Low- Versus High-Risk Rectal Cancer Based on MRI Features: Outcomes in Patients Treated Without Neoadjuvant Chemoradiotherapy

Jia, Xiaoxuan; Wang, Yi; Cheng, Jin; Yao, Xun; Yin, Ming; Zhou, Jing; Ye, Yingjiang

doi:10.2214/ajr.17.18980

Cited by 7 publications

(7 citation statements)

References 27 publications

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“…In locally advanced rectal cancer, MRI-detected EMVI predicted decreased disease-free survival (hazard ratio: 2.46) [52]. In another study, MRI-detected EMVI before neoadjuvant therapy was an independent poor prognostic factor for progression-free survival (hazard ratio: 1.85) [53], disease-free survival (hazard ratio: 1.35-31.33) [29,[54][55][56][57][58] and overall survival (hazard ratio: 1.18-2.90) (Fig.…”

Section: Predicting Survivalmentioning

confidence: 99%

“…MRI-detected EMVI is reported to be an independent significant prognostic factor for overall disease-free survival and systemic recurrence in rectal cancer [ 51 ]. In locally advanced rectal cancer, MRI-detected EMVI predicted decreased disease-free survival (hazard ratio: 2.46) [ 52 ]. In another study, MRI-detected EMVI before neoadjuvant therapy was an independent poor prognostic factor for progression-free survival (hazard ratio: 1.85) [ 53 ], disease-free survival (hazard ratio: 1.35–31.33) [ 29 , 54 – 58 ] and overall survival (hazard ratio: 1.18–2.90) (Fig.…”

Section: Introductionmentioning

confidence: 99%

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MRI-detected extramural venous invasion of rectal cancer: Multimodality performance and implications at baseline imaging and after neoadjuvant therapy

et al. 2021

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MRI is routinely used for rectal cancer staging to evaluate tumor extent and to inform decision-making regarding surgical planning and the need for neoadjuvant and adjuvant therapy. Extramural venous invasion (EMVI), which is intravenous tumor extension beyond the rectal wall on histopathology, is a predictor for worse prognosis. T2-weighted images (T2WI) demonstrate EMVI as a nodular-, bead-, or worm-shaped structure of intermediate T2 signal with irregular margins that arises from the primary tumor. Correlative diffusion-weighted images demonstrate intermediate to high signal corresponding to EMVI, and contrast enhanced T1-weighted images demonstrate tumor signal intensity in or around vessels. Diffusion-weighted and post contrast images may increase diagnostic performance but decrease inter-observer agreement. CT may also demonstrate obvious EMVI and is potentially useful in patients with a contraindication for MRI. This article aims to review the spectrum of imaging findings of EMVI of rectal cancer on MRI and CT, to summarize the diagnostic accuracy and inter-observer agreement of imaging modalities for its presence, to review other rectal neoplasms that may cause EMVI, and to discuss the clinical significance and role of MRI-detected EMVI in staging and restaging clinical scenarios.

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Section: Predicting Survivalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

MRI-detected extramural venous invasion of rectal cancer: Multimodality performance and implications at baseline imaging and after neoadjuvant therapy

et al. 2021

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“…In a Chinese series of 185 rectal cancer patients curatively operated without neo-adjuvant therapy between 2006-2014 [170], 120 belonged to a high-risk group according to MRI. In these patients, distant metastases were seen in 42% and local recurrences in 10% despite postoperative CRT to 84 patients.…”

Section: Rectal Cancermentioning

confidence: 99%

Recurrence Risk after Radical Colorectal Cancer Surgery—Less Than before, But How High Is It?

