Magnetic Resonance Imaging Value to Predict Pathologic Staging in Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiation

Pinta, Carolina de la; Martín, Marta; Sempere, Cayetano; Hervás, A.; Fernández-Lizarbe, E.; López, F.; Sancho, S.

doi:10.4274/tjcd.galenos.2018.36024

Cited by 2 publications

(4 citation statements)

References 28 publications

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“…The examination was deemed satisfactory by all patients, with no reports of pain or problems [17] . Additional study by De La Pinta, et al (2019) [16] included about 74 males and 43 females with a total number of 117 enrolled patients with primary cancer in the rectum, where their median age was 67.9 years (ranges between 41-85 years) Regarding this study, the main complaint was rectal bleeding in 64.2% of cases, altered bowel habits in 50%, generalized symptoms of cachexia in 35.7%, and abdominal pain in 14.2% El-Kady et al (2014) similarly reported a relevant point [17] . Their research discovered that almost 94% of these cases complained of rectum bleeding, with 86% also complaining of altered bowel habits.…”

Section: Discussionmentioning

confidence: 92%

“…High-resolution pelvic MRI has become absolutely crucial in rectal cancer staging and therapy decisions. It is also critical in determining the diagnostic accuracy of MRI in predicting the circumferential resection margin (CRM) of rectal cancer before surgical operations [16] .…”

Section: Discussionmentioning

confidence: 99%

“…12 cases(42.9 %) were categorized as T2 stage, 8 of them with no evidence of lymph nodes enlargement (N0), and 4 with evidence of regional lymph node enlargement and categorized as N1 (1-3 regional lymph nodes involvement), no soft tissue mass at mesorectal fat, no invasion of mesorectal fascia., 8 cases (28.5 %) were categorized as T3 stage, 6 of them were categorized as N1 (1-3 regional lymph nodes involvement) with no soft tissue mass at mesorectal fat, no invasion of mesorectal fascia, and 2 of them were categorized as N2 (4 or more regional lymph node involvement) with no soft tissue mass at mesorectal fat, but with invasion of mesorectal fascia.  Initial TNM staging by De La Pinta, et al 2019 [16] found that Pre-CRT MRI suggested that twenty patients (17.15%) had cT4 lesions, eighty-seven patients (74.3%) had cT3 lesions, and ten patients (8.55%) had cT2 lesions.  All studied cases (100%) showed diffusion restriction with ADC values ranging from.68 to 1.05 s/mm2 (with a cut value of 1.20 X 10 -3 s/mm2).…”

Section: Discussionmentioning

confidence: 99%

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Pre and postoperative magnetic resonance imaging for evaluation of cancer rectum

Anter,

Dawoud,

Allah

et al. 2023

Int. J. Radiol. Diagn. Imaging

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Background: Colorectal carcinoma (CRC) ranked as the second most prevalent form of cancer among individuals. Diagnostic imaging helps in planning before surgery by establishing a relationship between the carcinoma's mass and the surrounding anatomy, which consequently helps in selecting the optimal surgical approach and limiting the probability of injury to the neighboring structures. It could additionally help in estimating and predicting the therapeutic response and detecting the recurrence of the tumor. MR imaging has proven to be the most prevalent cross-sectional imaging technique for postrectal cancer patients' follow-up, it's mainly used to diagnose pelvic cancer recurrence and assess the extent of recurrence, which enables early resection and prolonged survival. Aim of the work:In the current study, we have attempted to evaluate the role of both functional and dynamic MRI in the staging of patients having cancer in their rectum before surgical operation and following up after it. Material and Methods: After signing a written consent, thirty patients were enrolled in this prospective clinical trial at Tanta University Hospitals -the Department of Radio Diagnosis and Medical Imaging. Duration from November 2018 to March 2022. All patients had a full patient history, medical examination, lab investigations (CBC, carbohydrate antigen 19-9 (CA 19-9), Renal function test, and carcinoembryonic antigen(CEA)), and dynamic and functional MRI which include: Weighted fast spin echo sequences, pre-contrast three-dimensional T, pre-contrast two-dimensional T, weighted fast gradient echo sequences, pre-contrast two-dimensional proton density-weighted sequences (saturation recovery turbo fast gradient echo, SRTF, or fast gradient echo, FLASH); and Pre-and postdynamic contrast-enhanced T Weighted SRTF or FLASH sequences MRI examination included: Pre contrast (2D T2 weighted images, 2D T1 weighted images, Diffusion-weighted images. And Postcontrast (T1 weighted images after IV administration of contrast). Results: The most common location of the tumor found by MRI was in the Middle rectum. MRI findings after chemoradiotherapy of 12 cases revealed a downstaging of cases, 9 of them became eligible for surgery. MRI findings of our studied cases after surgery revealed: 21 studied cases were free-restricted and 4 cases were restricted diffusion, 21(84%) cases had clear operative beds, and 4 (16%) cases had unclear operative beds. Conclusion:We conclude that post-operative MRI has a golden standard value not only for follow-up post-operative complication and detection of recurrent rectal carcinoma but furthermore for predicting the appropriateness of curative surgery and facilitating decisions on palliative resection, which have a significant impact on survival rate.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pre and postoperative magnetic resonance imaging for evaluation of cancer rectum

