JX, Zhang XY, Li XT, Zhou ZY, Zhao XM, Wen L, Sun YS. Magnetic resonance imaging tumor response score (mrTRS) predicts therapeutic effect and prognosis of locally advanced rectal cancer after neoadjuvant chemoradiotherapy: A prospective, multi-center study. Radiother Oncol 2020; 151:288-295. [PMID: 32890612 DOI: 10.1016/j.radonc.2020.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/25/2020] [Accepted: 08/30/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE The MRI-assessed tumor regression grade (mrTRG) is limited due to its subjectivity and poor consistency on pathological tumor regression grade (pTRG). A new MRI criterion was established to predict the prognosis of locally advanced rectal cancer (LARC). MATERIALS AND METHODS The new MRI criterion magnetic resonance imaging tumor response score (mrTRS) was based on the retrospective sample of 214 LARC patients (unpublished data). Subsequently, 878 LARC patients were enrolled for a prospective, multicenter study. Baseline and postoperative MRI were obtained, and imaging features were measured by collecting the pathological, clinical and follow-up data. Kaplan-Meier method with log-rank estimate and multivariate cox regression model was used to determine the prognosis of mrTRS in LARC patients with neoadjuvant chemoradiotherapy (NACRT). The predictive capability of 3-year prognosis between mrTRS and mrTRG was determined by time-dependent ROC curves. RESULTS The results demonstrated that mrTRS acted as an independent predictor of survival outcomes. mrTRS stratified by good and moderate responders showed significantly lower risk of death (HR = 0.04, 95%CI 0.01-0.31; HR = 0.35, 95%CI 0.23-0.52), distant metastasis (HR = 0.25, 95%CI 0.13-0.52; HR = 0.42, 95%CI 0.30-0.58), and local recurrence when compared with poor responders(HR = 0.01 95%CI 0.23-0.52;HR = 0.38, 95%CI 0.16-0.90). In contrast, no significant difference was observed among mrTRG stratified groups. Excellent and substantial interobserver agreement for mrTRS and mrTRG evaluation was observed (κ = 0.92 and 0.62), respectively. CONCLUSION mrTRS can serve as an effective predictor for assessing tumor regression grade in LARC patients with NACRT.
Collapse
Affiliation(s)
- Zhen Guan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Rui-Jia Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wu-Teng Cao
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hong-Mei Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Yu
- Department of Medical Imaging, Cancer Hospital of China Medical University, Shenyang, China; Department of Medical Imaging, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Xiao-Ping Yu
- Department of Radiology, Hunan Cancer Hospital, Changsha, China
| | - Jian-Xin Zhang
- Department of MR and CT, Shanxi Province Tumor Hospital, The Third People Hospital of Shanxi Province, Taiyuan, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhi-Yang Zhou
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin-Ming Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Wen
- Department of Radiology, Hunan Cancer Hospital, Changsha, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China.
