Can Magnetic Resonance Imaging Predict Circumferential Margins and TNM Stage in Rectal Cancer?

Branagan, Graham; Chave, Helen; Fuller, Clare; McGee, Shaun; Finnis, D

doi:10.1007/s10350-004-0594-z

Cited by 60 publications

(33 citation statements)

References 18 publications

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“…This deficiency biased the assessment of the accuracy of MRI for the prediction of mesorectal fascia involvement, which was 95.8%. However, this study, together with Beets-Tan et al (40) and Branagan et al (61) shows that MRI can predict patients in whom the CRM is not involved, which allows them to proceed to surgery without the need for preoperative radiotherapy.…”

Section: Discussionmentioning

confidence: 61%

The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results

Karatağ

Karatağ²,

Özkurt³

et al. 2011

Diagn Interv Radiol

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20T he prognosis and treatment of rectal carcinoma depends on the tumor stage at presentation (1). Local tumor extent, involved lymph nodes, and the presence of distant metastases are the main factors that influence prognosis (1-5). A poor prognosis of rectal cancer is associated with a high risk of metastases and local recurrence (6). Incomplete removal of the tumor is the major cause of local recurrence, which varies from 3% to 32% (7,8). Total mesorectal excision (TME) is the standard surgical approach in primary rectal cancer. TME involves the removal of the mesorectum, which contains the rectal tumor, all local draining nodes and the mesorectal fat by sharp dissection along the mesorectal fascia (9-12). This minimizes the chance of any tumor being left behind and results in a substantial reduction of the high local recurrence rate to less than 10% (8, 13) even without adjunctive treatment (13,14). When performing TME, knowledge of the relationship of the tumor to the circumferential resection margin (CRM) is important. When the CRM is involved with the tumor, the risk of local recurrence is high (9,(15)(16)(17).Chemoradiation therapy is the standard adjunctive preoperative treatment for patients with a high likelihood of curative resection failure (14,18). According to the recent literature, patients who received preoperative chemoradiation therapy had a lower rate of local recurrence compared to patients who received postoperative chemotherapy and radiation therapy (1,19). Therefore, there is a need for preoperative imaging methods to aid in the identification of patients with extrarectal spread who may benefit from preoperative chemoradiation therapy (20).Magnetic resonance imaging (MRI) is the most promising diagnostic method for the preoperative local staging of rectal cancer (8,21). Spatial resolution has dramatically improved with advances in MRI techniques, such as the use of endorectal and phased-array coils (22,23). Current evidence suggests that MRI is the most accurate technique for predicting tumor stage (24) because it provides an assessment of the local prognostic factors, including the extent of extramural tumor spread, the involvement of the lateral resection margin, the involvement of neighboring organs in the pelvis, the presence of local lymph node metastases, extramural lymphovascular infiltration and peritoneal involvement (9,25,26).The purposes of this study were to evaluate the accuracy of MRI performed with phased-array coil for preoperative local tumor staging in patients with rectal cancer and emphasize the importance of the preoperative differentiation of T2 tumors from T3 so the appropriate treatment plan can be applied. Materials and methods PatientsTwenty-four patients with histopathologically proven primary rectal cancer were prospectively examined using MRI with a phased-array PURPOSEThis study evaluated the accuracy of phased-array magnetic resonance imaging (MRI) for preoperative local tumor staging in primary rectal cancer and emphasized the importance of the preoperativ...

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Section: Discussionmentioning

confidence: 61%

The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results

Karatağ

Karatağ²,

Özkurt³

et al. 2011

Diagn Interv Radiol

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“…Tumor relationship to the MRF and MRF invasion is efficiently determined by MRI. [11][12][13][14] Compared with MRI, multidetectorrow CT (MDCT) is more widely available, quicker, less costly, 15 and provides the ability to assess the liver, peritoneum, and retroperitoneum for metastases. However, only a few studies have been published that consider the role of MDCT in the current diagnostic workup of rectal cancer patients.…”

Section: Resultsmentioning

confidence: 99%

Can CT Replace MRI in Preoperative Assessment of the Circumferential Resection Margin in Rectal Cancer?

Maizlin

Brown

et al. 2010

Diseases of the Colon &Amp; Rectum

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The results of this study differ from previously published data by demonstrating substantial agreement between readers in multidetector-row CT assessment of the tumor, mesorectal fascia, and lymph nodes. With the exceptions of mesorectal fascia in the distal rectum and the distance from the nodes to mesorectal fascia, other evaluated parameters were assessed with moderate and substantial agreement between multidetector-row CT and MRI. However, our findings suggest that multidetector-row CT does not correlate well enough with MRI findings to replace it in rectal cancer staging.

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“…Furthermore, retrospective data have suggested that a combined modality therapy could represent an overtreatment in patients at low risk of local failure after TME alone, such as some tumours staged as T3N0 (Willett et al, 1999). In this setting, MRI plays a key role, because it can predict the CRM involvement (Beets-Tan et al, 2000), so defining the patients at higher risk of local recurrence when treated with TME plus RT (Marijnen et al, 2003), although it has been demonstrated less sensitive and specific at identifying nodal disease and vascular invasion (Brown et al, 2003;Branagan et al, 2004). Our phase I -II study was carried out in patients with LARC at high risk of recurrence, as identified by both EUS and MRI.…”

Section: Discussionmentioning

confidence: 99%

Biweekly oxaliplatin, raltitrexed, 5-fluorouracil and folinic acid combination chemotherapy during preoperative radiation therapy for locally advanced rectal cancer: a phase I–II study

et al. 2006

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Oxaliplatin (OXA), raltitrexed (RTX), 5-fluorouracil (FU) and folinic acid (FA) have shown activity in metastatic colorectal cancer, radioenhancing effect and synergism when combined. We evaluated a chemotherapy (CT) combination of OXA, RTX and FU/FA during preoperative radiotherapy (RT) in locally advanced rectal cancer (LARC) patients. Fifty-one patients with LARC at high risk of recurrence (T4, N þ or T3N0 p5 cm from anal verge and/or circumferential resection margin p5 mm) received three biweekly courses of CT during pelvic RT (45 Gy). Surgery was planned 8 weeks after CT-RT. Recommended doses (RDs) determined during phase I were utilised in the subsequent phase II trial, where the rate of tumour regression grade (TRG) 1 or 2 was the main end point. No toxic deaths occurred, and severe toxicity was easily managed. In phase II, RDs delivered in 31 patients were OXA 100 mg m À2 and RTX 2.5 mg m À2 on day 1, and FU 900 mg m À2 and LFA 250 mg m À2 on day 2. Main severe toxicities by patients were grade 4 neutropenia (23%) and grade 3 diarrhoea (19%). In 71% (95% confidence limits, 52 -86%) of patients, TRG1 (13) or TRG2 (9) was obtained. All patients are alive and recurrence-free after a median follow-up of 29 months. Combination of OXA, RTX and FU/FA with pelvic RT has an acceptable toxicity and a high clinical activity in LARC and should be studied further in patients at high risk of recurrence.

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Can Magnetic Resonance Imaging Predict Circumferential Margins and TNM Stage in Rectal Cancer?

Cited by 60 publications

References 18 publications

The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results

The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results

Can CT Replace MRI in Preoperative Assessment of the Circumferential Resection Margin in Rectal Cancer?

Biweekly oxaliplatin, raltitrexed, 5-fluorouracil and folinic acid combination chemotherapy during preoperative radiation therapy for locally advanced rectal cancer: a phase I–II study

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