The treatment of all <scp>MRI</scp>‐defined low rectal cancers in a single expert centre over a 5‐year period: is there room for improvement?

Kusters, Miranda; Slater, Andrew; Betts, Margaret; Hompes, Roel; Guy, Richard; Jones, Oliver; George, Bruce; Lindsey, Ian; Mortensen, Neil; James, David; Cunningham, Chris

doi:10.1111/codi.13409

Cited by 19 publications

(11 citation statements)

References 13 publications

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“…Tumor height was assessed according to both the English Low Rectal Cancer National Development Program (LOREC) and the Japanese definition of low rectal cancer. LOREC criteria 26 defines low rectal cancer as a tumor of which the distal part is located below the origin of the levator muscles. In Japanese terminology, low rectal cancers are defined as those where the majority of the tumor is situated at or below the peritoneal reflection.…”

Section: Re-evaluation Of Mrismentioning

confidence: 99%

Neoadjuvant (Chemo)radiotherapy With Total Mesorectal Excision Only Is Not Sufficient to Prevent Lateral Local Recurrence in Enlarged Nodes: Results of the Multicenter Lateral Node Study of Patients With Low cT3/4 Rectal Cancer

Ogura

Konishi

Cunningham

et al. 2019

JCO

354

402

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Purpose Improvements in magnetic resonance imaging (MRI), total mesorectal excision (TME) surgery, and the use of (chemo)radiotherapy ([C]RT) have improved local control of rectal cancer; however, we have been unable to eradicate local recurrence (LR). Even in the face of TME and negative resection margins (R0), a significant proportion of patients with enlarged lateral lymph nodes (LLNs) suffer from lateral LR (LLR). Japanese studies suggest that the addition of an LLN dissection (LLND) could reduce LLR. This multicenter pooled analysis aims to ascertain whether LLNs actually pose a problem and whether LLND results in fewer LLRs. Patients and Methods Data from 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who underwent surgery in a 5-year period were collected. LLND was performed in 142 patients (12%). MRIs were re-evaluated with a standardized protocol to assess LLN features. Results On pretreatment MRI, 703 patients (58%) had visible LLN, and 192 (16%) had a short axis of at least 7 mm. One hundred eight patients developed LR (5-year LR rate, 10.0%), of which 59 (54%) were LLRs (5-year LLR rate, 5.5%). After multivariable analyses, LLNs with a short axis of at least 7 mm resulted in a significantly higher risk of LLR (hazard ratio, 2.060; P = .045) compared with LLNs of less than 7 mm. In patients with LLNs at least 7 mm, (C)RT plus TME plus LLND resulted in a 5-year LLR of 5.7%, which was significantly lower than that in patients who underwent (C)RT plus TME (5-year LLR, 19.5%; P = .042). Conclusion LLR is still a significant problem after (C)RT plus TME in LLNs with a short axis at least 7 mm on pretreatment MRI. The addition of LLND results in a significantly lower LLR rate.

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Section: Re-evaluation Of Mrismentioning

confidence: 99%

Neoadjuvant (Chemo)radiotherapy With Total Mesorectal Excision Only Is Not Sufficient to Prevent Lateral Local Recurrence in Enlarged Nodes: Results of the Multicenter Lateral Node Study of Patients With Low cT3/4 Rectal Cancer

Ogura

Konishi

Cunningham

et al. 2019

JCO

354

402

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“…Magnetic resonance imaging was performed using a 3.0 Tesla Siemens scanner (Siemens Magnetom Verio; Siemens Medical Systems, Erlangen, Germany) with a phased-array body coil. The DWI findings were obtained using the following parameters: echo planar imaging technique b values: 0, 400, 800, and 1500 s/mm 2 Image analysis. The magnetic resonance (MR) images were independently reviewed on the Picture Archiving and Communication System by 2 gastrointestinal radiologists (G.M.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Value of Apparent Diffusion Coefficient for Assessing Preoperative T Staging of Low Rectal Cancer and Whether This Is Correlated With Ki-67 Expression