| |
Collapse
|
19
|
Meng Y, Wan L, Zhang C, Wang C, Ye F, Li S, Zou S, Cheng J, Xu K, Zhou C, Zhang H. The Predictive Value of Pre-/Postneoadjuvant Chemoradiotherapy MRI Characteristics for Patient Outcomes in Locally Advanced Rectal Cancer. Acad Radiol 2020; 27:e233-e243. [PMID: 31780392 DOI: 10.1016/j.acra.2019.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/27/2019] [Accepted: 10/27/2019] [Indexed: 01/18/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to investigate the predictive value of pre-/postneoadjuvant chemoradiotherapy (nCRT) magnetic resonance imaging (MRI) characteristics for the long-term survival outcomes in patients with locally advanced rectal cancer (LARC). MATERIALS AND METHODS We retrospectively evaluated pre- and post-nCRT MRI and clinicopathologic characteristics of LARC patients. The 3-year disease-free survival (DFS) was estimated using the Kaplan-Meier product-limit method. Associations between MRI variabilities and survival outcomes were assessed using Cox proportional hazards model. RESULTS In total, 171 LARC patients (112 men and 59 women) with a median age of 55 years (range, 27-82 years) treated with nCRT were evaluated. The median follow-up was 47.6 months, and the 3-, 4-, and 5-year DFS in the overall cohort was 76.6%, 74.5%, and 73.7%, respectively. MRI assessment of extramural venous invasion (mrEMVI) positivity was a significant independent adverse factor of long-term survival (hazard ratio [HR] = 2.589, 95% confidence interval [CI] = 1.398-4.794, p = 0.002) on multivariate analysis. Patients with positive mrEMVI had significantly lower 3-year DFS than those with negative mrEMVI (52.6 months vs 65.1 months; p = 0.003). Moreover, the tumor regression grade on MRI (mrTRG) also significantly correlated with survival outcomes in patients with LARC. Patients with partial response on post-nCRT MRI (mrPR) showed short DFS than those with complete response (mrCR; HR = 4.914, 95% CI = 1.176-20.533, p = 0.029). The 3-year DFS of mrCR and mrPR patients were 74.3 months and 58.9 months, respectively (p = 0.011). CONCLUSION The pre-/post-nCRT MRI characteristics may be used to long-term survival stratification in LARC patients. mrEMVI positivity was an independent adverse prognostic indicator for 3-year DFS. Further, mrTRG may also be a predictive factor for the prognosis of LARC patients. The pre-/post-nCRT MR imaging may offer more information for providing individualized treatment.
Collapse
Affiliation(s)
- Yankai Meng
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China; College of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China
| | - Lijuan Wan
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing 100021, PR China
| | - Chongda Zhang
- Tandon school of Engineering, New York university, New York, USA
| | - Chen Wang
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China
| | - Feng Ye
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing 100021, PR China
| | - Shaodong Li
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China
| | - Shuangmei Zou
- Department of Pathology, National Cancer Center/ National Clinical Research Center for Cancer /Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jyh Cheng
- College of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China.; Department of Biomedical and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Kai Xu
- Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China; College of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China..
| | - Chunwu Zhou
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing 100021, PR China.
| | - Hongmei Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing 100021, PR China.
| |
Collapse
|
20
|
Survival Benefit for Metformin Through Better Tumor Response by Neoadjuvant Concurrent Chemoradiotherapy in Rectal Cancer. Dis Colon Rectum 2020; 63:758-768. [PMID: 32384406 DOI: 10.1097/dcr.0000000000001624] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Metformin may reduce cancer risk and mortality and improve radiotherapy responses in several malignancies. OBJECTIVE This study aimed to compare tumor responses and prognoses of metformin and nonmetformin groups of diabetic patients receiving neoadjuvant concurrent chemoradiotherapy for rectal cancer. DESIGN This is a retrospective study. SETTING This study was conducted at a single institution in the Republic of Korea. PATIENTS Between January 2000 and November 2017, 104 patients with