Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery

Beets-Tan, R. G. H.; Beets, G.L.; Vliegen, R.F.A.; Kessels, Alfons; Boven, Hester van; Bruı̈ne, Adriaan de; Meyenfeldt, MF von; Baeten, C.G.; Engelshoven, J van

doi:10.1016/s0140-6736(00)04040-x

Cited by 754 publications

(467 citation statements)

References 30 publications

Supporting

Mentioning

426

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, retrospective data have suggested that a combined modality therapy could represent an overtreatment in patients at low risk of local failure after TME alone, such as some tumours staged as T3N0 (Willett et al, 1999). In this setting, MRI plays a key role, because it can predict the CRM involvement (Beets-Tan et al, 2000), so defining the patients at higher risk of local recurrence when treated with TME plus RT (Marijnen et al, 2003), although it has been demonstrated less sensitive and specific at identifying nodal disease and vascular invasion (Brown et al, 2003;Branagan et al, 2004). Our phase I -II study was carried out in patients with LARC at high risk of recurrence, as identified by both EUS and MRI.…”

Section: Discussionmentioning

confidence: 99%

“…In the phase I study, we enrolled patients in clinical stage II or III, or requiring an abdomino-perineal resection (APR). In the phase II study, we accrued only patients at high risk of recurrence: T4, node positive or T3N0 of the lower third of the rectum and/or with circumferential resection margin (CRM) p5 mm by magnetic resonance imaging (MRI) (Beets-Tan et al, 2000). Additional inclusion criteria were Eastern Cooperative Oncology Group performance status p2, age X18 years and adequate baseline bone marrow and organ function.…”

Section: Eligibility Criteriamentioning

confidence: 99%

See 1 more Smart Citation

Biweekly oxaliplatin, raltitrexed, 5-fluorouracil and folinic acid combination chemotherapy during preoperative radiation therapy for locally advanced rectal cancer: a phase I–II study

et al. 2006

View full text Add to dashboard Cite

Oxaliplatin (OXA), raltitrexed (RTX), 5-fluorouracil (FU) and folinic acid (FA) have shown activity in metastatic colorectal cancer, radioenhancing effect and synergism when combined. We evaluated a chemotherapy (CT) combination of OXA, RTX and FU/FA during preoperative radiotherapy (RT) in locally advanced rectal cancer (LARC) patients. Fifty-one patients with LARC at high risk of recurrence (T4, N þ or T3N0 p5 cm from anal verge and/or circumferential resection margin p5 mm) received three biweekly courses of CT during pelvic RT (45 Gy). Surgery was planned 8 weeks after CT-RT. Recommended doses (RDs) determined during phase I were utilised in the subsequent phase II trial, where the rate of tumour regression grade (TRG) 1 or 2 was the main end point. No toxic deaths occurred, and severe toxicity was easily managed. In phase II, RDs delivered in 31 patients were OXA 100 mg m À2 and RTX 2.5 mg m À2 on day 1, and FU 900 mg m À2 and LFA 250 mg m À2 on day 2. Main severe toxicities by patients were grade 4 neutropenia (23%) and grade 3 diarrhoea (19%). In 71% (95% confidence limits, 52 -86%) of patients, TRG1 (13) or TRG2 (9) was obtained. All patients are alive and recurrence-free after a median follow-up of 29 months. Combination of OXA, RTX and FU/FA with pelvic RT has an acceptable toxicity and a high clinical activity in LARC and should be studied further in patients at high risk of recurrence.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Eligibility Criteriamentioning

confidence: 99%

Biweekly oxaliplatin, raltitrexed, 5-fluorouracil and folinic acid combination chemotherapy during preoperative radiation therapy for locally advanced rectal cancer: a phase I–II study

et al. 2006

View full text Add to dashboard Cite

show abstract

“…By close collaboration between the rectal surgeons and radiotherapists, it is possible to select patients who are sufficiently treated by a nondownstaging short course of preoperative radiotherapy to prevent local failure. This is presently facilitated by using phased-array pelvic MRI (Beets-Tan et al, 2001). An actuarial local recurrence rate of 2.1% at 4 years compares favourably with any reported recurrence rates in the literature in comparable patients, especially in a multi-institutional setting with regard to surgery.…”

