Assessment of the 2020 NICE criteria for preoperative radiotherapy in patients with rectal cancer treated by surgery alone in comparison with proven MRI prognostic factors: a retrospective cohort study

Lord, Amy; Corr, Alison; Chandramohan, Anuradha; Hodges, Nicola; Pring, Edward; Airo-Farulla, Clizia; Moran, Brendan; Jenkins, John T.; Fabio, Francesco Di; Brown, Gina

doi:10.1016/s1470-2045(22)00214-5

Cited by 29 publications

(22 citation statements)

References 18 publications

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“…Die MRT-Kriterien waren jedoch sowohl hinsichtlich des krankheitsfreien Überlebens als auch des Gesamtüberlebens prädiktiv. Möglicherweise findet bei alleiniger Verwendung der 2020 NICE-Kriterien also eine Übertherapie bei einem Teil der Patienten statt [ 29 ]. Dies unterstreicht die Bedeutung der MRT im Rahmen des Rektumkarzinomstagings.…”

Section: Ergebnisseunclassified

Was muss der Allgemein- und Viszeralchirurg von der onkologisch ausgerichteten Strahlentherapie wissen?

Müller¹,

Trommer²,

Meyer

et al. 2023

Chirurgie

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Zusammenfassung Hintergrund Die Strahlentherapie ist ein integraler Bestandteil in den meisten modernen multimodalen Tumortherapiekonzepten sowohl in kurativen als auch in palliativen Therapiesituationen. Dies gilt auch für viele Tumorentitäten im allgemein- und viszeralchirurgischen Bereich. Dabei kann es zu neuen Herausforderungen im Rahmen des klinischen Alltags und der interdisziplinären Tumorkonferenzen kommen. Ziel Praxisrelevanter Überblick, basierend auf selektiven Referenzen der aktuellen medizinisch-wissenschaftlichen Literatur und gewonnenen klinischen Alltagserfahrungen, für den onkologisch tätigen Chirurgen über strahlentherapeutische Therapieoptionen bei viszeralmedizinischen Tumoren mit dem Fokus auf die viszeralonkologischen Tumoren wie Rektumkarzinom, Ösophaguskarzinom, Analkarzinom und Lebermetastasen Methode Es wird eine narrative Übersicht präsentiert. Ergebnisse (selektive Eckpunkte) In ausgewählten Fällen ist es beispielsweise möglich, dass im Rahmen neuer Konzepte beim Rektumkarzinom ein derart gutes Ansprechen erreicht wird, dass unter engmaschiger Kontrolle eine Resektion vermieden werden kann. Beim Ösophaguskarzinom gilt die neoadjuvante Radiochemotherapie mit anschließender Resektion bei allen geeigneten Patienten als Therapieregime der Wahl. Sollte eine Operation nicht infrage kommen, so steht mit der definitiven Radiochemotherapie, insbesondere bei einem Plattenepithelkarzinom, eine gute Alternative zur Verfügung. Beim Analkarzinom bleibt auch im Licht neuster Erkenntnisse die primär definitive Radiochemotherapie als strahlentherapeutische Therapie der Wahl. Lebertumoren können mithilfe der stereotaktischen Strahlentherapie lokal abladiert werden. Mit der Leberstereotaxie ist ein hoch wirksames Mittel mit geringer Nebenwirkungsrate verfügbar. Schlussfolgerung Auch vor dem Hintergrund der jüngsten Studien bleibt die enge Zusammenarbeit der Disziplinen im Rahmen der Tumortherapie essenziell zur bestmöglichen Therapie der betroffenen Patienten.

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Section: Ergebnisseunclassified

Was muss der Allgemein- und Viszeralchirurg von der onkologisch ausgerichteten Strahlentherapie wissen?

Müller¹,

Trommer²,

Meyer

et al. 2023

Chirurgie

View full text Add to dashboard Cite

show abstract

“…Increased tumor neovascularization and continuous enrichment of collateral circulation increase the likelihood of cancer cell invasion into the outer muscularis propria vessels of the intestinal wall and the occurrence of cancer thrombi in the lumen ( 41 , 42 ). Therefore, differences in the tumor proportion of intestinal wall, T2WI sequence EMVI score, and diameter of the superior rectal vein may lead to different EMVI outcomes ( 43 ). In addition, an increase in invasive tumor involvement in the intestinal wall leads to an increase in new blood vessel formation.…”

Section: Discussionmentioning

confidence: 99%

Extramural vascular invasion nomogram before radical resection of rectal cancer based on magnetic resonance imaging

Tian

Li²,

Xie³

et al. 2023

Front. Oncol.