rectal cancer who were taking diabetes medication and treated with neoadjuvant concurrent chemoradiotherapy followed by radical surgery were reviewed. Patients were divided into those taking (n = 62) and not taking metformin (n = 42). Tumor responses, survival, and other outcomes were analyzed. MAIN OUTCOME MEASURES Tumor response, rectal cancer-specific survival, and disease-free survival rates were measured. RESULTS Tumor regression grade (p = 0.002), pathological complete response (p = 0.037), and N downstaging (p < 0.001) after neoadjuvant concurrent chemoradiotherapy were significantly higher in the metformin group than in the nonmetformin group. In analysis of cancer-specific mortality, metformin use, differentiation (well, moderate vs poor), pathological Union for International Cancer Control stage (3 vs 1-2), ypN stage (1-2 vs 0), and N downstaging (HR, 0.256 (95% CI, 0.082-0.794), p = 0.018; HR, 0.147 (95% CI, 0.031-0.697), p = 0.016; HR, 3.693 (95% CI, 1.283-10.635), p = 0.015; HR, 3.181 (95% CI, 1.155-8.759), p = 0.025, and HR, 0.175 (95% CI, 0.040-0.769), p = 0.021) were significant factors related to mortality in diabetic patients with rectal cancer. In addition, in the multivariate analysis of cancer recurrence, the interaction between metformin use and lymph node downstaging was a significant predictive factor (HR, 0.222 (95% CI, 0.077-0.639); p = 0.005). LIMITATIONS This was a small retrospective study conducted at a single institution. CONCLUSIONS Metformin use was associated with better tumor responses and cancer-specific survival, as well as a lower risk of cancer recurrence, in patients with diabetes mellitus who had lymph node downstaging after neoadjuvant concurrent chemoradiotherapy in rectal cancer. See Video Abstract at http://links.lww.com/DCR/B185. BENEFICIO EN SUPERVIVENCIA CON METFORMINA A TRAVÉS DE UNA MEJOR RESPUESTA TUMORAL CON QUIMIORRADIOTERAPIA CONCURRENTE NEOADYUVANTE EN CÁNCER RECTAL: La metformina puede reducir el riesgo de cáncer y la mortalidad y mejorar las respuestas a la radioterapia en varios tumores malignos.Comparar las respuestas tumorales y los pronósticos de los grupos con metformina y sin metformina de pacientes diabéticos que reciben quimiorradioterapia concurrente neoadyuvante para cáncer de recto.Estudio retrospectivo.Institución única en la República de Corea.Se revisaron 104 pacientes entre enero de 2000 y noviembre de 2017, con cáncer rectal que tomaban medicamentos para diabetes y que fueron tratados con quimiorradioterapia concurrente neoadyuvante seguida de cirugía radical. Los pacientes se dividieron en aquellos que tomaban (n = 62) y los que no tomaban metformina (n = 42). Se analizaron las respuestas tumorales, la supervivencia y otros resultados.Se midieron las tasas de la respuesta tumoral, la supervivencia específica de cáncer rectal y de la supervivencia libre de enfermedad.El grado de regresión tumoral (p = 0.002), la remisión patológica completa (p = 0.037) y la reducción de la etapa N (p < 0.001) después de la quimiorradioterapia concurrente neoadyuvante fueron significativamente mayores en el grupo de metformina que en el grupo sin metformina. En el análisis de la mortalidad específica por cáncer, el uso de metformina, la diferenciación (bien, moderada vs pobre), el estadio patológico UICC (3 vs 1-2), el estadio ypN (1-2 vs 0) y la disminución de la etapa N (hazard ratios [intervalos de confianza 95%]: 0.256 [0.082-0.794], p = 0.018; 0.147 [0.031-0.697], p = 0.016; 3.693 [1.283-10.635], p = 0.015; 3.181 [1.155-8.759], p = 0.025 y 0.175 [0.040-0.769], p = 0.021, respectivamente) fueron factores significativos relacionados con la mortalidad en pacientes diabéticos con cáncer rectal. Adicionalmente, en el análisis multivariado de la recurrencia del cáncer, la interacción entre el uso de metformina y la disminución de la etapa ganglionar (N) fue un factor predictivo significativo (hazard ratios [intervalos de confianza del 95%]: 0.222 [0.077-0.639]; p = 0.005).Este fue un estudio retrospectivo pequeño realizado en un solo instituto.El uso de metformina se asoció con mejores respuestas tumorales y supervivencia específica de cáncer, así como un menor riesgo de recurrencia del cáncer, en pacientes con disminución de la etapa ganglionar (N) después de quimiorradioterapia concurrente neoadyuvante en pacientes con cáncer rectal y diabetes. Consulte Video Resumen en http://links.lww.com/DCR/B185. (Traducción-Dr. Jorge Silva Velazco).
