Interobserver agreement of radiologists assessing the response of rectal cancers to preoperative chemoradiation using the MRI tumour regression grading (mrTRG)

Siddiqui, Muhammed R; Gormly, Kirsten; Bhoday, Jemma; Balyansikova, S.; Battersby, Nick; Chand, Manish; S, Rao; Tekkis, Paris; Abulafi, A. M.; Brown, Gina

doi:10.1016/j.crad.2016.05.005

Cited by 67 publications

(49 citation statements)

References 49 publications

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“…The authors concluded that with minimal training, good agreement and differentiation between good and intermediate/poor responders could be achieved. 103 The mrTRG appears to be a valuable way of differentiating between the "responder" and "nonresponder." It has been evaluated in several prospective trials and is emerging as a promising biomarker for evaluation of response, which may be used to stratify rectal cancer patients with regard to future management.…”

Section: Post-crt Tumor Response Assessmentmentioning

confidence: 99%

How Should Imaging Direct/Orient Management of Rectal Cancer?

Bhoday

Balyasnikova

Wale

et al. 2017

Clinics in Colon and Rectal Surgery

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Modern rectal cancer management is dependent on preoperative staging, and radiological assessment is a crucial part of this process. Imaging must provide sufficient information to guide preoperative decision-making that is reliable and reproducible. Different methods have been used for local staging; however, magnetic resonance imaging (MRI) has shown to be the most reliable tool for this purpose. MRI offers prognostic information about the patients and guides the decision between neoadjuvant treatment and total mesorectal excision alone. Also, not only the initial staging but also restaging by MRI can provide significant information regarding tumor response that is essential when considering alternative approaches.

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Section: Post-crt Tumor Response Assessmentmentioning

confidence: 99%

How Should Imaging Direct/Orient Management of Rectal Cancer?

Bhoday

Balyasnikova

Wale

et al. 2017

Clinics in Colon and Rectal Surgery

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“…MR as optional non-invasive examination has also played an increasingly important role and become the gold standard for rectal cancer staging and assessment of response to neoadjuvant treatment as restaging after CRT [4]. mrTRG as a potential biomarker for predicting pTRG to preoperative CRT and disease-free survival and overall survival in patients with LARC, was reported [1,[5][6][7][8][9][10]. However, mrTRG suffers from different interreader agreement.…”

Section: Introductionmentioning

confidence: 99%

“…However, mrTRG suffers from different interreader agreement. Siddiqui et al reported a wide range of κ values (0.14-0.82), and the assessment of the response of rectal cancers to chemoradiation therapy may be performed effectively using mrTRG [7].…”

Section: Introductionmentioning

confidence: 99%

“…In previous study, SI and V was used to discriminate pCR or response groups from non-pCR or non response groups, and not for discrimination between TRG groups. To our knowledge, different TRG after CRT has DFS and OS in patients withLARC [7,9], the determination of a TRG before surgery would in uence the subsequent treatment choice, so an accurate clinical assessment of response becomes essential. However, MR quantitative was evaluated to distinguish different TRG has not been reported, we hypothesized that relative SI (SIR) and V change rate on MR sequence included T2WI, DW/ADC, ceT1W between after and after CRT was also associated with TRG, and to evaluate the diagnostic value of their and determine which ones perform best as a potential biomarker for predicting pTRG to preoperative CRT in patients with LARC.…”

Section: Introductionmentioning

confidence: 99%

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A Comparison of Diagnostic Performance of Signal Intensity and Volume Related MRI Multiparameters for Assessing Different Response of Rectal Cancer to Neoadjuvant Chemoradiotherapy

Tan¹,

Zhang

Cheng

et al. 2020

Preprint

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Background: “Wait-and-see”, has been proposed as a possible method of treatment in patients with locally advanced rectal cancer (LARC) after chemoradiotherapy (CRT), MR is important to predict the pathological tumor regression grade(TRG) to preoperative CRT. This study aims to evaluate the diagnostic value of signal intensity (SI) and volume (V) change rate in magnetic resonance imaging (MR) and determine which ones perform best as a potential biomarker for predicting pathological TRG to preoperative CRT in patients with LARC.Methods: A retrospective analysis of 82 patients with LARC, for whom clinical and imaging data were retrieved from our institute was conducted between Oct 2017and Oct 2019. Patients underwent pre- and post-CRT T2-weighted (T2W), diffusion-weighted (DW)/apparent diffusion coefficient (ADC) and contrast-enhanced T1-weighted (ceT1W). V, difference of volume between pre-CRT and post-CRT tumor (△V), V of tumor reduction rate (%△V), as well as SI of tumor (SIt), SI of muscle (SIm), relative SI ratio of tumor/muscle (SIR), changed difference SIR between pre- and post-CRT SIR (△SIR), SIR of tumor changed rate (%△SIR) on T2W, ADC and ceT1W were measured. All of LARC after CRT were confirmed pathologically and classifed into histologic TRG: TRG 0 (complete response), TRG 1 (moderate response), TRG 2 (minimal response), TRG 3 (poor response). Descriptive statistics and areas under the receiver operating characteristic curves (ROC) were generated to compare performance of %△V and %△SIR on T2W, DW, ceT1W for distinguishing between different pathological TRG.Result: Of the 82 patients, TRG 0 (16), TRG 1 (15), TRG 2 (35), TRG 3 (16).Except for ADC-%△SIR, the remaining %△V and %△SIR on T1W, ADC/DWI, ceT1W showed statistics significance between four groups. There was not distinguishable between TRG 1 and TRG 2, TRG 2 and TRG 3 by %△V and/ or %△SIR, the remaining different TRG all were identified by %△V and/ or %△SIR on T2W, ADC/DWI, ceT1W. Compared with other individual %△V or %△SIR, the combination of DW-%△V and T2W-%△SIR (DW-%△V * T2W-%△SIR) yielded higher AUCs to predict TRG 0 from TRG 2 (AUCs: 0.954, sensitivity: 93.75%, specificity: 97.14%) and TRG 3 (AUCs: 1.000, sensitivity: 100%, specificity: 100%), although AUC of all had not significant differences between TRG groups. there was statistically significant differences in post-CRT T restage and ypT stage between fours groups, respectively, but the agreement between post-CRT T restage and ypT is low ( kappa=0.191).Conclusions: V and/or SIR change rate on T2W, DW, ceT1W with high diagnostic performance could be useful in differentiating complete response from non-complete response; SIR change rate could be useful for distinguishing between moderate response and poor response.

