{"title":"局部晚期癌症新辅助治疗后MRI重建的作用","authors":"A. D. Di Re, Raymond Lee, James T. Toh","doi":"10.4103/WJCS.WJCS_11_20","DOIUrl":null,"url":null,"abstract":"Background: Rectal cancer management has evolved from surgery to neoadjuvant radiotherapy to total chemoradiotherapy regimens. Magnetic resonance imaging (MRI) is the gold standard for staging; however, its role for assessing response to neoadjuvant therapy is less than clear. Objective: To assess the role of restaging MRI post neoadjuvant long-course chemoradiotherapy (NA CRT) for locoregionally advanced rectal cancer. Design: A retrospective audit of prospectively collected data. Setting: A tertiary hospital colorectal unit. Patients and Methods: Patients with locoregionally advanced rectal adenocarcinoma (T3/T4 and/or nodal disease), who underwent restaging pelvic MRI scans post-NA CRT were included. Medical records of relevant radiology and operative histopathology were reviewed. Main Outcome Measures: To determine whether restaging MRI altered subsequent patient management (compared to the initial plan as documented in the pretreatment colorectal multidisciplinary team meeting). Sample Size: Twenty-three patients with restaging MRI. Results: On diagnosis, 15 patients (65.2%) had American Joint Committee on Cancer (AJCC) stage-III disease; two patients had AJCC stage-II disease (8.7%), and five patients (21.7%) had AJCC stage-IV disease with limited metastases (curative intent to treatment). Three patients had a complete clinical response (cCR) post NA CRT. Fourteen tumors had downstaging (MRI tumor regression grade 2-3, 58.3%). In three patients (13.0%), restaging MRI altered patient management. Two of them had extensive disease that underwent significant downstaging, enabling avoidance of a pelvic exenteration; and one also had sufficient downstaging and was able to have a sphincter preserving operation as a result. Conclusions: MRI may have a role in patients with the extensive locoregional disease or in ultralow rectal cancers where it is unclear if sphincter preservation is possible. Limitations: Small sample size; additionally, “watch and wait” methods are not routinely practiced in this tertiary unit. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The role of restaging MRI post neoadjuvant therapy for locoregionally advanced rectal cancer\",\"authors\":\"A. D. Di Re, Raymond Lee, James T. Toh\",\"doi\":\"10.4103/WJCS.WJCS_11_20\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: Rectal cancer management has evolved from surgery to neoadjuvant radiotherapy to total chemoradiotherapy regimens. Magnetic resonance imaging (MRI) is the gold standard for staging; however, its role for assessing response to neoadjuvant therapy is less than clear. Objective: To assess the role of restaging MRI post neoadjuvant long-course chemoradiotherapy (NA CRT) for locoregionally advanced rectal cancer. Design: A retrospective audit of prospectively collected data. Setting: A tertiary hospital colorectal unit. Patients and Methods: Patients with locoregionally advanced rectal adenocarcinoma (T3/T4 and/or nodal disease), who underwent restaging pelvic MRI scans post-NA CRT were included. Medical records of relevant radiology and operative histopathology were reviewed. Main Outcome Measures: To determine whether restaging MRI altered subsequent patient management (compared to the initial plan as documented in the pretreatment colorectal multidisciplinary team meeting). Sample Size: Twenty-three patients with restaging MRI. Results: On diagnosis, 15 patients (65.2%) had American Joint Committee on Cancer (AJCC) stage-III disease; two patients had AJCC stage-II disease (8.7%), and five patients (21.7%) had AJCC stage-IV disease with limited metastases (curative intent to treatment). Three patients had a complete clinical response (cCR) post NA CRT. Fourteen tumors had downstaging (MRI tumor regression grade 2-3, 58.3%). In three patients (13.0%), restaging MRI altered patient management. Two of them had extensive disease that underwent significant downstaging, enabling avoidance of a pelvic exenteration; and one also had sufficient downstaging and was able to have a sphincter preserving operation as a result. Conclusions: MRI may have a role in patients with the extensive locoregional disease or in ultralow rectal cancers where it is unclear if sphincter preservation is possible. Limitations: Small sample size; additionally, “watch and wait” methods are not routinely practiced in this tertiary unit. Conflict of Interest: None.\",\"PeriodicalId\":90396,\"journal\":{\"name\":\"World journal of colorectal surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2020-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World journal of colorectal surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4103/WJCS.WJCS_11_20\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World journal of colorectal surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/WJCS.WJCS_11_20","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
The role of restaging MRI post neoadjuvant therapy for locoregionally advanced rectal cancer
Background: Rectal cancer management has evolved from surgery to neoadjuvant radiotherapy to total chemoradiotherapy regimens. Magnetic resonance imaging (MRI) is the gold standard for staging; however, its role for assessing response to neoadjuvant therapy is less than clear. Objective: To assess the role of restaging MRI post neoadjuvant long-course chemoradiotherapy (NA CRT) for locoregionally advanced rectal cancer. Design: A retrospective audit of prospectively collected data. Setting: A tertiary hospital colorectal unit. Patients and Methods: Patients with locoregionally advanced rectal adenocarcinoma (T3/T4 and/or nodal disease), who underwent restaging pelvic MRI scans post-NA CRT were included. Medical records of relevant radiology and operative histopathology were reviewed. Main Outcome Measures: To determine whether restaging MRI altered subsequent patient management (compared to the initial plan as documented in the pretreatment colorectal multidisciplinary team meeting). Sample Size: Twenty-three patients with restaging MRI. Results: On diagnosis, 15 patients (65.2%) had American Joint Committee on Cancer (AJCC) stage-III disease; two patients had AJCC stage-II disease (8.7%), and five patients (21.7%) had AJCC stage-IV disease with limited metastases (curative intent to treatment). Three patients had a complete clinical response (cCR) post NA CRT. Fourteen tumors had downstaging (MRI tumor regression grade 2-3, 58.3%). In three patients (13.0%), restaging MRI altered patient management. Two of them had extensive disease that underwent significant downstaging, enabling avoidance of a pelvic exenteration; and one also had sufficient downstaging and was able to have a sphincter preserving operation as a result. Conclusions: MRI may have a role in patients with the extensive locoregional disease or in ultralow rectal cancers where it is unclear if sphincter preservation is possible. Limitations: Small sample size; additionally, “watch and wait” methods are not routinely practiced in this tertiary unit. Conflict of Interest: None.