Bao

Mao

et al. 2020

Can Assoc Radiol J

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Purpose: To explore the value of the apparent diffusion coefficient (ADC) in assessing preoperative T staging of low rectal cancer and the correlation between ADC value and Ki-67 expression. Methods: Data on 77 patients with a proven pathology of low rectal cancer were retrospectively analyzed. All patients underwent a magnetic resonance imaging scan 1 week prior to operation, and the mean ADC value was measured. All tumors were fully removed, and pathologic staging was determined. The Ki-67 expression was determined using immunohistochemical methods in all patients. The correlation between Ki-67 expression and ADC features was studied. Results: A total of 77 patients with low rectal cancer were included in the study. The pathology type was adenocarcinoma. The numbers of patients with pathological stages T1, T2, T3, and T4 were 9, 23, 32, and 13, respectively. The ADC value of all tumors ranged from 0.60 to 1.20 mm2/s. The average Ki-67 proliferation index was 55.3% ± 20.2%. A significant difference was observed between the preoperative ADC value and pathological T staging of low rectal cancer ( P < .01). The more advanced the T stage, the lower the detected ADC values were. A negative correlation was noted between the preoperative ADC value and Ki-67 proliferation index of rectal cancer ( r = −0.71, P < .01). When the Ki-67 proliferation index increased, lower ADC values were detected. Conclusion: The ADC values can provide useful information on preoperative tumor staging and may facilitate evaluation of the biological behavior of low rectal cancer. The ADC values should be considered a sensitive image biomarker of rectal cancer.

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“…First, an experienced abdominal radiologist evaluated all MRI scans to determine the height and length of the tumour as well as the cTNM stage and involvement of the mesorectal fascia (MRF). The height of the tumour was assessed according to both the criterion of the low rectal cancer national development programme (LOREC) and the Japanese definition of low rectal cancer. The LOREC criterion defines low rectal cancer as a tumour of which the distal part is located below the attachment of the levator muscles to the pelvic bone, measured on axial T2 images.…”

Section: Methodsmentioning

confidence: 99%

“…Slice thickness varied between 3 and 5 mm; different machines were used for imaging because the patients were referred from different hospitals. First, an experienced abdominal radiologist evaluated all MRI scans to determine the height and length of the tumour as well as 19 . The LOREC criterion defines low rectal cancer as a tumour of which the distal part is located below the attachment of the levator muscles to the pelvic bone, measured on axial T2 images.…”

Section: Radiological Assessmentmentioning

confidence: 99%

Prognostic implications of MRI-detected lateral nodal disease and extramural vascular invasion in rectal cancer

Schaap

Ogura

Maas

et al. 2018

British Journal of Surgery

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The treatment of all MRI‐defined low rectal cancers in a single expert centre over a 5‐year period: is there room for improvement?

Abstract: In curative resections, a clear margin is the most important determinant of survival. In 24% of the patients treated with neoadjuvant chemoradiotherapy, surgery could potentially have been avoided. There is scope for improvement in the treatment of locally advanced rectal cancers.

Cited by 19 publications

References 13 publications

Neoadjuvant (Chemo)radiotherapy With Total Mesorectal Excision Only Is Not Sufficient to Prevent Lateral Local Recurrence in Enlarged Nodes: Results of the Multicenter Lateral Node Study of Patients With Low cT3/4 Rectal Cancer

Neoadjuvant (Chemo)radiotherapy With Total Mesorectal Excision Only Is Not Sufficient to Prevent Lateral Local Recurrence in Enlarged Nodes: Results of the Multicenter Lateral Node Study of Patients With Low cT3/4 Rectal Cancer

Value of Apparent Diffusion Coefficient for Assessing Preoperative T Staging of Low Rectal Cancer and Whether This Is Correlated With Ki-67 Expression

Prognostic implications of MRI-detected lateral nodal disease and extramural vascular invasion in rectal cancer

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