Emanuele Neri1, Elisa Guidi2, Francesca Pancrazi2, Maura Castagna3, Elisa Castelluccio3, Riccardo Balestri4, Piero Buccianti4, Luca Masi5, Alfredo Falcone5, Bruno Manfredi6, Lorenzo Faggioni2, Carlo Bartolozzi2. 1. Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Unit of Diagnostic and Interventional Radiology, Pisa University Hospital, Italy. Electronic address: emanuele.neri@med.unipi.it. 2. Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Unit of Diagnostic and Interventional Radiology, Pisa University Hospital, Italy. 3. Unit of Anatomy and Pathology, Pisa University Hospital, Italy. 4. Unit of Colorectal Surgery, Pisa University Hospital, Italy. 5. Unit of Oncology, Pisa University Hospital, Italy. 6. Unit of Radiotherapy, Pisa University Hospital, Italy.
Abstract
OBJECTIVE: To compare tumor volume reduction rate (TVRR) measured by MR volumetry after preoperative chemoradiotherapy (CRT) and pathological tumor regression grade (TRG) in locally advanced rectal cancer (LARC). MATERIAL AND METHODS: In total, 20 patients with LARC (cT3-T4) treated with CRT followed by Total Mesorectal Excision (TME) between April 2011 and April 2013 were analyzed retrospectively. Pre- and post- CRT tumor volumes (MR volumetry) were measured on 3D MR sequences. TVRR was determined using the equation TVRR (%)=(pre-CRT tumor volume-post-CRT tumor volume)×100/pre-CRT tumor volume. The downstaging (defined as ypT0-T2) of tumor mass was evaluated and the correlation between TVRR and TRG was calculated with the method proposed by Dworak using the Spearman rank test. RESULTS: The median TVRR was 77.3% (range, 26.4-99.3%); TVRR was >60% in 18 cases (90%) and in 8 of these patients (44.4 %) it was >80%. Downstaging of tumor lesions was obtained in 15 patients (75%). In 4 cases there was a complete tumor regression (TRG4) at histological examination and in the same patients there was also a TVRR>80% measured by MR volumetry. A statistically significant correlation between TVRR and TRG (r(s)=0.5466, p=0.0126) was observed. CONCLUSION: TVRR after preoperative CRT correlates with TRG in LARC. The MR volumetry is a prognostic factor to estimate the tumor response after preoperative CRT. TVRR data may be an useful biomarker for tailoring surgery and postoperative adjuvant chemotherapy.
OBJECTIVE: To compare tumor volume reduction rate (TVRR) measured by MR volumetry after preoperative chemoradiotherapy (CRT) and pathological tumor regression grade (TRG) in locally advanced rectal cancer (LARC). MATERIAL AND METHODS: In total, 20 patients with LARC (cT3-T4) treated with CRT followed by Total Mesorectal Excision (TME) between April 2011 and April 2013 were analyzed retrospectively. Pre- and post- CRT tumor volumes (MR volumetry) were measured on 3D MR sequences. TVRR was determined using the equation TVRR (%)=(pre-CRT tumor volume-post-CRT tumor volume)×100/pre-CRT tumor volume. The downstaging (defined as ypT0-T2) of tumor mass was evaluated and the correlation between TVRR and TRG was calculated with the method proposed by Dworak using the Spearman rank test. RESULTS: The median TVRR was 77.3% (range, 26.4-99.3%); TVRR was >60% in 18 cases (90%) and in 8 of these patients (44.4 %) it was >80%. Downstaging of tumor lesions was obtained in 15 patients (75%). In 4 cases there was a complete tumor regression (TRG4) at histological examination and in the same patients there was also a TVRR>80% measured by MR volumetry. A statistically significant correlation between TVRR and TRG (r(s)=0.5466, p=0.0126) was observed. CONCLUSION: TVRR after preoperative CRT correlates with TRG in LARC. The MR volumetry is a prognostic factor to estimate the tumor response after preoperative CRT. TVRR data may be an useful biomarker for tailoring surgery and postoperative adjuvant chemotherapy.
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