Evaluation of Volumetric Magnetic Resonance Imaging in Determining the Indication for Total Neoadjuvant Therapy in Rectal Cancer.

IF 1.6 Q4 ONCOLOGY

Journal of Gastrointestinal Cancer Pub Date : 2024-11-12 DOI:10.1007/s12029-024-01138-z

Osman Sutcuoglu, Salimli Leyla, Kadriye Bir Yucel, Ahmet Ozet, Mehmet Arda İnan, Ozan Yazıcı, Murat Uçar, Nuriye Ozdemir

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引用次数: 0

Abstract

Background: This study aims to evaluate the relationship between volumetric measurements of residual tumor via magnetic resonance imaging (MRI) and pathologic complete response (pCR) in rectal cancer patients undergoing neoadjuvant chemoradiotherapy (nCRT).

Methods: Patients with locally advanced rectal cancer who had pelvic MRI for clinical staging and completed nCRT followed by radical resection were included. Two experienced radiologists measured tumor volume on MRI obtained before and after nCRT. We compared the pre- and post-CRT tumor volume and measured tumor volume reduction rates.

Results: The median value of tumor volume reduction rate in all patients was 64.7% (min-max - 81.1-98.1%). When the relationship between tumor volume and tumor regression grade (TRG) after nCRT was assessed, it was found that 18 of 21 (86%) patients with a good response (TRG 1) had a post-CRT tumor volume of ≤ 8 cm3 (p = 0.001). While 9 of 10 patients with pCR after nCRT had a tumor volume of ≤ 8 cm3, one patient had pCR despite having a tumor volume greater than 8 cm3 (p = 0.015).

Conclusion: The correlation between post-nCRT residual tumor volume and pCR underscores the potential of volumetric MRI as a predictive tool in tailoring rectal cancer treatment. For patients with residual tumor volumes greater than 8 cm³, extending neoadjuvant chemotherapy as part of TNT may enhance the likelihood of achieving pCR. This approach advocates for a more personalized treatment strategy, potentially optimizing outcomes for rectal cancer patients.

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评估容积磁共振成像在确定直肠癌新辅助疗法适应症方面的作用

研究背景本研究旨在评估通过磁共振成像（MRI）测量残留肿瘤体积与接受新辅助化放疗（nCRT）的直肠癌患者病理完全反应（pCR）之间的关系：方法：纳入的局部晚期直肠癌患者均接受了盆腔磁共振成像（MRI）进行临床分期，并完成了新辅助化放疗（nCRT）和根治性切除术。两名经验丰富的放射科医生分别测量了nCRT前后磁共振成像上的肿瘤体积。我们比较了CRT前后的肿瘤体积，并测量了肿瘤体积缩小率：所有患者肿瘤体积缩小率的中位值为 64.7%（最小值-最大值-81.1%-98.1%）。在评估nCRT后肿瘤体积与肿瘤消退等级（TRG）之间的关系时发现，21例良好反应（TRG 1）患者中有18例（86%）的CRT后肿瘤体积小于8立方厘米（P = 0.001）。10例nCRT后获得pCR的患者中有9例的肿瘤体积≤8立方厘米，1例患者的肿瘤体积大于8立方厘米，但仍获得了pCR（p = 0.015）：结论：nCRT 后残留肿瘤体积与 pCR 之间的相关性强调了容积 MRI 作为定制直肠癌治疗的预测工具的潜力。对于残留肿瘤体积大于 8 cm3 的患者，延长新辅助化疗作为 TNT 的一部分可能会提高获得 pCR 的可能性。这种方法主张采用更加个性化的治疗策略，有可能优化直肠癌患者的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Cancer ONCOLOGY-

CiteScore

3.80

自引率

0.00%

发文量

121

期刊介绍： The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.