Collapse
|
21
|
MRI T2-weighted sequences-based texture analysis (TA) as a predictor of response to neoadjuvant chemo-radiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC). Radiol Med 2020; 125:1216-1224. [DOI: 10.1007/s11547-020-01215-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/27/2020] [Indexed: 12/13/2022]
|
22
|
Han JG, Wang ZJ, Zeng WG, Wang YB, Wei GH, Zhai ZW, Zhao BC, Yi BQ. Efficacy and safety of self-expanding metallic stent placement followed by neoadjuvant chemotherapy and scheduled surgery for treatment of obstructing left-sided colonic cancer. BMC Cancer 2020; 20:57. [PMID: 31992260 PMCID: PMC6986080 DOI: 10.1186/s12885-020-6560-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/20/2020] [Indexed: 12/14/2022] Open
Abstract
Background This study aimed to evaluate the safety and feasibility of self-expanding metallic stent (SEMS) followed by neoadjuvant chemotherapy prior to elective surgery for obstructing left-sided colon cancer. Methods Eleven consecutive patients with obstructing left-sided colon cancer between May 2014 and November 2015 were included retrospectively. All patients received SEMS followed by neoadjuvant chemotherapy. The primary outcome measure was stoma and laparoscopic surgery. Results Chemotherapy was with two cycles of CAPOX (54.5%) or three cycles mFOLFOX6 (45.5%). Median serum albumin and hemoglobin levels before surgery were significantly higher than before neoadjuvant chemotherapy (p = 0.01 and p = 0.008 respectively) and before SEMS (p = 0.01 and p = 0.003 respectively). Median bowel wall thickness proximal to the upper edge of tumor was significantly more before neoadjuvant chemotherapy than before stent (p = 0.003), and significantly less before surgery than before neoadjuvant chemotherapy (p = 0.003). No patient underwent stoma creation. Laparoscopic surgery was performed in nine (81.8%) patients. No local recurrence or metastases developed over median cancer-specific follow-up of 44 months (range, 37–55 months). Conclusion SEMS followed by neoadjuvant chemotherapy prior to elective surgery appears to be safe and well tolerated in patients with obstructing left-sided colon cancer.
Collapse
Affiliation(s)
- Jia Gang Han
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Zhen Jun Wang
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang District, Beijing, 100020, People's Republic of China.
| | - Wei Gen Zeng
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Yan Bin Wang
- Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guang Hui Wei
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Zhi Wei Zhai
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Bao Cheng Zhao
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Bing Qiang Yi
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang District, Beijing, 100020, People's Republic of China
| |
Collapse
|
23
|
MRI morphologic and clinicopathologic characteristics for predicting outcomes in patients with locally advanced rectal cancer. Abdom Radiol (NY) 2019; 44:3652-3663. [PMID: 30456561 DOI: 10.1007/s00261-018-1828-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to investigate the value of MRI morphologic and clinicopathologic factors for predicting 3-year disease-free survival (DFS) in patients with locally advanced rectal cancer (LARC). METHOD In this retrospective study, pre- and post-neoadjuvant chemoradiotherapy (nCRT) MRI morphologic (e.g., pre-nCRT MRI-detected extramural venous invasion) and clinicopathologic variabilities (e.g., pathological complete response) were evaluated in all patients. Three-year DFS was estimated using Kaplan-Meier product-limit method, and Cox proportional hazards models were used to determine associations between morphologic or clinicopathologic variabilities and survival outcomes. RESULTS A total of 115 patients (39 females and 76 males; median age, 54 years; age range, 28-82 years) with LARC treated with nCRT were enrolled. With a median follow-up of 48.0 months, the 3-year DFS was 79.0% for all patients. During follow-up, 18 patients died, 28 patients experienced relapse (26 distant, one local, and one both), and 69 patients were censored. MRI-detected extramural venous invasion (mrEMVI) was the only significantly independent factor of long-term survival, while HR was 2.308 (95% CI 1.151-4.629, P = 0.018) on univariate and 2.495 (95% CI 1.243-5.012, P = 0.010) on multivariate analysis. The 3-year cumulative survival rate in patients with mrEMVI negativity compared with positivity were 86.6% versus 65.0% (P = 0.015), respectively. CONCLUSION In conclusion, pre-nCRT mrEMVI status was the independent significant risk factor for long-term outcomes in LARC patients treated with nCRT, while the other morphologic and clinicopathologic characteristics were not related to the patient survival.
