Regional lymph node metastasis and locoregional recurrence of rectal carcinoma in the era of TNM surgery. Implications for treatment decisions

Hermanek, P.; Merkel, Susanne; Fietkau, Rainer; Rödel, Claus; Hohenberger, Werner

doi:10.1007/s00384-009-0864-2

Cited by 52 publications

(24 citation statements)

References 88 publications

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“…In certain constellations, nodal status is less decisive for prognosis than previously assumed. Nodal-negative and N1 nodal-positive tumors have the same local relapse rates after neoadjuvant therapy and total mesorectal excision [93]. The same is true for T3a and T3b tumors with similar survival rates as T2 tumors regardless of nodal status [81].…”

Section: Local Staging Of Rectal Cancermentioning

confidence: 50%

A Review of Scientific Topics and Literature in Abdominal Radiology in Germany – Part 1: Gastrointestinal Tract

Schreyer

Weßling

Kinner

et al. 2015

Fortschr Röntgenstr

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The working group for abdominal and gastrointestinal diagnosis is a group of the German Radiological Society (DRG) focusing clinically and scientifically on the diagnosis and treatment of the gastrointestinal tract with all parenchymatous abdominal organs. In addition to the clinical and scientific further development of abdominal radiology, the education of radiologists within this core discipline of radiology is one of the major aims. In this article we give an up-to-date literature review of scientific radiological topics especially covered by German radiologists. This manuscript focuses on the most recent literature on the diagnosis of the stomach, small bowel, colon and rectum. The review with a focus on the most recent studies published by German radiologists concludes with a synopsis of mesenterial bleeding and ischemia followed by a critical appraisal of the current literature on conventional abdominal radiography. Key Points: ??Based on recent literature and guidelines there is a change of paradigms regarding the diagnosis of esophagus and gastric cancer towards CT, which is considered equally to endosonography. ??For small bowel imaging in Crohn?s disease ultrasound as well as MRI with a new focus on DWI are the most important imaging modalities scientifically. ??For colonic diagnosis virtual colonoscopy has replaced the conventional radiological methods. For staging of rectal carcinoma as well as for therapeutic stratification a high resolution MRI of the pelvis is of paramount interest. ??Multislice CT is considered the most important modality to assess mesenteric ischemia or bleeding. Citation Format: ??Schreyer AG, Wessling J, Kinner S et?al. A Review of Scientific Topics and Literature in Abdominal Radiology in Germany ? Part 1: Gastrointestinal Tract. Fortschr R?ntgenstr 2016; 188: 134???145

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Section: Local Staging Of Rectal Cancermentioning

confidence: 50%

A Review of Scientific Topics and Literature in Abdominal Radiology in Germany – Part 1: Gastrointestinal Tract

Schreyer

Weßling

Kinner

et al. 2015

Fortschr Röntgenstr

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“…In an article by Hermanek et al [17], however, a 33% LRR was reported for pN2 patients after surgery alone. Moreover, a recently published pooled analysis of five European randomized studies, comparing different preoperative radiotherapy schedules confirmed that lymph node status was a significant predictive factor not only for distant metastases and survival, but also for local recurrences [44].…”

Section: Schlüsselwörtermentioning

confidence: 93%

“…Operation · Strahlentherapie · Neoadjuvante Therapie · Radiochemotherapie · Behandlungserfolg moval of the lymphatic drainage upwards and therefore regional lymph nodes (except, lateral pelvic nodes) would no longer remain as origin of LR [17].…”