Section: Discussionmentioning

confidence: 99%

Preoperative short-term radiation therapy (25 Gy, 2.5 Gy twice daily) for primary resectable rectal cancer (phase II)

et al. 2005

View full text Add to dashboard Cite

To evaluate the feasibility, effectiveness, and long-term bowel function of preoperative hyperfractionated accelerated radiotherapy in primary resectable rectal cancer. A total of 184 consecutive patients (median age 65 years, male : female ¼ 2 : 1) with clinical T3Nx rectal adenocarcinoma received preoperative pelvic radiation therapy with single fractions of 2.5 Gy twice daily (interval 6 h between fractions) to a total dose of 25 Gy within 1 week. Surgery was conducted the following week. Postoperative histology revealed UICC stage I in 33%, stage II in 26%, stage III in 34%, and stage IV in 7% of the patients. Median follow-up was 43 months (53 months for surviving patients). The actuarial 4-year-local-recurrence rate was 2.1%, overall recurrence 23%. Disease-specific and disease-free survivals at 4 years (excluding stage IV) were 82 and 69%, respectively. Overall survival for 4 years was 68%. Postoperative mortality was 0.5% (one patient), early anastomotic leakage occurred in 11.4%, and anastomotic stenosis requiring treatment in 6%, of 132 patients with primary anastomosis. Seven of 184 patients (3.8%) died of abdominal complications, all within the first year. Bowel function was satisfactory after more than 5 years. Local control in primarily resectable rectal cancer after 10 Â 2.5 Gy is excellent, warranting further evaluation of this treatment.

show abstract

“…Pelvic MRI scanning has been established as the investigation of choice for local staging of rectal cancer prior to surgery [13,14,15] [16,17]. This is commonly defined as disease encroaching to within 1mm of mesorectal fascia (MRF) or lower rectal cancers involving the levator-sphincter complex.…”

Section: Introductionmentioning

confidence: 99%

“…For patients with such features, with optimum surgery and selective use of pre-operative radiotherapy, DM relapse is Gollins approximately 6-fold greater than LR (approximately 30% vs. 5%) [6,7,28] and is now the main cause of death. MRI scanning is the pre-treatment investigation which can most reliably identify such features [13,14,15].…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Gollins

Sebag‐Montefiore

2016

Clinical Oncology

View full text Add to dashboard Cite

Improved surgical technique plus selective pre-operative radiotherapy, has decreased rectal cancer pelvic local recurrence (LR) from historically 25%, down to approximately 5-10%. However, this improvement has not reduced distant metastatic relapse, the main cause of death and a key issue in rectal cancer management.The current standard is local pelvic treatment (surgery +/-pre-operative radiotherapy) followed by adjuvant chemotherapy (AC), depending on resection histology. For circumferential resection margin (CRM)-threatened cancer on baseline MRI, downstaging long-course pre-operative chemoradiation (LCPCRT) is generally used. However, for non-CRM threatened disease, varying approaches are currently adopted in the UK, including straight to surgery (STS), short-course pre-operative radiotherapy (SCPRT) and LCPCRT.Clinical trials are investigating intensification of concurrent chemoradiation. There is also increasing interest in investigating pre-operative neoadjuvant chemotherapy (NAC) as a way of exposing micro-metastatic disease to full dose systemic chemotherapy as early as possible and potentially reducing metastatic relapse.Phase II trials suggest that this strategy is feasible, with promising histological response and low rates of tumour progression during NAC. Phase III trials are needed to determine the benefit of NAC when added to standard therapy and also to determine if it can be used instead of neoadjuvant radiotherapy based schedules.

show abstract

Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery

Cited by 754 publications

References 30 publications

Biweekly oxaliplatin, raltitrexed, 5-fluorouracil and folinic acid combination chemotherapy during preoperative radiation therapy for locally advanced rectal cancer: a phase I–II study

Biweekly oxaliplatin, raltitrexed, 5-fluorouracil and folinic acid combination chemotherapy during preoperative radiation therapy for locally advanced rectal cancer: a phase I–II study

Preoperative short-term radiation therapy (25 Gy, 2.5 Gy twice daily) for primary resectable rectal cancer (phase II)

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Contact Info

Product

Resources

About