Magnetic resonance tumour regression grade and pathological correlates in patients with rectal cancer

Jang, Jong Keon; Lee, J L; Park, H J; Park, I J; Kim, J H; Choi, Sang Hyun; Kim, Jeewon; Yu, Chang Sik; Kim, J C

doi:10.1002/bjs.10898

Cited by 24 publications

(25 citation statements)

References 42 publications

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“…More specifically, a 5-year OS rate was significantly different among the five mrTRG groups (100% for mrTRG 1, 92.7% for mrTRG 2, 89.6% for mrTRG 3, 80.0% for mrTRG 4, and 40.0% for mrTRG 5, respectively) ( p = 0.024) and between the two mrTRG groups (91.0% for good responders and 79.1% for poor responders) ( p = 0.010). Considering that reassessment of the tumor after neoadjuvant treatment is essential to enable optimized treatment for patients with locally advanced rectal cancer ( 3 27 28 ), our results seem to be promising. We thought that technological development such as high-resolution imaging in MRI and accumulated knowledge in rectal MRI to discriminate cellular component of tumor signal from fibrosis might attribute to this excellent performance of mrTRG.…”

Section: Discussionmentioning

confidence: 86%

Prognostic Value of Tumor Regression Grade on MR in Rectal Cancer: A Large-Scale, Single-Center Experience

et al. 2020

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Objective To determine the prognostic value of MRI-based tumor regression grading (mrTRG) in rectal cancer compared with pathological tumor regression grading (pTRG), and to assess the effect of diffusion-weighted imaging (DWI) on interobserver agreement for evaluating mrTRG. Materials and Methods Between 2007 and 2016, we retrospectively enrolled 321 patients (male:female = 208:113; mean age, 60.2 years) with rectal cancer who underwent both pre-chemoradiotherapy (CRT) and post-CRT MRI. Two radiologists independently determined mrTRG using a 5-point grading system with and without DWI in a one-month interval. Two pathologists graded pTRG using a 5-point grading system in consensus. Kaplan-Meier estimation and Cox-proportional hazard models were used for survival analysis. Cohen's kappa analysis was used to determine interobserver agreement. Results According to mrTRG on MRI with DWI, there were 6 mrTRG 1, 48 mrTRG 2, 109 mrTRG 3, 152 mrTRG 4, and 6 mrTRG 5. By pTRG, there were 7 pTRG 1, 59 pTRG 2, 180 pTRG 3, 73 pTRG 4, and 2 pTRG 5. A 5-year overall survival (OS) was significantly different according to the 5-point grading mrTRG ( p = 0.024) and pTRG ( p = 0.038). The 5-year disease-free survival (DFS) was significantly different among the five mrTRG groups ( p = 0.039), but not among the five pTRG groups ( p = 0.072). OS and DFS were significantly different according to post-CRT MR variables: extramural venous invasion after CRT (hazard ratio = 2.259 for OS, hazard ratio = 5.011 for DFS) and extramesorectal lymph node (hazard ratio = 2.610 for DFS). For mrTRG, k value between the two radiologists was 0.309 (fair agreement) without DWI and slightly improved to 0.376 with DWI. Conclusion mrTRG may predict OS and DFS comparably or even better compared to pTRG. The addition of DWI on T2-weighted MRI may improve interobserver agreement on mrTRG.

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Section: Discussionmentioning

confidence: 86%

Prognostic Value of Tumor Regression Grade on MR in Rectal Cancer: A Large-Scale, Single-Center Experience

et al. 2020

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“…In a recent study, Nahas et al, 10 showed, in contrast to most studies, that the clinical and radiological criteria for the identification of pCR exhibit low sensitivity (18.2%), with only 5% of the patients exhibiting pCR. 10 More recent studies still show that an MRI has a moderate and even low degrees of accuracy, even when working with a larger number of patients, as demonstrated by JK Jang et al, 17 whom was in his article had a sampled 439 patients. 17 Another current limitation is the fact that there is no specific protocol for the determination of tumour regression rates with either magnetic resonance imaging or histopathological analysis.…”

Section: Discussionmentioning

confidence: 99%

“…10 More recent studies still show that an MRI has a moderate and even low degrees of accuracy, even when working with a larger number of patients, as demonstrated by JK Jang et al, 17 whom was in his article had a sampled 439 patients. 17 Another current limitation is the fact that there is no specific protocol for the determination of tumour regression rates with either magnetic resonance imaging or histopathological analysis. This lack motivated the development of a specific questionnaire for the collection of these data, which were obtained retrospectively.…”

Section: Discussionmentioning

confidence: 99%

“…8 TRG has also been evaluated from the standpoint of an indication of adjuvant therapy and has not been shown to be a good indicator of chemotherapy after resection. 17 Bohlok et al, 18 in a study with 74 patients demonstrated that it was not safe to have TRG with predictor of adjuvant treatment. 18 Preventing a rectal cancer patient from being subjected to surgical resection is not yet an option, except in scientific investigation protocols.…”

