Rectal cancer pelvic recurrence: imaging patterns and key concepts to guide treatment planning

Inoue, Akitoshi; Sheedy, Shannon P.; Wells, Michael; Mileto, Achille; Goenka, Ajit H.; Ehman, Eric C.; Yalon, Mariana; Murthy, Naveen S.; Mathis, Kellie L.; Behm, Kevin T.; Shawki, Sherief; Graham, Rondell P.; Fletcher, Joel G.

doi:10.1007/s00261-022-03746-4

Cited by 9 publications

(9 citation statements)

References 60 publications

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“…The present study highlights that a pathologic finding of a distal margin of ≤1 mm is not related to lower 5-year LRRFS in patients with a major response or pCR (87.0% vs. 94.7%, p = 0.77), provided that R0 resection is achieved [ 21 ], but a worse LRRFS was observed with a distal margin of ≤1 mm in TRG3–5 patients (68.5% vs. 84.2%, p = 0.027). In other words, a ≤1 mm clear margin width seems to be inadequate in low responders, probably due to the overwhelmingly high risk of residual tumor burden beyond the distal edge of the tumor [ 22 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 89%

Impact of Microscopically Positive (≤1 mm) Distal Margins on Disease Recurrence in Rectal Cancer Treated by Neoadjuvant Chemoradiotherapy

Sorrentino

Sileo

Daveri

et al. 2023

Cancers

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Background: The adequate distal resection margin is still controversial in rectal cancer treated by neoadjuvant chemoradiotherapy (nCRT). The aim of this study was to assess the impact of a distal margin of ≤1 mm on locoregional recurrence-free survival (LRRFS). Methods: Among 255 patients treated with nCRT and surgery at the National Cancer Institute of Milan, 83 (32.5%) had a distal margin of ≤1 mm and 172 (67.5%) had a distal margin of >1 mm. Survival analyses were performed to assess the impact of distal margin on 5-year LRRFS, as well as Cox survival analysis. The role of distal margin on survival was analyzed according to different tumor regression grades (TRGs). Results: The overall 5-year LRRFS rate was 77.6% with a distal margin of ≤1 mm vs. 88.3% with a distal margin of >1 mm (Log-rank p = 0.09). Only stage ypT4 was an independent predictor of worse LRRFS (HR 15.14, p = 0.026). The 5-year LRRFS was significantly lower in TRG3–5 patients with a distal margin of ≤1 mm compared to those with a distal margin of >1 mm (68.5% vs. 84.2%, p = 0.027), while no difference was observed in case of TRG1–2 (p = 0.77). Conclusions: Low-responder rectal cancers after nCRT still require a distal margin of >1 mm to reduce the high likelihood of local relapse.

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Section: Discussionmentioning

confidence: 89%

Impact of Microscopically Positive (≤1 mm) Distal Margins on Disease Recurrence in Rectal Cancer Treated by Neoadjuvant Chemoradiotherapy

Sorrentino

Sileo

Daveri

et al. 2023

Cancers

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“…The only poor prognostic factor that was evidenced at histological report was IPN. For this reason, we questioned whether we could evaluate IPN with imaging, similar to head and neck tumors, since the clinical-radiological evaluation is fundamental timepoint to define optimal multimodal treatment based on patient's risk [16 , 17] .…”

Section: Discussionmentioning

confidence: 99%

Identification of perineural invasion at imaging staging as a novel potential risk factor in rectal cancer: A case report

Del Tufo,

Atripaldi,

Nicastro

et al. 2024

Radiology Case Reports

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“…The lateral pelvic compartment is a major site of local recurrence after TME in patients with stage II-III low-to-mid rectal cancer due to patterns of lymphatic drainage [ 36 ]. The management of lateral pelvic lymph nodes is a topic of active discussion in the era of TNT.…”

Section: Current Evidence On Tnt For Rectal Cancermentioning

confidence: 99%

Total Neoadjuvant Therapy for Rectal Cancer: Which Regimens to Use?

Ochiai,

Bhutiani,

Ikeda

et al. 2024

Cancers

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Total neoadjuvant therapy (TNT) is a novel strategy for rectal cancer that administers both (chemo)radiotherapy and systemic chemotherapy before surgery. TNT is expected to improve treatment compliance, tumor regression, organ preservation, and oncologic outcomes. Multiple TNT regimens are currently available with various combinations of the treatments including induction or consolidation chemotherapy, triplet or doublet chemotherapy, and long-course chemoradiotherapy or short-course radiotherapy. Evidence on TNT is rapidly evolving with new data on clinical trials, and no definitive consensus has been established on which regimens to use for improving outcomes. Clinicians need to understand the advantages and limitations of the available regimens for multidisciplinary decision making. This article reviews currently available evidence on TNT for rectal cancer. A decision making flow chart is provided for tailor-made use of TNT regimens based on tumor location and local and systemic risk.

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Rectal cancer pelvic recurrence: imaging patterns and key concepts to guide treatment planning

Cited by 9 publications

References 60 publications

Impact of Microscopically Positive (≤1 mm) Distal Margins on Disease Recurrence in Rectal Cancer Treated by Neoadjuvant Chemoradiotherapy

Impact of Microscopically Positive (≤1 mm) Distal Margins on Disease Recurrence in Rectal Cancer Treated by Neoadjuvant Chemoradiotherapy

Identification of perineural invasion at imaging staging as a novel potential risk factor in rectal cancer: A case report

Total Neoadjuvant Therapy for Rectal Cancer: Which Regimens to Use?

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