Section: Schlüsselwörtermentioning

confidence: 99%

Rectal cancer

et al. 2013

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When is the local recurrence risk low enough to refrain from the aim to prevent it?Local recurrence (LR) of rectal cancer is a devastating incident for each affected individual [2,21]. Thus, along with the attempt of improving survival, local tumor control has been an essential goal in the management of rectal cancer. Adjuvant radiotherapy (RT) with or without chemotherapy (ChT) reduced local recurrence and became a standard treatment in the 1980s [14], which was later on gradually replaced by preoperative RT (nRT) [9,45] or neoadjuvant radiochemotherapy (nRCT) [3,4,10,34,37]. Further substantial progress in terms of local recurrence reduction was achieved with the advent of quality-assured total mesorectal excision (TME; [15]). The next step was the introduction of magnetic resonance imaging (MRI) as a routine preoperative staging tool [1] facilitating the visualization of the distance between tumor and mesorectal fascia. If this distance is ≥1 mm on MRI, a negative circumferential resection margin (CRM) is assumed, provided that total mesorectal excision surgery is performed adequately. A negative CRM (defined as ≥1 mm on pathological work-up) has consecutively been identified and validated as an important surrogate parameter to predict the individual LR risk [12]. Results of the MERCURY study group (Magnetic Resonance Imaging in Rectal Cancer European Equivalence Study) whose authors propagated and investigated MRI-based treatment for rectal cancer were encouraging [23,43] and promoted similar attempts in the German-speaking community such as the OCUM study (optimized surgery and MRI-based multimodal therapy of rectal cancer). Preliminary results were recently published [22,42] and are commented in this editorial.Altogether, 230 patients with rectal cancer clinically staged as cT2-4, any cN, cM0 were included in this observational study. The anticipated CRM assessed by MRI (mrCRM) was used as a decision tool for selecting patients (n=230) either to undergo primary surgery (n=134) or to receive nRCT (n=96). For the lower third of the rectum (defined as <6 cm from the anal verge, 37%), nRCT was performed in all cT3 and cT4 tumors, irrespective of the anticipated CRM status; tumors of the middle third (i.e., 6 to <12 cm) were treated by nRCT in case of positive mrCRM only. For the upper third (12-16 cm), the decision was left to the discretion of the treating center. Clinically positive lymph nodes did not influence the choice of therapy; in patients with pathologically positive lymph nodes, chemotherapy was offered according to the standard of the respective centers. Postoperative RCT was restricted to patients with an involved CRM (pCRM ≤1 mm) [42].The mrCRM was positive in 74/230 patients, 72 in the nRCT group and 2 of the patients selected for surgery alone. A pathologically positive CRM (pCRM) occurred in 5.7% of all patients (nCRT: 11%, primary surgery: 1.5%). Pathology revealed complete remission (ypT0N0) after nRCT in 15% of patients, a partial remission in 67%. Even in patients whose margins were involv...

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“…The relevance of nodal status has been highlighted in a study by Hermanek et al [27]. They evaluated the relationship between the number of involved regional lymph nodes and the risk of locoregional recurrence.…”

Section: Lymph Nodes Involvedmentioning

confidence: 99%

Resectable Rectal Cancer: Which Patient Does Not Need Preoperative Radiotherapy?

Kulu

Ulrich

Büchler³

2012

Dig Dis

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It is well known that some patients with resectable rectal cancer benefit from preoperative radiotherapy in combination with or without chemotherapy. In order to reduce local recurrence and improve long-term survival, current guidelines advocate such neoadjuvant treatment in UICC (Union for International Cancer Control) stage II and III patients. However, the vast majority of patients may be adequately treated by rectal resection with total mesorectal excision (TME) alone. Recent evidence suggests an overtreatment of patients leading to unnecessary exposure to acute and long-term toxicity of radiation therapy. The question which consequently arises is which patient does not need preoperative radiotherapy. Improvements in MRI combined with better understanding of prognostic indicators suggest that patients with UICC stage I tumors, with tumors more than 12 cm proximal the anal verge can and patients with a circumferential resection margin ≥2 mm as assessed by preoperative MRI might be managed by radical surgery with adequate TME alone.

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Regional lymph node metastasis and locoregional recurrence of rectal carcinoma in the era of TNM surgery. Implications for treatment decisions

Cited by 52 publications

References 88 publications

A Review of Scientific Topics and Literature in Abdominal Radiology in Germany – Part 1: Gastrointestinal Tract

A Review of Scientific Topics and Literature in Abdominal Radiology in Germany – Part 1: Gastrointestinal Tract

Rectal cancer

Resectable Rectal Cancer: Which Patient Does Not Need Preoperative Radiotherapy?

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