Collapse
|
24
|
Mari GM, Achilli P, Maggioni D, Crippa J, Costanzi ATM, Scotti MA, Giardini V, Garancini M, Cocozza E, Borroni G, Benzoni I, Martinotti M, Totaro L, Origi M, Mazzola M, Ferrari G, Ziccarelli A, Petri R, Bagnardi V, Pugliese G, Forgione A, Pugliese R. Creation of a rectal cancer registry in Italy by the Advanced International Mini-Invasive Surgery (AIMS) academy clinical research network. F1000Res 2019; 8:1736. [PMID: 31723425 PMCID: PMC6833985 DOI: 10.12688/f1000research.20702.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 12/13/2022] Open
Abstract
Background: The management of rectal cancer is multimodal and involves a multidisciplinary team of cancer specialists with expertise in medical oncology, surgical oncology, radiation oncology and radiology. It is crucial for highly specialized centers to collaborate via networks that aim to maintain uniformity in every aspect of treatment and rigorously gather patients’ data, from the first clinical evaluation to the last follow-up visit. The Advanced International Mini-Invasive Surgery (AIMS) academy clinical research network aims to create a rectal cancer registry. This will prospectively collect the data of patients operated on for non-metastatic rectal cancer in high volume colorectal surgical units through a well design pre-fashioned database for non-metastatic rectal cancer, in order to take all multidisciplinary aspects into consideration. Methods/Design: The protocol describes a multicenter prospective observational cohort study, investigating demographics, frailty, cancer-related features, surgical and radiological parameters, and oncological outcomes among patients with non-metastatic rectal cancer who are candidates for surgery with curative intent. Patients enrolled in the present registry will be followed up for 5 years after surgery. Discussion: Standardization and centralization of data collection for neoplastic diseases is a virtuous process for patient care. The creation of a register will allow the control of the quality of treatments provided and permit prospective and retrospective studies to be carried out on complete and reliable high quality data. Establishing data collection in a prospective and systematic fashion is the only possibility to preserve the enormous resource that each patient represents.
Collapse
Affiliation(s)
- Giulio M Mari
- General Surgery Department, Desio Hospital, Desio, Italy
| | - Pietro Achilli
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Dario Maggioni
- General Surgery Department, Desio Hospital, Desio, Italy
| | - Jacopo Crippa
- General Surgery Residency Program, University of Milan, Milan, Italy
| | | | - Mauro A Scotti
- General Surgery Department, San Gerardo Hospital, Monza, Italy
| | | | | | | | | | | | | | - Luigi Totaro
- Department of Surgery, Cremona Hospital, Cremona, Italy
| | - Matteo Origi
- General Surgery Department, Niguarda Hospital, Milan, Italy
| | | | | | | | - Roberto Petri
- General Surgery Department, AOU "SSMM della Misericordia", Udine, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Giacomo Pugliese
- AIMS Academy Clinical Research Network, Advanced International Mini-Invasive Surgery (AIMS) Academy, Milan, Italy
| | | | - Raffaele Pugliese
- AIMS Academy Clinical Research Network, Advanced International Mini-Invasive Surgery (AIMS) Academy, Milan, Italy
| | | |
Collapse
|
25
|
Keller DS, Brown G. Invited editorial re: "Response assessment after (chemo) radiotherapy for rectal cancer: Why are we missing complete responses with MRI and endoscopy?". Eur J Surg Oncol 2019; 45:929-930. [PMID: 30890283 DOI: 10.1016/j.ejso.2018.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 02/07/2023] Open
Affiliation(s)
- Deborah S Keller
- Division of Colorectal Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Gina Brown
- Royal Marsden NHS Foundation Trust, Professor of Gastrointestinal Cancer Imaging, Imperial College London, London, UK.