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PurposeThis study verified the value of magnetic resonance imaging (MRI) to construct a nomogram to preoperatively predict extramural vascular invasion (EMVI) in rectal cancer using MRI characteristics.Materials and methodsThere were 55 rectal cancer patients with EMVI and 49 without EMVI in the internal training group. The external validation group consisted of 54 rectal cancer patients with EMVI and 55 without EMVI. High-resolution rectal T2WI, pelvic diffusion-weighted imaging (DWI) sequences, and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) were used. We collected the following data: distance between the lower tumor margin and the anal margin, distance between the lower tumor margin and the anorectal ring, tumor proportion of intestinal wall, mrT stage, maximum tumor diameter, circumferential resection margin, superior rectal vein width, apparent diffusion coefficient (ADC), T2WI EMVI score, DWI and DCE-MRI EMVI scores, demographic information, and preoperative serum tumor marker data. Logistic regression analyses were used to identify independent risk factors of EMVI. A nomogram prediction model was constructed. Receiver operating characteristic curve analysis verified the predictive ability of the nomogram. P < 0.05 was considered significant.ResultTumor proportion of intestinal wall, superior rectal vein width, T2WI EMVI score, and carbohydrate antigen 19-9 were significant independent predictors of EMVI in rectal cancer and were used to create the model. The areas under the receiver operating characteristic curve, sensitivities, and specificities of the nomogram were 0.746, 65.45%, and 83.67% for the internal training group, respectively, and 0.780, 77.1%, and 71.3% for the external validation group, respectively.Data conclusionA nomogram including MRI characteristics can predict EMVI in rectal cancer preoperatively and provides a valuable reference to formulate individualized treatment plans and predict prognosis.

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“…It has been reported that TDs can be better identified using MRI than using pathology. To date, the diagnosis of TDs using MRI has not been prospectively validated against pathological diagnosis, which is the gold standard 21,36 . Lord et al .…”

Section: Beyond T N and M: Tumour Deposits In Rectal Cancermentioning

confidence: 99%

“…To date, the diagnosis of TDs using MRI has not been prospectively validated against pathological diagnosis, which is the gold standard. 21,36 Lord et al proposed the Concordance in MRI and Pathology Diagnosis of Extranodal Tumour Deposits (COMET) trial, which aims to map the location of TDs using MRI and to correlate the diagnosis of MRIdetected TDs and pathologically-diagnosed TDs at each location. 36 The occurrence of MRI-detected EMVI and TDs is associated with reduced likelihood of tumour response to neoadjuvant treatment.…”

Section: Beyond T N and M: Tumour Deposits In Rectal Cancermentioning

confidence: 99%

“…19 On the other hand it has been reported that current MRI staging based on T and N status does not adequately predict prognosis, whereas MRIdiagnosed EMVI and tumour deposit (TD) status have greater prognostic accuracy and are superior in determining treatment and follow-up protocols. [20][21][22] Then in addition to well-recognized pathological prognostic factors, namely T, N and M included in the classical TNM staging system, identification of novel pathological entities, that is, TDs, should be taken into account in predicting the regional and systemic spread of rectal carcinoma and in the evaluation of treatment strategies. 23,24 This review aims to discuss the impact of TDs on the oncological outcome of patients who undergo TME with LPLND for low rectal carcinoma.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Oncological outcome after lateral pelvic lymphadenectomy for low rectal carcinoma: not only an N‐status matter

Peparini

2022

ANZ Journal of Surgery

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Tumour deposits (TDs), novel pathological entities, should be considered when estimating the regional and systemic spread of rectal carcinoma and formulating treatment strategies. In fact, TDs may have more severe prognostic impact than lymph node positivity or the lymph node ratio. The assessment of the presence of TDs can be performed only through accurate postoperative pathological examination; however, the detection of TDs is not part of any of the procedures currently used to assess preoperative or intraoperative staging. This review aims to analyse and discuss the impact of TDs on the oncological outcome of patients who undergo surgery for advanced low rectal carcinoma. No prospective study has evaluated the impact of lateral pelvic TDs on oncological outcomes following total mesorectal excision with lateral pelvic lymphadenectomy. Although adequate total mesorectal excision allows for the excision of intramesorectal TDs, lateral pelvic lymph node dissection cannot guarantee the removal of lateral pelvic TDs; moreover, it remains to be determined whether surgical excision of lateral pelvic TDs can impact long‐term outcomes. However, the identification of lateral pelvic TDs strengthens the ‘staging effect’ and limits the ‘therapeutic effect’ of lateral pelvic lymphadenectomy, supporting the rationale for the use of neoadjuvant chemoradiotherapy for rectal cancer. When evaluating the oncological outcomes after total mesorectal excision with lateral pelvic lymphadenectomy, the impact of lateral pelvic TDs should be considered.

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Assessment of the 2020 NICE criteria for preoperative radiotherapy in patients with rectal cancer treated by surgery alone in comparison with proven MRI prognostic factors: a retrospective cohort study

Cited by 29 publications

References 18 publications

Was muss der Allgemein- und Viszeralchirurg von der onkologisch ausgerichteten Strahlentherapie wissen?

Was muss der Allgemein- und Viszeralchirurg von der onkologisch ausgerichteten Strahlentherapie wissen?

Extramural vascular invasion nomogram before radical resection of rectal cancer based on magnetic resonance imaging

Oncological outcome after lateral pelvic lymphadenectomy for low rectal carcinoma: not only an N‐status matter

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