Magnetic Resonance Imaging–Detected Tumor Response for Locally Advanced Rectal Cancer Predicts Survival Outcomes: MERCURY Experience

Patel, Uday; Taylor, Fiona; Blomqvist, Lennart; George, Christopher B.; Evans, Hywel; Tekkis, Paris; Quirke, Philip; Sebag‐Montefiore, David; Moran, Brendan; Heald, R. J.; Guthrie, Ashley; Bees, Nicola; Swift, Ian; Pennert, Kjell; Brown, Gina

doi:10.1200/jco.2011.34.9068

Cited by 598 publications

(437 citation statements)

References 24 publications

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“…A NAC phase III trial also provides excellent opportunities for linked translational research aimed at identifying biomarkers predictive of longterm outcome. Such biomarkers could be derived from imaging such as tumour regression grade (TRG) or response of EMVI [53,54]. Alternatively they could be pathological, such as changes in TRG or in tumour cell density (TCD) [55,56], or molecular, such as stratifiers of response to chemotherapy and radiotherapy.…”

Section: Addition Of Nac To Preoperative Treatmentmentioning

confidence: 99%

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Gollins

Sebag‐Montefiore

2016

Clinical Oncology

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Improved surgical technique plus selective pre-operative radiotherapy, has decreased rectal cancer pelvic local recurrence (LR) from historically 25%, down to approximately 5-10%. However, this improvement has not reduced distant metastatic relapse, the main cause of death and a key issue in rectal cancer management.The current standard is local pelvic treatment (surgery +/-pre-operative radiotherapy) followed by adjuvant chemotherapy (AC), depending on resection histology. For circumferential resection margin (CRM)-threatened cancer on baseline MRI, downstaging long-course pre-operative chemoradiation (LCPCRT) is generally used. However, for non-CRM threatened disease, varying approaches are currently adopted in the UK, including straight to surgery (STS), short-course pre-operative radiotherapy (SCPRT) and LCPCRT.Clinical trials are investigating intensification of concurrent chemoradiation. There is also increasing interest in investigating pre-operative neoadjuvant chemotherapy (NAC) as a way of exposing micro-metastatic disease to full dose systemic chemotherapy as early as possible and potentially reducing metastatic relapse.Phase II trials suggest that this strategy is feasible, with promising histological response and low rates of tumour progression during NAC. Phase III trials are needed to determine the benefit of NAC when added to standard therapy and also to determine if it can be used instead of neoadjuvant radiotherapy based schedules.

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Section: Addition Of Nac To Preoperative Treatmentmentioning

confidence: 99%

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Gollins

Sebag‐Montefiore

2016

Clinical Oncology

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“…These include post-treatment T staging (ymrT), volume reduction between baseline and posttreatment, [15] and modified Response Evaluation Criteria in Solid Tumors (RECIST) measurement [16]. In addition to these assessment criteria, the MERCURY study group has developed an MRI-based tumor regression grading (ymrTRG) system by applying the principles of histopathology ypTRG [17,18] and showed that MRI assessment of ypTRG following preoperative therapy predicted survival [17]. It has been suggested that there may 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 be benefits in prolonging the interval between end of NACRT and surgery beyond the common 6-8 weeks [19][20][21], but evidence is limited.…”

Section: Introductionmentioning

confidence: 99%

Timing of surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer – A comparison of magnetic resonance imaging at two time points and histopathological responses

West

Dimitrov

Moyses

et al. 2016

European Journal of Surgical Oncology (EJSO)

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Purpose: There is wide inter-institutional variation in the interval between neoadjuvant chemoradiotherapy (NACRT) and surgery for locally advanced rectal cancer. We aimed to assess the association of magnetic resonance imaging (MRI) at 9 and 14 weeks post-NACRT;T-staging (ymrT) and post-NACRT tumour regression grading (ymrTRG) with histopathological outcomes; histopathological T-stage (ypT) and histopathological tumour regression grading (ypTRG) in order to inform decision-making about timing of surgery. Patients and Methods:We prospectively studied 35 consecutive patients (26 males) with MRI-defined resection margin threatened rectal cancer who had completed standardized NACRT. Patients underwent a MRI at Weeks 9 and 14 post-NACRT, and surgery at Week 15. Two readers independently assessed MRIs for ymrT, ymrTRG and volume change. ymrT and ymrTRG were analysed against histopathological ypT and ypTRG as predictors by logistic regression modelling and receiver operating characteristic (ROC) curve analyses.

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“…According to data from the MERCURY study [111], rectal cancer is one of the best oncological settings to test the relevance of dynamic techniques aspotential predictive indicatorsof neoadjuvant treatment efficacy in LARC. Therefore, future translational studies should be also aimed to incorporate imaging studies in patients treated with new targeted anticancer agents.…”

Section: Resultsmentioning

confidence: 99%