| |
Collapse
|
26
|
Lambregts DMJ, Boellaard TN, Beets-Tan RGH. Response evaluation after neoadjuvant treatment for rectal cancer using modern MR imaging: a pictorial review. Insights Imaging 2019; 10:15. [PMID: 30758688 PMCID: PMC6375095 DOI: 10.1186/s13244-019-0706-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/24/2018] [Indexed: 01/02/2023] Open
Abstract
In recent years, neoadjuvant chemoradiotherapy (CRT) has become the standard of care for patients with locally advanced rectal cancer. Until recently, patients routinely proceeded to surgical resection after CRT, regardless of the response. Nowadays, treatment is tailored depending on the response to chemoradiotherapy. In patients that respond very well to CRT, organ-preserving treatments such as watch-and-wait are increasingly considered as an alternative to surgery. To facilitate such personalized treatment planning, there is now an increased demand for more detailed radiological response evaluation after chemoradiation. MRI is one of the main tools used to assess response, but has difficulties in assessing response within areas of post-radiation fibrosis. Hence, MR sequences such as diffusion-weighted imaging are increasingly adopted in clinical MR protocols to improve the differentiation between tumor and fibrosis. In this pictorial review, we discuss the strengths and weaknesses of modern MR imaging, including functional imaging sequences such as diffusion-weighted MRI, for response evaluation after chemoradiation treatment and provide the main pearls and pitfalls for image interpretation.
Collapse
Affiliation(s)
- Doenja M J Lambregts
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Thierry N Boellaard
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology - Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
27
|
Song C, Chung JH, Kang SB, Kim DW, Oh HK, Lee HS, Kim JW, Lee KW, Kim JH, Kim JS. Impact of Tumor Regression Grade as a Major Prognostic Factor in Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy: A Proposal for a Modified Staging System. Cancers (Basel) 2018; 10:cancers10090319. [PMID: 30205529 PMCID: PMC6162780 DOI: 10.3390/cancers10090319] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/23/2018] [Accepted: 09/06/2018] [Indexed: 12/20/2022] Open
Abstract
There is ongoing debate regarding the significance of complete or near-complete response after neoadjuvant chemoradiotherapy (CRT) for rectal cancer. This study assessed the prognostic value of the Dworak tumor regression grade (TRG) following neoadjuvant CRT and surgery primarily in patients with pathological stage (ypStage) II and III rectal cancer. The records of 331 patients who underwent neoadjuvant CRT followed by total mesorectal excision between 2004 and 2015 were retrospectively reviewed. Patients were categorized as having a good response (GR, TRG 3/4, n = 122) or a poor response (PR, TRG 1/2, n = 209). At a median follow-up of 65 months, five-year disease-free survival (DFS) was higher in the GR group than in the PR group (91.3% vs. 66.6%, p < 0.001). Patients with a GR and ypStage II disease had a five-year DFS that was indistinguishable from that of patients with ypStage 0–I disease (92.3% vs. 90.7%, p = 0.885). Likewise, patients with a GR and ypStage III disease had a five-year DFS similar to those with ypStage II disease (76.0% vs. 75.9%, p = 0.789). A new modified staging system that incorporates grouped TRG (GR vs. PR) was developed. The prognostic performance of this modified stage and the ypStage was compared with the Harrell C statistic. C statistic of the modified stage was higher than that of the ypStage (0.784 vs. 0.757, p = 0.012). The results remained robust after multivariate Cox regression analyses. In conclusion, a GR to neoadjuvant CRT is an independent predictor of good DFS and overall survival and further stratifies patients so as to estimate the risk of recurrence and survival among patients with ypStage II and III rectal cancer.
Collapse
Affiliation(s)
- Changhoon Song
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Joo-Hyun Chung
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Hye Seung Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea.
| |
Collapse
|
28
|
Taveras LR, Cunningham HB, Imran JB. Can We Reliably Predict a Clinical Complete Response in Rectal Cancer? Current Trends and Future Strategies. CURRENT COLORECTAL CANCER REPORTS 2018. [DOI: 10.1007/s11888-018-0401-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
29
|
Zhang C, Ye F, Liu Y, Ouyang H, Zhao X, Zhang H. Morphologic predictors of pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Oncotarget 2017; 9:4862-4874. [PMID: 29435147 PMCID: PMC5797018 DOI: 10.18632/oncotarget.23419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/02/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose To evaluate the value of morphological parameters that can be obtained conveniently by MRI for predicting pathologically complete response (pCR) in patients with rectal cancer. Materials and Methods A cohort of 101 patients was examined using MRI before and after Neoadjuvant chemoradiotherapy (nCRT). Morphological parameters including maximum tumor area (MTA), maximum tumor length (MTL) and maximum tumor thickness (MTT), as well as cylindrical approximated tumor volume (CATV), distance to anal verge (DTA), and the reduction rates were evaluated by two experienced readers independently. Results Post-nCRT MTA and MTL, reduction rates and pre-nCRT DTA were proved to be significantly different between pCR and non-pCR with the AUCs of 0.672-0.853. The sensitivity and specificity for assessing pCR were 61.1-89.9% and 59.0-80.7% respectively. No significant correlation between pre-nCRT size measurements and pCR was obtained. Conclusion The convenient morphological measurements may be useful for predicting pCR with moderate sensitivity and specificity. Combining these predictors with the aim of building diagnostic model should be explored.