Section: Discussionmentioning

confidence: 99%

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Submit Manuscript | http://medc rav eonline.co m Introduction Colorectal adenocarcinoma is the third most common malignant neoplasia and the third leading cause of death from cancer in men and women in the United States. Current data show that the incidence of colorectal adenocarcinoma is decreasing in developed countries but increasing in developing countries. 1 The 2018 estimates of the Bra - zilian National Cancer Institute (Instituto Nacional do Câncer–INCA) were 17,380

Oliveira

Lacerda‐Filho

Queiroz

et al. 2018

IJRRT

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Introduction: Rectal cancer (RC) is a tumor commonly diagnosed in developing countries, accounting to the considerable rates of morbi-mortality. The neoadjuvant therapy (NT) with radiotherapy and chemotherapy plays a leading role in the management of this neoplasm, according to oncological results and the preservation of anal function. Magnetic resonance imaging (MRI) is one of the main tools for the evaluation of NTresults in rectal cancer in order to manage the patient's therapy. Objectives: To compare the results of the MRI performed right after NTwith histopathologic findings of surgical specimens in patients with RC whom underwent radical surgery. Methods: This retrospective study of 31 patients with extraperitoneal RC Whom underwent radical surgery with a total mesorectal excision (TME) and with the preservation of sphincter after performing an NT. The selected patients underwent an pelvis MRI with an emphasis on the rectum, before and after performing an NT. The initial stage of the disease was detected on the first MRI, and the second MRI (post-NT) was responsible for determining the tumor's regression grade (TRG) and downstaging disease. This TRG was compared with the estimated regression obtained by histopathology of the specimen based on Dworak-TRG classification and TNM classification and trying to analyze the degree of agreement of the two methods and the occurrence of downstaging. Results: Most patients presented a downstaging of (74.4%) of thedisease after NT, when compared to the initial stage. Six patients (19.4%) achieved a complete pathological response. An MRI had a sensitivity of 83.3% and specificity of 73.7%, with Positive Predictive Value PPV=66.7%, Negative Predictive Value NPV=87.5% and an accuracy of 0.774 in estimating the TRG compared to histopathology. There was no correlation between patient characteristics and pathological findings and the results of TRG. Conclusion: An MRI of the pelvis with an emphasis on the rectum has a high accuracy rate when evaluating patients with RC submitted to NTwith radiotherapy and quimioterapy compared with histopathology and should be used routinely in clinical practice.

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“…For patients in whom there has been a good response but not an apparent cCR, local transanal excision is an alternative to major resection. MRI can be useful in guiding patient selection for such treatments. However, the recently published GRECCAR 2 study, which used a composite endpoint of surgical complications and recurrence, failed to show a difference between the two approaches in this setting, suggesting that more prospective studies are needed in this area.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of treatment intensification using novel agents for chemoradiotherapy in rectal cancer

Clifford

Govindarajah

Parsons

et al. 2018

British Journal of Surgery

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BackgroundWith the well established shift to neoadjuvant treatment for locally advanced rectal cancer, there is increasing focus on the use of radiosensitizers to improve the efficacy and tolerability of radiotherapy. There currently exist few randomized data exploring novel radiosensitizers to improve response and it is unclear what the clinical endpoints of such trials should be.MethodsA qualitative systematic review was performed according to the PRISMA guidelines using preset search criteria across the PubMed, Cochrane and Scopus databases from 1990 to 2017. Additional results were generated from the reference lists of included papers.ResultsA total of 123 papers were identified, of which 37 were included; a further 60 articles were obtained from additional referencing to give a total of 97 articles. Neoadjuvant radiosensitization for locally advanced rectal cancer using fluoropyrimidine‐based chemotherapy remains the standard of treatment. The oral derivative capecitabine has practical advantages over 5‐fluorouracil, with equal efficacy, but the addition of a second chemotherapeutic agent has yet to show a consistent significant efficacy benefit in randomized clinical assessment. Preclinical and early‐phase trials are progressing with promising novel agents, such as small molecular inhibitors and nanoparticles.ConclusionDespite extensive research and promising preclinical studies, a definite further agent in addition to fluoropyrimidines that consistently improves response rate has yet to be found.

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Magnetic resonance tumour regression grade and pathological correlates in patients with rectal cancer

Abstract: Patients with mrTRG1 without tumour spread may be suitable for TAE.

Cited by 24 publications

References 42 publications

Prognostic Value of Tumor Regression Grade on MR in Rectal Cancer: A Large-Scale, Single-Center Experience

Prognostic Value of Tumor Regression Grade on MR in Rectal Cancer: A Large-Scale, Single-Center Experience

Systematic review of treatment intensification using novel agents for chemoradiotherapy in rectal cancer

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