Anter,

Dawoud,

Allah

et al. 2023

Int. J. Radiol. Diagn. Imaging

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“…Recently we are studied the predictive value of MRI in this approach. 13 Predictive factors of pathological complete response after neoadjuvant treatment were tumor location to anal verge, CEA or Ca 19.9, histology, stage, time to surgery, type of surgery or tumour volume.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors for tumour response after the neoadjuvant-treatment of rectal adenocarcinoma

Pinta

Martín

Hervás

et al. 2020

Journal of Coloproctology

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Purpose Standard of care for locally advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. This study identified predictive factors for tumour response in our series. Patients and methods Between January 2005 and December 2018, 292 patients with locally advanced rectal cancer treated by preoperative chemo-radiation before surgery were retrospectively analyzed. The radiation dose was 50.4 Gy with fluoropyrimidine-based chemotherapy regimens. Patients-tumour and treatment-factors were tested for influence on tumour down staging and regression grade using Mandard scoring system on surgical specimens (TRG). Results Median age was 69 years (range 39–87); 33.9% of patients was Stage II and 54.5% Stage IIIB. Tumour down staging occurred in 211 patients (73%), including 63 patients (21.6%) with ypT0 (documented T0 at surgery) and 148 patients (50.7%) with a satisfactory tumour regression grade defined as TRG2–3. Upper rectal tumours were identified to predictive factors for pathologic complete response by univariate analysis (p = 0.002). TRG1–3 was associated with intervals from chemo-radiation to surgery (p = 0.004); TRG1–3 rates were higher with longer intervals: 1.71% in ≤ 5 weeks, 23.63% in 6–8 weeks and 46.9% in ≥ 9 weeks; and PTV 50.4 ≥ 800cc (p = 0.06); 3 and 5 years survivals were 85% and 90% for the group as a whole. Among ypT0 cases, the overall survival was 91.1% without significantly different (p = 0.25) compared with the remaining group, 87.2%. Among ypT0 cases, the relapse-free survival was 94.5%, with significantly different (p = 0.03) compared with the remaining group 78.2%. There were no treatment-associated fatalities. Thirty-two patients (10.96%) experienced Grade III/IV toxicities (proctitis, ephitelitis and neutropenia). Conclusions Tumour localization was identified as predictive factors of pathologic complete response for locally advanced rectal cancer treated with preoperative chemo-radiation. Upper rectal tumours are more likely to develop complete responses. Delay in surgery was identified as a favorable predictive factor for TRG1–3. The relapse-free survival in pathologic complete response group was higher compared with non-pathologic complete response.

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Magnetic Resonance Imaging Value to Predict Pathologic Staging in Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiation

Cited by 2 publications

References 28 publications

Pre and postoperative magnetic resonance imaging for evaluation of cancer rectum

Pre and postoperative magnetic resonance imaging for evaluation of cancer rectum

Predictive factors for tumour response after the neoadjuvant-treatment of rectal adenocarcinoma

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