Collapse
Affiliation(s)
- Chongda Zhang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Feng Ye
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Yuan Liu
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Han Ouyang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Hongmei Zhang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| |
Collapse
|
30
|
Rengo M, Picchia S, Marzi S, Bellini D, Caruso D, Caterino M, Ciolina M, De Santis D, Musio D, Tombolini V, Laghi A. Magnetic resonance tumor regression grade (MR-TRG) to assess pathological complete response following neoadjuvant radiochemotherapy in locally advanced rectal cancer. Oncotarget 2017; 8:114746-114755. [PMID: 29383117 PMCID: PMC5777729 DOI: 10.18632/oncotarget.21778] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/21/2017] [Indexed: 01/06/2023] Open
Abstract
This study aims to evaluate the feasibility of a magnetic resonance (MR) automatic method for quantitative assessment of the percentage of fibrosis developed within locally advanced rectal cancers (LARC) after neoadjuvant radiochemotherapy (RCT). A total of 65 patients were enrolled in the study and MR studies were performed on 3.0 Tesla scanner; patients were followed-up for 30 months. The percentage of fibrosis was quantified on T2-weighted images, using automatic K-Means clustering algorithm. According to the percentage of fibrosis, an optimal cut-off point for separating patients into favorable and unfavorable pathologic response groups was identified by ROC analysis and tumor regression grade (MR-TRG) classes were determined and compared to histopathologic TRG. An optimal cut-off point of 81% of fibrosis was identified to differentiate between favorable and unfavorable pathologic response groups resulting in a sensitivity of 78.26% and a specificity of 97.62% for the identification of complete responders (CRs). Interobserver agreement was good (0.85). The agreement between P-TRG and MR-TRG was excellent (0.923). Significant differences in terms of overall survival (OS) and disease free survival (DFS) were found between favorable and unfavorable pathologic response groups. The automatic quantification of fibrosis determined by MR is feasible and reproducible.
Collapse
Affiliation(s)
- Marco Rengo
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
| | - Simona Picchia
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
| | - Simona Marzi
- Medical Physics Laboratory, Regina Elena National Cancer Institute, Rome, Italy
| | - Davide Bellini
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
| | - Damiano Caruso
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
| | - Mauro Caterino
- Radiology Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Ciolina
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
| | - Domenico De Santis
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
| | - Daniela Musio
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Radiotherapy Unit, Policlinico Umberto I, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Radiotherapy Unit, Policlinico Umberto I, Rome, Italy
| | - Andrea Laghi
- Department of Radiological Sciences, Oncology and Pathology. "Sapienza" - University of Rome, Diagnostic Imaging Unit - I.C.O.T. Hospital, Latina, Italy
| |
Collapse
|
31
|
Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer. Br J Cancer 2017; 117:1478-1485. [PMID: 28934761 PMCID: PMC5680467 DOI: 10.1038/bjc.2017.320] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/10/2017] [Accepted: 08/22/2017] [Indexed: 12/15/2022] Open
Abstract
