MRI‑based neoadjuvant therapy indication in middle and low rectal cancer

Abstract

OBJECTIVE: The aim of this study was to evaluate the indication of neoadjuvant therapy in patients with middle and low rectal cancer based on MRI examination. BACKGROUND: In spite of noticeable advances in the diagnosis of rectal cancer, the optimal treatment remains highly debated. Current guidelines advise the use of neoadjuvant therapy in UICC stage II patients or higher. However, in clinical praxis, there is gradual implementation of new criterions and variables used in rectal cancer stage evaluation, the fact of which infl uences the treatment choice. The most important emerging variables taken currently into account are the distance from mesorectal fascia, circumferential resection margin, extramural venous invasion and intersphincteric plane, all of which can be evaluated using the MRI examination. METHODS: The accuracy of MRI staging was compared with defi nite histopathological results from resected tumors. Patient data were prospectively collected between the years 2013 and 2018 at 3rd Surgical Clinic, Faculty of Medicine, Comenius University in Bratislava, Slovakia. Data from 101 patients were gathered and divided into two groups, according to the localization of tumor within rectum, while 9 patients were excluded from the study because of benign lesion diagnosis based upon fi nal histopathologic evaluation. RESULTS: In 92 evaluated patients, no signifi cant change was noted between MRI and histopathological T-staging. However, in N-staging, signifi cant differences were noted between preoperative MRI staging and postoperative histopathological staging. CONCLUSION: The results of this study demonstrate ineffi cient preoperative lymph node staging, suggesting overtreatment of rectal cancer patients. Although the use of neoadjuvant therapy has led to great advances in modern cancer treatment, it is connected with a number of side effects and therefore should be indicated only for patients who can benefi t from this treatment (Tab. 1, Fig. 3, Ref. 16). Text in PDF www.elis.sk.

Clinical efficacy of Neoadjuvant Chemotherapy combined with Laparoscopic Surgery in patients with Middle and Low Rectal Cancer and its Effect on serum VEGF Levels and quality of life

“…Neoadjuvant chemoradiotherapy is an adjuvant chemoradiotherapy regimen given to patients with malignant tumors before surgery, promoting the function of reducing preoperative tumor load and improving overall therapeutic effect. 4 It was reported in a study by Pinto et al 5 That patients receiving neoadjuvant radiotherapy may have increased serious defecation times, reduced fecal control ability and reduced quality of life due to radiation enteritis, and some patients may even need permanent fistula due to anal incontinence or stricture. 6 In this study, neoadjuvant chemotherapy combined with laparoscopic surgery was utilized to treat patients with middle and low rectal cancer, now the specific report is as follows.…”