U B Patel1, G Brown2, I Machado3, J Santos-Cores4, C Pericay5, E Ballesteros6, A Salud5, M Isabel-Gil7, C Montagut8, J Maurel5, J Ramón-Ayuso9, N Martin10, R Estevan11, C Fernandez-Martos12. 1. Radiology Department, London North-West Healthcare NHS Trust, London. 2. Radiology Department, The Royal Marsden Hospital NHS Foundation Trust, London, UK. 3. Department of Pathology, Valencia Institute of Oncology, Valencia, Spain 4. Department of Radiology, Fundacion InstitutoValenciano de Oncologia, Valencia, Spain 5. Department of Medical Oncology, Corporació Sanitària Parc Taulí, Parc Taulí, 1, Sabadell, Barcelona, Spain. 6. Department of Radiology, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, Spain. 7. Department of Radiology, Hospital Universitari Arnau de Vilanova, Lleida. 8. Department of Medical Oncology Department, Hospital del Mar, Barcelona. 9. Department of Radiology, Hospital Clinic de Barcelona, Barcelona. 10. Department of Pivotal, Madrid, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain. 11. Department of Surgery, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain. 12. Department of Medical Oncology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain.
Abstract
Background: Primary chemotherapy has been tested as a possible approach for patients with high risk features but predicted clear mesorectal margins on preoperative MRI assessment. This study investigates the prognostic relevance of baseline and post-treatment MRI and pathology staging in rectal cancer patients undergoing primary chemotherapy. Patients and methods: Forty-six patients with T3 tumour > =2 mm from the mesorectal fascia were prospectively treated with Neoadjuvant Capecitabine, Oxaliplatin and Bevacizumab prior to surgery between 2009 and 2011. The baseline and post-treatment MRI: T, Nodal and Extra-mural venous invasion (EMVI) status were recorded as well as post-treatment MRI Tumour regression grade (TRG) and modified-RECIST assessment of tumour length. The post-treatment pathology (yp) assessments of T3 substage, N, EMVI and TRG status were also recorded. Three-year disease-free survival (DFS) and cumulative incidence of recurrence were estimated by using the Kaplan-Meier product-limit method, and Cox proportional hazards models were used to determine associations between staging and response on MRI and pathology with survival outcomes. Results: About 46 patients underwent neoadjuvant chemotherapy alone for high risk margin safe primary rectal cancer. The median follow-up was 41 months, 5 patients died and 11 patients experienced relapse (2 local, 8 distant and 1 both). In total 23/46 patients were identified with MRI features of EMVI at baseline. mrEMVI positive status carried independent prognostic significance for DFS (P = 0.0097) with a hazard ratio of 31.33 (95% CI: 2.3-425.4). The histopathologic factor that was of independent prognostic importance was a final ypT downstage of ypT3a or less, hazard ratio: 14.0 (95% CI: 1.5-132.5). Conclusions: mrEMVI is an independent prognostic factor at baseline for poor outcomes in rectal cancer treated with neoadjuvant chemotherapy while ≤ypT3a is associated with an improvement in DFS. Future preoperative therapy evaluation in rectal cancer patients will need to stratify treatment according to baseline EMVI status as a crucial risk factor for recurrence in patients with predicted CRM clear rectal cancer.
Background: Primary chemotherapy has been tested as a possible approach for patients with high risk features but predicted clear mesorectal margins on preoperative MRI assessment. This study investigates the prognostic relevance of baseline and post-treatment MRI and pathology staging in rectal cancerpatients undergoing primary chemotherapy. Patients and methods: Forty-six patients with T3 tumour > =2 mm from the mesorectal fascia were prospectively treated with Neoadjuvant Capecitabine, Oxaliplatin and Bevacizumab prior to surgery between 2009 and 2011. The baseline and post-treatment MRI: T, Nodal and Extra-mural venous invasion (EMVI) status were recorded as well as post-treatment MRI Tumour regression grade (TRG) and modified-RECIST assessment of tumour length. The post-treatment pathology (yp) assessments of T3 substage, N, EMVI and TRG status were also recorded. Three-year disease-free survival (DFS) and cumulative incidence of recurrence were estimated by using the Kaplan-Meier product-limit method, and Cox proportional hazards models were used to determine associations between staging and response on MRI and pathology with survival outcomes. Results: About 46 patients underwent neoadjuvant chemotherapy alone for high risk margin safe primary rectal cancer. The median follow-up was 41 months, 5 patients died and 11 patients experienced relapse (2 local, 8 distant and 1 both). In total 23/46 patients were identified with MRI features of EMVI at baseline. mrEMVI positive status carried independent prognostic significance for DFS (P = 0.0097) with a hazard ratio of 31.33 (95% CI: 2.3-425.4). The histopathologic factor that was of independent prognostic importance was a final ypT downstage of ypT3a or less, hazard ratio: 14.0 (95% CI: 1.5-132.5). Conclusions: mrEMVI is an independent prognostic factor at baseline for poor outcomes in rectal cancer treated with neoadjuvant chemotherapy while ≤ypT3a is associated with an improvement in DFS. Future preoperative therapy evaluation in rectal cancerpatients will need to stratify treatment according to baseline EMVI status as a crucial risk factor for recurrence in patients with predicted CRM clear rectal cancer.
Authors: Rory F Kokelaar; Huw G Jones; Jeremy Williamson; Namor Williams; A Paul Griffiths; John Beynon; Gareth J Jenkins; Dean A Harris Journal: Cancer Biol Ther Date: 2018-01-19 Impact factor: 4.742
Authors: Marc J Gollub; Ivana Blazic; David D B Bates; Naomi Campbell; Andrea Knezevic; Mithat Gonen; Patricio Lynn; Martin R Weiser; Julio Garcia-Aguilar; Andreas M Hötker; Andrea Cercek; Leonard Saltz Journal: Eur Radiol Date: 2018-10-02 Impact factor: 5.315
Authors: Jong Keon Jang; Sang Hyun Choi; Seong Ho Park; Kyung Won Kim; Hyun Jin Kim; Jong Seok Lee; Ah Young Kim Journal: Eur Radiol Date: 2020-01-17 Impact factor: 5.315