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Annals of Surgical Oncology

, Volume 19, Issue 9, pp 2842–2852 | Cite as

Comparison of Magnetic Resonance Imaging and Histopathological Response to Chemoradiotherapy in Locally Advanced Rectal Cancer

  • Uday Bharat Patel
  • Gina BrownEmail author
  • Harm Rutten
  • Nicholas West
  • David Sebag-Montefiore
  • Robert Glynne-Jones
  • Eric Rullier
  • Marc Peeters
  • Eric Van Cutsem
  • Sergio Ricci
  • Cornelius Van de Velde
  • Pennert Kjell
  • Philip Quirke
Colorectal Cancer

Abstract

Background

Magnetic resonance imaging (MRI) methods for chemoradiotherapy (CRT) response assessment of rectal cancer include posttreatment T staging (ymrT), tumor regression grading (mrTRG), volume reduction posttreatment, and modified RECIST measurement. We compared these methods in identifying good versus poor responders with the histopathological standards of T stage (ypT) and tumor regression grading (TRG).

Methods

A total of 86 patients underwent CRT in a prospective phase II trial for MRI-defined locally advanced rectal cancer. Two readers independently assessed MRIs for ymrT, mrTRG, volume change, and RECIST. Parameters for each case were categorized as good or poor response and analyzed against ypT and TRG by univariate logistic regression.

Results

A total of 83 patients had evaluable imaging, and 78 had final pathology (five did not undergo surgery). Of these, 34 patients had good response (ypT0-3a) and 44 had poor response (>ypT3a). Also, 27 patients had favorable pathologic TRG (predominant fibrosis) and 51 had unfavorable TRG (predominant tumor). Good mrTRG and ymr <T3b stage were both significantly (P = 0.001) associated with favorable pathology odds ratio [OR] = 16.11 (95 % confidence interval [95 % CI]: 3.36–77.29) and 17.50 (95 % CI: 5.38–56.89), respectively. RECIST measurements and volume reduction of >80 % showed an OR of 3.23 (95 % CI: 1.14–9.17), 4.25 (95 % CI: 0.92–15.45), respectively, for a good ypT score (P = 0.028), but there was no association for histopathological TRG.

Conclusion

Favorable and unfavorable histopathology are predicted by both ymrT and mrTRG, and we recommend these parameters for post-treatment assessment of rectal cancers treated with CRT.

Keywords

Rectal Cancer Circumferential Resection Margin Advanced Rectal Cancer Tumor Regression Grade Tumor Length 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgement

GB., H. R., D. S. M., R. G. J., E. R., M. P., S. R., C. V. V., and P. Q. were paid honoraria by Sanofi-Aventis for the design of study protocol. E.V.C. received research funding at the University Hospital Leuven paid by Sanofi-Aventis.

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Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Uday Bharat Patel
    • 1
  • Gina Brown
    • 1
    Email author
  • Harm Rutten
    • 2
  • Nicholas West
    • 3
  • David Sebag-Montefiore
    • 4
  • Robert Glynne-Jones
    • 5
  • Eric Rullier
    • 6
  • Marc Peeters
    • 7
  • Eric Van Cutsem
    • 8
  • Sergio Ricci
    • 9
  • Cornelius Van de Velde
    • 10
  • Pennert Kjell
    • 1
  • Philip Quirke
    • 3
  1. 1.Department of RadiologyThe Royal Marsden HospitalSuttonUK
  2. 2.Department of SurgeryCatharina HospitalEindhovenThe Netherlands
  3. 3.Section of Pathology and Tumor BiologyLeeds Institute of Molecular Medicine, University of LeedsLeedsUK
  4. 4.St James’s Institute of OncologyLeedsUK
  5. 5.Department of Clinical OncologyMount Vernon Cancer CenterNorthwoodUK
  6. 6.Department of SurgerySaint-Andre HospitalBordeauxFrance
  7. 7.Digestive Oncology UnitUniversity Hospital GhentGhentBelgium
  8. 8.Digestive OncologyUniversity Hospital Gasthuisberg/LeuvenLeuvenBelgium
  9. 9.Department of Medical OncologySanta Chiara HospitalPisaItaly
  10. 10.Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands

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