Objective Magnetic resonance imaging (MRI) is increasingly accepted as the radiological modality of choice staging rectal cancer but is subject to error. Neoadjuvant therapy is increasingly used in rectal cancer and MRI is used to stage response and occasionally plan surgery. We aim to assess the staging accuracy of MRI following chemoradiotherapy in rectal cancer.Method Retrospective analysis of 86 patients with MRI stage pre-and postlong-course chemoradiotherapy and comparison with pathological assessment.Results Fourty-nine patients (34 men, 15 women) with median age 68 years (60-74) were analysed. The median time from completion of CRT to MRI was 32 days (16-37). Chemoradiotherapy led to significant down-staging (P < 0.001). MRI-staging accuracy was 43% (21 ⁄ 49) with over-and under-staging in 43% (21 ⁄ 49) and 14% (7 ⁄ 49) respectively. T-stage accuracy was 45% (22 ⁄ 49) with overstaging in 33% (16 ⁄ 49) and under-staging in 22% (11 ⁄ 49).MRI stage correlated poorly with pathological assessment for International Union Against Cancer (j = 0.255) and T stages (j = 0.112). MRI nodal assessment was 71% (35 ⁄ 49) accurate, with 82% (9 ⁄ 11) sensitivity, 68% (26 ⁄ 38) specificity and positive predictive value (PPV) of 43% (9 ⁄ 21) and negative predictive value of 93% (26 ⁄ 28). There was a significant difference in node positivity between MRI and pathological staging (P = 0.005, Fisher's exact). Complete radiological response was observed in 4% (2 ⁄ 49). Complete pathological response was observed in 10% (5 ⁄ 49), which were staged 0(1), I(1), II(2) and III(1) postchemoradiotherapy by MRI.Conclusion MRI staging following chemoradiation is poor. Over-staging occurs three times more commonly than under-staging. Over-staging is due to poor PPV of nodal assessment.
Objective Multidisciplinary teams (MDTs) are an integral part of the National Cancer Plan. However, there is surprisingly little empirical research on how these are perceived by colorectal surgeons (CRSs) and colorectal clinical nurse specialists (CNSs). The purpose of this study therefore was to obtain the views of a national cohort of CRSs and CNSs regarding various important aspects of MDT functioning and role of CNS in current setting.Method Two hundred and fifty-three CRSs and 177 CNSs, identified from the Association of Coloproctologists of Great Britain and Ireland, responded to an ad hoc postal questionnaire.Results 96.5% of respondents considered that MDTs improved the overall quality of care of colorectal cancer patients, and 78.6% thought MDTs were good for their morale. Eighty per cent considered that they improved training. Seventy-three per cent of surgeons and nurses thought that MDTs were cost effective, and 89% did not consider them to be a passing fad. However, more than half (50.4%) of the CRSs and 35.2% of the CNSs stated that their job plan did not contain adequate time to attend MDT meetings. Compared with CRSs, CNSs were significantly more likely to have positive views regarding the MDT (P < 0.005).Conclusion CNSs and CRSs consider that colorectal MDTs have very beneficial effects on patient care, training and morale. However, many surgeons and nurse specialists consider that attendance at MDTs is not taken into account adequately in terms of their job plans, and this issue needs to be addressed.
Both Entonox and the modified TCI propofol provide equally effective sedation and pain relief, simultaneously allowing patients to be easily manoeuvred during the procedures.
Thyroid dysfunction is a well-recognised side-effect of treatment with interleukin-2 (IL2). We assessed the correlation between the development of abnormal thyroid function and tumour response in 13 patients receiving IL2 and interferon-2 alpha (IFN2 alpha) for advanced malignancy. Seven patients had normal thyroid function during treatment, and all of these patients have since died of progressive disease. Of six patients who did develop thyroid dysfunction during treatment, one patient has died of progressive disease. However, statistically we were unable to confirm a definite correlation between the development of thyroid dysfunction and survival in this small group of patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.