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“…Patients with a poor CRT response have a 5-year overall survival of 27% versus 72% ( p = 0.001) for a good CRT response [ 10 ]. This novel imaging biomarker has been reliable and reproducible between multiple independent radiologists, and validated against both pathology and survival outcomes [ 10 – 12 ]. However, there is currently insufficient evidence that this information can be safely used to alter treatment decisions.…”

Section: Introductionmentioning

confidence: 99%

A rectal cancer feasibility study with an embedded phase III trial design assessing magnetic resonance tumour regression grade (mrTRG) as a novel biomarker to stratify management by good and poor response to chemoradiotherapy (TRIGGER): study protocol for a randomised controlled trial

Battersby

Dattani

et al. 2017

Trials

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A rectal cancer feasibility study with an embedded phase III trial design assessing magnetic resonance tumour regression grade (mrTRG) as a novel biomarker to stratify management by good and poor response to chemoradiotherapy (TRIGGER): study protocol for a randomised controlled trial AbstractBackground: Pre-operative chemoradiotherapy (CRT) for MRI-defined, locally advanced rectal cancer is primarily intended to reduce local recurrence rates by downstaging tumours, enabling an improved likelihood of curative resection. However, in a subset of patients complete tumour regression occurs implying that no viable tumour is present within the surgical specimen. This raises the possibility that surgery may have been avoided. It is also recognised that response to CRT is a key determinant of prognosis. Recent radiological advances enable this response to be assessed pre-operatively using the MRI tumour regression grade (mrTRG). Potentially, this allows modification of the baseline MRI-derived treatment strategy. Hence, in a 'good' mrTRG responder, with little or no evidence of tumour, surgery may be deferred. Conversely, a 'poor response' identifies an adverse prognostic group which may benefit from additional pre-operative therapy. Methods/design: TRIGGER is a multicentre, open, interventional, randomised control feasibility study with an embedded phase III design. Patients with MRI-defined, locally advanced rectal adenocarcinoma deemed to require CRT will be eligible for recruitment. During CRT, patients will be randomised (1:2) between conventional management, according to baseline MRI, versus mrTRG-directed management. The primary endpoint of the feasibility phase is to assess the rate of patient recruitment and randomisation. Secondary endpoints include the rate of unit recruitment, acute drug toxicity, reproducibility of mrTRG reporting, surgical morbidity, pathological circumferential resection margin involvement, pathology regression grade, residual tumour cell density and surgical/specimen quality rates. The phase III trial will focus on long-term safety, regrowth rates, oncological survival analysis, quality of life and health economics analysis.Discussion: The TRIGGER trial aims to determine whether patients with locally advanced rectal cancer can be recruited and subsequently randomised into a control trial that offers MRI-directed patient management according to radiological response to CRT (mrTRG). The feasibility study will inform a phase III trial design investigating stratified treatment of good and poor responders according to 3-year disease-free survival, colostomy-free survival as well as an increase in cases managed without a major resection.Trial registration: ClinicalTrials.gov, ID: NCT02704520. Registered on 5 February 2016.

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Interobserver agreement of radiologists assessing the response of rectal cancers to preoperative chemoradiation using the MRI tumour regression grading (mrTRG)

Cited by 67 publications

References 49 publications

How Should Imaging Direct/Orient Management of Rectal Cancer?

How Should Imaging Direct/Orient Management of Rectal Cancer?

A Comparison of Diagnostic Performance of Signal Intensity and Volume Related MRI Multiparameters for Assessing Different Response of Rectal Cancer to Neoadjuvant Chemoradiotherapy

A rectal cancer feasibility study with an embedded phase III trial design assessing magnetic resonance tumour regression grade (mrTRG) as a novel biomarker to stratify management by good and poor response to chemoradiotherapy (TRIGGER): study protocol for a randomised controlled trial

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