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Timing of surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer - A comparison of magnetic resonance imaging at two time points and histopathological responses

Timing of surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer - A comparison of magnetic resonance imaging at two time points and histopathological responses
Timing of surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer - A comparison of magnetic resonance imaging at two time points and histopathological responses
Purpose There is wide inter-institutional variation in the interval between neoadjuvant chemoradiotherapy (NACRT) and surgery for locally advanced rectal cancer. We aimed to assess the association of magnetic resonance imaging (MRI) at 9 and 14 weeks post-NACRT; T-staging (ymrT) and post-NACRT tumour regression grading (ymrTRG) with histopathological outcomes; histopathological T-stage (ypT) and histopathological tumour regression grading (ypTRG) in order to inform decision-making about timing of surgery.Patients and methods We prospectively studied 35 consecutive patients (26 males) with MRI-defined resection margin threatened rectal cancer who had completed standardized NACRT. Patients underwent a MRI at Weeks 9 and 14 post-NACRT, and surgery at Week 15. Two readers independently assessed MRIs for ymrT, ymrTRG and volume change. ymrT and ymrTRG were analysed against histopathological ypT and ypTRG as predictors by logistic regression modelling and receiver operating characteristic (ROC) curve analyses.Results Thirty-five patients were recruited. Inter-observer agreement was good for all MR variables (Kappa > 0.61). Considering ypT as an outcome variable, a stronger association of favourable ymrTRG and volume change at Week 14 compared to Week 9 was found (ymrTRG – p = 0.064 vs. p = 0.010; Volume change – p = 0.062 vs. p = 0.007). Similarly, considering ypTRG as an outcome variable, a greater association of favourable ymrTRG and volume change at Week 14 compared to Week 9 was found (ymrTRG – p = 0.005 vs. p = 0.042; Volume change – p = 0.004 vs. 0.055).Conclusion Following NACRT, greater tumour down-staging and volume reduction was observed at Week 14. Timing of surgery, in relation to NACRT, merits further investigation.
0748-7983
1350-1358
West, Malcolm
98b67e58-9875-4133-b236-8a10a0a12c04
Dimitrov, Borislav
366d715f-ffd9-45a1-8415-65de5488472f
Moyses, Helen
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Kemp, Graham
daf4d5c6-b98c-4b6c-a1b1-00c68933501d
Loughney, Lisa
9c3e7db1-468b-405c-b32f-cedd9cc251fe
White, David
5fb22cb9-1126-4b70-8b6d-79a64a97ab76
Grocott, Mike
1e87b741-513e-4a22-be13-0f7bb344e8c2
Jack, Sandy
3275b6b3-9f60-4901-9b2f-b03aab101638
Brown, Gina
1027731d-2d56-4ce1-8f95-49b453d8fc35
West, Malcolm
98b67e58-9875-4133-b236-8a10a0a12c04
Dimitrov, Borislav
366d715f-ffd9-45a1-8415-65de5488472f
Moyses, Helen
56434d9c-870f-4539-a66a-c791add44f67
Kemp, Graham
daf4d5c6-b98c-4b6c-a1b1-00c68933501d
Loughney, Lisa
9c3e7db1-468b-405c-b32f-cedd9cc251fe
White, David
5fb22cb9-1126-4b70-8b6d-79a64a97ab76
Grocott, Mike
1e87b741-513e-4a22-be13-0f7bb344e8c2
Jack, Sandy
3275b6b3-9f60-4901-9b2f-b03aab101638
Brown, Gina
1027731d-2d56-4ce1-8f95-49b453d8fc35

West, Malcolm, Dimitrov, Borislav, Moyses, Helen, Kemp, Graham, Loughney, Lisa, White, David, Grocott, Mike, Jack, Sandy and Brown, Gina (2016) Timing of surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer - A comparison of magnetic resonance imaging at two time points and histopathological responses. European Journal of Surgical Oncology, 42 (9), 1350-1358. (doi:10.1016/j.ejso.2016.04.003).

Record type: Article

Abstract

Purpose There is wide inter-institutional variation in the interval between neoadjuvant chemoradiotherapy (NACRT) and surgery for locally advanced rectal cancer. We aimed to assess the association of magnetic resonance imaging (MRI) at 9 and 14 weeks post-NACRT; T-staging (ymrT) and post-NACRT tumour regression grading (ymrTRG) with histopathological outcomes; histopathological T-stage (ypT) and histopathological tumour regression grading (ypTRG) in order to inform decision-making about timing of surgery.Patients and methods We prospectively studied 35 consecutive patients (26 males) with MRI-defined resection margin threatened rectal cancer who had completed standardized NACRT. Patients underwent a MRI at Weeks 9 and 14 post-NACRT, and surgery at Week 15. Two readers independently assessed MRIs for ymrT, ymrTRG and volume change. ymrT and ymrTRG were analysed against histopathological ypT and ypTRG as predictors by logistic regression modelling and receiver operating characteristic (ROC) curve analyses.Results Thirty-five patients were recruited. Inter-observer agreement was good for all MR variables (Kappa > 0.61). Considering ypT as an outcome variable, a stronger association of favourable ymrTRG and volume change at Week 14 compared to Week 9 was found (ymrTRG – p = 0.064 vs. p = 0.010; Volume change – p = 0.062 vs. p = 0.007). Similarly, considering ypTRG as an outcome variable, a greater association of favourable ymrTRG and volume change at Week 14 compared to Week 9 was found (ymrTRG – p = 0.005 vs. p = 0.042; Volume change – p = 0.004 vs. 0.055).Conclusion Following NACRT, greater tumour down-staging and volume reduction was observed at Week 14. Timing of surgery, in relation to NACRT, merits further investigation.

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Accepted/In Press date: 8 April 2016
e-pub ahead of print date: 26 April 2016
Published date: 1 September 2016
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 391392
URI: https://eprints.soton.ac.uk/id/eprint/391392
ISSN: 0748-7983
PURE UUID: c440b15e-d697-49cf-b2d9-1dc2373a9592
ORCID for Malcolm West: ORCID iD orcid.org/0000-0002-0345-5356
ORCID for Mike Grocott: ORCID iD orcid.org/0000-0002-9484-7581

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Date deposited: 12 Apr 2016 10:41
Last modified: 10 Dec 2019 06:35

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Contributors

Author: Malcolm West ORCID iD
Author: Borislav Dimitrov
Author: Helen Moyses
Author: Graham Kemp
Author: Lisa Loughney
Author: David White
Author: Mike Grocott ORCID iD
Author: Sandy Jack
Author: Gina Brown

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