Background: Limited data exist regarding the correlation between MRI tumour regression grade (mrTRG) and pathological TRG (pTRG) in rectal cancer. Methods: mrTRG and pTRG were compared in rectal cancer patients from two phase II trials (EXPERT and EXPERT-C). The agreement between radiologist and pathologist was assessed with the weighted κ test while the Kaplan–Meier method was used to estimate survival outcomes. Results: One hundred ninety-one patients were included. Median time from completion of neoadjuvant treatment to pre-operative MRI and surgery was 4.1 weeks (interquartile range (IQR): 3.7–4.7) and 6.6 weeks (IQR: 5.9–7.6), respectively. Fair agreement was found between mrTRG and pTRG when regression was classified according to standard five-tier systems (κ=0.24) or modified three-tier systems (κ=0.25). Sensitivity and specificity of mrTRG 1–2 (complete/good radiological regression) for the prediction of pathological complete response was 74.4% (95% CI: 58.8–86.5) and 62.8% (95% CI: 54.5–70.6), respectively. Survival outcomes of patients with intermediate pathological regression (pTRG 2) were numerically better if complete/good regression was also observed on imaging (mrTRG 1–2) compared to poor regression (mrTRG 3–5) (5-year recurrence-free survival 76.9% vs 65.9%, P=0.18; 5-year overall survival 80.6% vs 68.8%, P=0.22). Conclusions: The agreement between mrTRG and pTRG is low and mrTRG cannot be used as a surrogate of pTRG. Further studies are warranted to assess the ability of mrTRG to identify pathological complete responders for the adoption of non-operative management strategies and to provide complementary prognostic information to pTRG for better risk-stratification after surgery.
Collapse
|
32
|
Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, Arnold D. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28:iv22-iv40. [PMID: 28881920 DOI: 10.1093/annonc/mdx224] [Citation(s) in RCA: 966] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- R Glynne-Jones
- Department of Radiotherapy, Mount Vernon Centre for Cancer Treatment, Northwood, London, UK
| | - L Wyrwicz
- Department of Gastrointestinal Cancer, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - E Tiret
- Department of Surgery, Sorbonne Universités, UPMC Univ Paris 06, Paris
- APHP, Hôpital Saint-Antoine, Paris, France
| | - G Brown
- Department of Radiology, The Imperial College and Royal Marsden Hospital, Sutton, Surrey, UK
| | - C Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany
| | - A Cervantes
- CIBERONC, Medical Oncology Department, INCLIVA University of Valencia, Valencia, Spain
| | - D Arnold
- Instituto CUF de Oncologia (I.C.O.), Lisbon, Portugal
| |
Collapse
|
33
|
Glimelius B. On a prolonged interval between rectal cancer (chemo)radiotherapy and surgery. Ups J Med Sci 2017; 122:1-10. [PMID: 28256956 PMCID: PMC5361426 DOI: 10.1080/03009734.2016.1274806] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/08/2016] [Accepted: 12/16/2016] [Indexed: 12/25/2022] Open
Abstract
Preoperative radiotherapy (RT) or chemoradiotherapy (CRT) is often required before rectal cancer surgery to obtain low local recurrence rates or, in locally advanced tumours, to radically remove the tumour. RT/CRT in tumours responding completely can allow an organ-preserving strategy. The time from the end of the RT/CRT to surgery or to the decision not to operate has been prolonged during recent years. After a brief review of the literature, the relevance of the time interval to surgery is discussed depending upon the indication for RT/CRT. In intermediate rectal cancers, where the aim is to decrease local recurrence rates without any need for down-sizing/-staging, short-course RT with immediate surgery is appropriate. In elderly patients at risk for surgical complications, surgery could be delayed 5-8 weeks. If CRT is used, surgery should be performed when the acute radiation reaction has subsided or after 5-6 weeks. In locally advanced tumours, where CRT is indicated, the optimal delay is 6-8 weeks. In patients not tolerating CRT, short-course RT with a 6-8-week delay is an alternative. If organ preservation is a goal, a first evaluation should preferably be carried out after about 6 weeks, with planned surgery for week 8 if the response is inadequate. In case the response is good, a new evaluation should be carried out after about 12 weeks, with a decision to start a 'watch-and-wait' programme or operate. Chemotherapy in the waiting period is an interesting option, and has been the subject of recent trials with promising results.
Collapse
Affiliation(s)
- Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| |
Collapse
|