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Significance of Magnetic Resonance Imaging–Assessed Tumor Response for Locally Advanced Rectal Cancer Treated With Preoperative Long-Course Chemoradiation
PURPOSE: To study the predictive and prognostic value of magnetic resonance imaging (MRI)–assessed tumor response after long-course neoadjuvant therapy for locally advanced rectal cancer. METHODS: This study included 79 patients who had T3 or T4 and/or N+ rectal cancer treated with long-course neoad...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Society of Clinical Oncology
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497621/ https://www.ncbi.nlm.nih.gov/pubmed/28717704 http://dx.doi.org/10.1200/JGO.2015.001479 |
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author | Fayaz, Mohamed Salah Demian, Gerges Attia Fathallah, Wael Moftah Eissa, Heba El-Sayed El-Sherify, Mustafa Shawki Abozlouf, Sadeq George, Thomas Samir, Suzanne Mona |
author_facet | Fayaz, Mohamed Salah Demian, Gerges Attia Fathallah, Wael Moftah Eissa, Heba El-Sayed El-Sherify, Mustafa Shawki Abozlouf, Sadeq George, Thomas Samir, Suzanne Mona |
author_sort | Fayaz, Mohamed Salah |
collection | PubMed |
description | PURPOSE: To study the predictive and prognostic value of magnetic resonance imaging (MRI)–assessed tumor response after long-course neoadjuvant therapy for locally advanced rectal cancer. METHODS: This study included 79 patients who had T3 or T4 and/or N+ rectal cancer treated with long-course neoadjuvant chemoradiation. MRI-assessed tumor regression grade (mrTRG) was assessed in 64 patients. MRIs were reviewed by the study radiologist. Surgical and pathologic reports for those who underwent surgery were reviewed. Disease-free survival (DFS) was estimated. Progression during therapy, local relapse, metastasis, and death resulting from the tumor were classified as events. Statistical significance was calculated. RESULTS: In 11 patients, the tumor completely disappeared on MRI; that is, it had an mrTRG of 1. All but one patient, who chose deferred surgery, had a complete pathologic response (pCR), with a positive predictive value of nearly 100%. Of the 20 patients who had an mrTRG of 2 on MRI, six had a pCR. mrTRG 3, mrTRG 4, and mrTRG 5 were detected in 24, six, and three patients, respectively, of whom only one patient had a pCR. The 2-year DFS was 77%. The mrTRG was significant for DFS. The 2-year DFS was 88% for patients with a good response versus 66% for those with a poor response (P = .046). CONCLUSION: MRI-assessed complete tumor response was strongly correlated with pCR and, therefore, can be used as a surrogate marker to predict absence of viable tumor cells. Our results can be used to implement use of mrTRGs in larger prospective correlative studies as a tool to select patients for whom deferred surgery may be appropriate. Also, those with a poor response may be offered further treatment options before definitive surgery. |
format | Online Article Text |
id | pubmed-5497621 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | American Society of Clinical Oncology |
record_format | MEDLINE/PubMed |
spelling | pubmed-54976212017-07-17 Significance of Magnetic Resonance Imaging–Assessed Tumor Response for Locally Advanced Rectal Cancer Treated With Preoperative Long-Course Chemoradiation Fayaz, Mohamed Salah Demian, Gerges Attia Fathallah, Wael Moftah Eissa, Heba El-Sayed El-Sherify, Mustafa Shawki Abozlouf, Sadeq George, Thomas Samir, Suzanne Mona J Glob Oncol Original Reports PURPOSE: To study the predictive and prognostic value of magnetic resonance imaging (MRI)–assessed tumor response after long-course neoadjuvant therapy for locally advanced rectal cancer. METHODS: This study included 79 patients who had T3 or T4 and/or N+ rectal cancer treated with long-course neoadjuvant chemoradiation. MRI-assessed tumor regression grade (mrTRG) was assessed in 64 patients. MRIs were reviewed by the study radiologist. Surgical and pathologic reports for those who underwent surgery were reviewed. Disease-free survival (DFS) was estimated. Progression during therapy, local relapse, metastasis, and death resulting from the tumor were classified as events. Statistical significance was calculated. RESULTS: In 11 patients, the tumor completely disappeared on MRI; that is, it had an mrTRG of 1. All but one patient, who chose deferred surgery, had a complete pathologic response (pCR), with a positive predictive value of nearly 100%. Of the 20 patients who had an mrTRG of 2 on MRI, six had a pCR. mrTRG 3, mrTRG 4, and mrTRG 5 were detected in 24, six, and three patients, respectively, of whom only one patient had a pCR. The 2-year DFS was 77%. The mrTRG was significant for DFS. The 2-year DFS was 88% for patients with a good response versus 66% for those with a poor response (P = .046). CONCLUSION: MRI-assessed complete tumor response was strongly correlated with pCR and, therefore, can be used as a surrogate marker to predict absence of viable tumor cells. Our results can be used to implement use of mrTRGs in larger prospective correlative studies as a tool to select patients for whom deferred surgery may be appropriate. Also, those with a poor response may be offered further treatment options before definitive surgery. American Society of Clinical Oncology 2016-02-10 /pmc/articles/PMC5497621/ /pubmed/28717704 http://dx.doi.org/10.1200/JGO.2015.001479 Text en © 2016 by American Society of Clinical Oncology http://creativecommons.org/licenses/by/4.0/ Licensed under the Creative Commons Attribution 4.0 License: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Original Reports Fayaz, Mohamed Salah Demian, Gerges Attia Fathallah, Wael Moftah Eissa, Heba El-Sayed El-Sherify, Mustafa Shawki Abozlouf, Sadeq George, Thomas Samir, Suzanne Mona Significance of Magnetic Resonance Imaging–Assessed Tumor Response for Locally Advanced Rectal Cancer Treated With Preoperative Long-Course Chemoradiation |
title | Significance of Magnetic Resonance Imaging–Assessed Tumor Response for Locally Advanced Rectal Cancer Treated With Preoperative Long-Course Chemoradiation |
title_full | Significance of Magnetic Resonance Imaging–Assessed Tumor Response for Locally Advanced Rectal Cancer Treated With Preoperative Long-Course Chemoradiation |
title_fullStr | Significance of Magnetic Resonance Imaging–Assessed Tumor Response for Locally Advanced Rectal Cancer Treated With Preoperative Long-Course Chemoradiation |
title_full_unstemmed | Significance of Magnetic Resonance Imaging–Assessed Tumor Response for Locally Advanced Rectal Cancer Treated With Preoperative Long-Course Chemoradiation |
title_short | Significance of Magnetic Resonance Imaging–Assessed Tumor Response for Locally Advanced Rectal Cancer Treated With Preoperative Long-Course Chemoradiation |
title_sort | significance of magnetic resonance imaging–assessed tumor response for locally advanced rectal cancer treated with preoperative long-course chemoradiation |
topic | Original Reports |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497621/ https://www.ncbi.nlm.nih.gov/pubmed/28717704 http://dx.doi.org/10.1200/JGO.2015.001479 |
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