MRI demonstration of the effect of neoadjuvant radiotherapy on rectal carcinoma

Jacques, Audrey; Rockall, Andrea; Alijani, Mandana; Hughes, John; Babar, Syed; Aleong, Jo-Anne Chin; Cottrill, Christopher P.; Dorudi, Sina; Reznek, Rodney H.

doi:10.1080/02841860701317865

Cited by 7 publications

(4 citation statements)

References 34 publications

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“…Patients were selected for neoadjuvant treatment based on pretreatment MRI stage in all studies, except one , that used clinical fixity to select patients. All studies assessed response following long‐course neoadjuvant regimes, and one study additionally assessed response following short‐course radiotherapy . Three studies were performed on a 3‐Tesla (T) magnet , otherwise 1.0T and 1.5T strength magnets were used.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of the accuracy of MRI and endorectal ultrasound in the restaging and response assessment of rectal cancer following neoadjuvant therapy

et al. 2015

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The heterogeneity amongst restaging studies is high, limiting conclusive findings regarding their accuracies. The accuracy of restaging imaging is different for different pathological T stages and highest for T3 tumours. Morphological assessment of T- or N-stage by MRI or ERUS is currently not accurate or consistent enough for clinical application. Restaging MRI appears to have a role in excluding circumferential resection margin involvement.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of the accuracy of MRI and endorectal ultrasound in the restaging and response assessment of rectal cancer following neoadjuvant therapy

et al. 2015

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“…It is, however, not entirely clear which staging (MRI1, MRI2 or postoperative histopathology) provides the best diagnostic and prognostic information. Though one study claims that MRI before treatment correlates better with prognosis and local recurrence than histopathology after preoperative treatment [104], the TNM staging after treatment still has prognostic value [105]. Unfortunately, as MRI2 is a relatively new concept its prognostic value has not been validated, especially because it is done only in a subset of patients and with different protocols.…”

Section: Tumour Status After Preoperative Treatmentmentioning

confidence: 99%

Magnetic resonance imaging (MRI) in rectal cancer: a comprehensive review

2010

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Magnetic resonance imaging (MRI) has established itself as the primary method for local staging in patients with rectal cancer. This is due to several factors, most importantly because of the ability to assess the status of circumferential resection margin. There are several newer developments being introduced continuously, such as diffusion-weighted imaging and imaging with 3 T. Assessment of loco-regional lymph nodes has also been investigated extensively using different approaches, but more work needs to be done. Finally, evaluation of tumours during or after preoperative treatment is becoming an everyday reality. All these new aspects prompt a review of the most recent advances and opinions. In this review, a comprehensive overview of the current status of MRI in the loco-regional assessment and management of rectal cancer is presented. The findings on MRI and their accuracy are reviewed based on the most up-to-date evidence. Optimisation of MRI acquisition and relevant regional anatomy are also presented, based on published literature and our own experience.

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“…31,32 Surprisingly, T-stage downstaging was observed in the CR07 trial (or perhaps the arms were imbalanced at randomisation), 5 but overall, the Dutch TME trial found no significant difference in tumour node metastasis (TNM) classification between SCPRT and surgery alone groups 6,30 and so the aim of SCPRT is simply to reduce the risk of pelvic recurrence. Further extension of the interval following SCPRT to surgery of at least 6 weeks does demonstrate significant histopathogical response and downstaging.…”

Section: 24mentioning

confidence: 99%

“…[27][28][29] Although size may diminish, 30 no reduction in tumour or nodal classification is expected if the interval is less than 10 days. 31 Yet, some downstaging is observed if surgery is delayed for more than 10 days.…”

Section: 24mentioning

confidence: 99%

How to Select for Preoperative Short-course Radiotherapy, While Considering Long-course Chemoradiotherapy or Immediate Surgery, and Who Benefits?

Glynne-Jones¹,

Dt²,

Moran³

et al. 2014

European Oncology &Amp; Haematology

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The management of patients with locally advanced rectal cancer (LARC) has evolved with the aim of reducing local recurrence and improving survival. Current practice has developed from refinements in surgical technique, the availability of different types of preoperative imaging, the selective or blanket use of neoadjuvant treatment (usually radiation) and sophisticated efforts exploring multimodality treatments to achieve organ preservation. Both short-course preoperative radiotherapy (SCPRT) and long-course chemoradiation (CRT) are considered standard neoadjuvant strategies, which are advocated in different parts of the world. New techniques in the delivery of radiotherapy, such as intensity-modulated radiotherapy (IMRT), may allow more precise dosing to the target volume (tumour and/or locoregional lymph nodes) and limit radiation doses to critical normal structures; however, current schedules of SCPRT and CRT impact on late function, and if they do not improve survival in resectable cancers, can they be omitted in selected cases? KeywordsRectal adenocarcinoma, neoadjuvant radiation, chemoradiation, chemotherapy, short-course preoperative radiation, long-course chemoradiation Disclosure: Rob Glynne-Jones has received honoraria for lectures and advisory boards and has been supported in attending international meetings in the last five years by Eli Lilly, Merck, Pfizer, Sanofi-Aventis and Roche. He has received unrestricted grants for research from Merck-Serono, Sanofi-Aventis and Roche. He is principal investigator of a randomised phase II neoadjuvant chemotherapy study in the UK called BACCHUS. David Tan In patients with locally advanced rectal cancer (LARC), not involving the mesorectal fascia (MRF), surgery with total mesorectal excision (TME) is the standard of care. Prior to the TME era, high rates of local recurrence (LR) were observed after radical surgery, and 10-40 % of patients required a permanent stoma, even for tumours arising in the mid/upper rectum. In the 1990s, randomised trials 1-3 established shortcourse preoperative pelvic radiotherapy (SCPRT) using 5 x 5 Gy as a component of the curative treatment of resectable and early rectal cancers. These historical trials reported LR rates of 20-30 % after surgery alone, reflecting the suboptimal surgical practice at the time.Two subsequent trials examined whether SCPRT simply compensated for poor surgical technique, i.e. whether SCPRT still reduced LR if TME was performed. By then, it was recognised that the risk of LR, after a potentially curative resection, is mainly explained by microscopic tumour cells within 1 mm of the circumferential resection margin (CRM). 4 Hence, in the control group in the event of a histopathological involved CRM, postoperative RT or chemoradiotherapy was intended in the Dutch TME study 5 and CR07 trial,6 respectively. Both trials confirmed a reduction in LR, but overall survival (OS) was not improved, and the risk of metastases predominated over LR. [5][6][7][8] During the same period, the strategy of postoperativ...

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MRI demonstration of the effect of neoadjuvant radiotherapy on rectal carcinoma

Abstract: (2007) MRI demonstration of the effect of neoadjuvant radiotherapy on rectal carcinoma, Acta Oncologica, 46:7,[989][990][991][992][993][994][995]

Cited by 7 publications

References 34 publications

Systematic review and meta‐analysis of the accuracy of MRI and endorectal ultrasound in the restaging and response assessment of rectal cancer following neoadjuvant therapy

Systematic review and meta‐analysis of the accuracy of MRI and endorectal ultrasound in the restaging and response assessment of rectal cancer following neoadjuvant therapy

Magnetic resonance imaging (MRI) in rectal cancer: a comprehensive review

How to Select for Preoperative Short-course Radiotherapy, While Considering Long-course Chemoradiotherapy or Immediate Surgery, and Who Benefits?

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