Osterman

Hammarström

Imam

et al. 2020

Cancers

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Adjuvant chemotherapy aims at eradicating tumour cells sometimes present after radical surgery for a colorectal cancer (CRC) and thereby diminish the recurrence rate and prolong time to recurrence (TTR). Remaining tumour cells will lead to recurrent disease that is usually fatal. Adjuvant therapy is administered based upon the estimated recurrence risk, which in turn defines the need for this treatment. This systematic overview aims at describing whether the need has decreased since trials showing that adjuvant chemotherapy provides benefits in colon cancer were performed decades ago. Thanks to other improvements than the administration of adjuvant chemotherapy, such as better staging, improved surgery, the use of radiotherapy and more careful pathology, recurrence risks have decreased. Methodological difficulties including intertrial comparisons decades apart and the present selective use of adjuvant therapy prevent an accurate estimate of the magnitude of the decreased need. Furthermore, most trials do not report recurrence rates or TTR, only disease-free and overall survival (DFS/OS). Fewer colon cancer patients, particularly in stage II but also in stage III, today display a sufficient need for adjuvant treatment considering the burden of treatment, especially when oxaliplatin is added. In rectal cancer, neo-adjuvant treatment will be increasingly used, diminishing the need for adjuvant treatment.

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“…Magnetic resonance imaging (MRI) is the most accurate technique for rectal cancer (RC) pretreatment staging and restaging [ 6 , 8 , 9 , 10 ]. Tumor findings identified on baseline MRI (‘primary staging’) steer the subsequent clinical management, including whether neoadjuvant chemoradiotherapy (CRT) or short course radiotherapy prior to surgical resection is needed [ 11 , 12 ]. Post-treatment assessment MRI (‘restaging’) helps to determine the operating technique or alternative treatment, including the ‘watch and wait’ strategy [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Structured Reporting of Rectal Cancer Staging and Restaging: A Consensus Proposal

Granata

Grassi

Cappabianca

et al. 2021

Cancers

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Background: Structured reporting (SR) in oncologic imaging is becoming necessary and has recently been recognized by major scientific societies. The aim of this study was to build MRI-based structured reports for rectal cancer (RC) staging and restaging in order to provide clinicians all critical tumor information. Materials and Methods: A panel of radiologist experts in abdominal imaging, called the members of the Italian Society of Medical and Interventional Radiology, was established. The modified Delphi process was used to build the SR and to assess the level of agreement in all sections. The Cronbach’s alpha (Cα) correlation coefficient was used to assess the internal consistency of each section and to measure the quality analysis according to the average inter-item correlation. The intraclass correlation coefficient (ICC) was also evaluated. Results: After the second Delphi round of the SR RC staging, the panelists’ single scores and sum of scores were 3.8 (range 2–4) and 169, and the SR RC restaging panelists’ single scores and sum of scores were 3.7 (range 2–4) and 148, respectively. The Cα correlation coefficient was 0.79 for SR staging and 0.81 for SR restaging. The ICCs for the SR RC staging and restaging were 0.78 (p < 0.01) and 0.82 (p < 0.01), respectively. The final SR version was built and included 53 items for RC staging and 50 items for RC restaging. Conclusions: The final version of the structured reports of MRI-based RC staging and restaging should be a helpful and promising tool for clinicians in managing cancer patients properly. Structured reports collect all Patient Clinical Data, Clinical Evaluations and relevant key findings of Rectal Cancer, both in staging and restaging, and can facilitate clinical decision-making.

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Low- Versus High-Risk Rectal Cancer Based on MRI Features: Outcomes in Patients Treated Without Neoadjuvant Chemoradiotherapy

Abstract: The LR and long-term survival of patients in the low-risk group were more favorable than those of patients in the high-risk group. EMVI and CRM status were independent risk factors.

Cited by 7 publications

References 27 publications

MRI-detected extramural venous invasion of rectal cancer: Multimodality performance and implications at baseline imaging and after neoadjuvant therapy

MRI-detected extramural venous invasion of rectal cancer: Multimodality performance and implications at baseline imaging and after neoadjuvant therapy

Recurrence Risk after Radical Colorectal Cancer Surgery—Less Than before, But How High Is It?

Structured Reporting of Rectal Cancer Staging and Restaging: A Consensus Proposal

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