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MRI in local advanced rectal

Finn Ole Larsen, Alice Markussen, Benny V Jensen, Anne L Fromm, Kirsten K Vistisen, Vibeke K Parner, Dorte Linnemann, Rasmus H Hansen, Helle H Johannesen, Jakob V Schou
PURPOSE: To evaluate the effect of capecitabine and oxaliplatin before, during, and after radiotherapy for high-risk rectal cancer. PATIENTS AND METHODS: Patients with rectum cancer T4 or T3 involving the mesorectal fascia was included in a prospective phase 2 trial. Liver or lung metastases were accepted if the surgeons found them resectable. The patients received 6 weeks of capecitabine and oxaliplatin before chemoradiotherapy (CRT), continued capecitabine and oxaliplatin during radiotherapy, and received 4 weeks of capecitabine and oxaliplatin after CRT...
September 14, 2016: Clinical Colorectal Cancer
A McBrearty, K McCallion, R J Moorehead, I McAllister, K Mulholland, R Gilliland, W J Campbell
BACKGROUND: In patients with locally advanced or low rectal cancers, long-course chemoradiotherapy (LCCRT) is recommended prior to surgical management.(1) The need for restaging afterwards has been questioned as it may be difficult to interpret imaging due to local tissue effects of chemoradiotherapy. The purpose of this study was to determine if restaging affected the management of patients receiving long-course chemoradiotherapy for rectal cancer. METHODS: A retrospective review of patients with rectal cancer discussed at the South Eastern Health and Social Care Trust Lower Gastrointestinal Multi-Disciplinary Team Meeting (LGIMDT) in 2013 who had received long-course chemoradiotherapy was performed...
September 2016: Ulster Medical Journal
Peter Bondeven
Rectal cancer constitutes one-third of all colorectal cancers, and the incidence in Denmark increasing. In 2012, 1.400 cases were registered, and of these 38% were located in the upper rectum. There have been several key advances in the optimal management of rectal cancer during the past decades, primarily by standardisation and improvement of the surgical procedure. There is now general agreement that the optimal surgical treatment involves the concept of total mesorectal excision and that a resection with tumour-free margins is crucial...
October 2016: Danish Medical Journal
Manish Chand, Shahnawaz Rasheed, Richard Heald, Ian Swift, Nick West, Sheela Rao, Paris Tekkis, Gina Brown
AIM: MRI-detected extramural venous invasion (mrEMVI) is a poor prognostic factor in rectal cancer. Pre-operative chemoradiotherapy (CRT) can cause regression in the severity of EMVI and subsequently improve survival whereas mrEMVI persisting after CRT confers an increased risk of recurrence. The effect of adjuvant chemotherapy (AC) following CRT on survival in rectal cancer remains unclear. The aim of this study was to determine whether there is a survival advantage for AC given to patients with mrEMVI persisting after CRT...
September 27, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Roberta Fusco, Mario Sansone, Antonella Petrillo
OBJECT: The objective of this study is to propose a modified VARiable PROjection (VARPRO) algorithm specifically tailored for fitting the intravoxel incoherent motion (IVIM) model to diffusion-weighted magnetic resonance imaging (DW-MRI) data from locally advanced rectal cancer (LARC). MATERIALS AND METHODS: The proposed algorithm is compared with classical non-linear least squares (NLLS) analysis using the Levenberg-Marquardt (LM) algorithm and with two recently proposed algorithms for 'segmented' analysis...
September 26, 2016: Magma
Jing Yu, Qing Xu, Jia-Cheng Song, Yan Li, Xin Dai, Dong-Ya Huang, Ling Zhang, Yang Li, Hai-Bin Shi
OBJECTIVES: To evaluate the feasibility and value of diffusion kurtosis (DK) imaging in assessing treatment response to neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). METHODS: Forty-one patients were included. All patients underwent pre- and post-CRT DCE-MRI on a 3.0-Tesla MRI scanner. Imaging indices (D app , K app and ADC values) were measured. Change value (∆X) and change ratio (r∆X) were calculated. Pathological tumour regression grade scores (Mandard) were the standard reference (good responders: pTRG 1-2; poor responders: pTRG 3-5)...
September 8, 2016: European Radiology
Minna Räsänen, Ari Ristimäki, Ritja Savolainen, Laura Renkonen-Sinisalo, Anna Lepistö
AIM: The primary purpose of this study was to analyse the overall survival and local recurrence rate after extended resection of locally advanced rectal cancer. The second aim was to determine the ability of radiological irradiation response to predict R0 resection. METHOD: A retrospective study was performed of 94 consecutive patients with locally advanced rectal cancer operated on at the Helsinki University Hospital, Helsinki, Finland during 2005-2013. Data were collected from patient records...
September 13, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Omer Jalil, Asim Afaq, Balaji Ganeshan, Uday B Patel, Darren Boone, Raymond Endozo, Ashley Groves, Bruce Sizer, Tan Arulampalam
AIM: The study aimed to investigate whether textural features of rectal cancer on magnetic resonance imaging (MRI) can predict long term survival in patients treated with long-course chemoradiotherapy. METHOD: Textural analysis (TA) using a filtration-histogram technique of T2-weighted pre- and six-week post chemoradiotherapy MRI was undertaken using TexRAD, a proprietary software algorithm. Regions of interest enclosing the largest cross-sectional area of the tumour were manually delineated on the axial images and filtration-step extracted features at different anatomical scales (fine, medium, and coarse) followed by quantification of statistical features (mean intensity, standard-deviation, entropy, skewness, kurtosis and mean of positive pixels [MPP]) using histogram analysis...
August 18, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Hossein Arabi, Nikolaos Koutsouvelis, Michel Rouzaud, Raymond Miralbell, Habib Zaidi
Magnetic resonance imaging (MRI)-guided attenuation correction (AC) of positron emission tomography (PET) data and/or radiation therapy (RT) treatment planning is challenged by the lack of a direct link between MRI voxel intensities and electron density. Therefore, even if this is not a trivial task, a pseudo-computed tomography (CT) image must be predicted from MRI alone. In this work, we propose a two-step (segmentation and fusion) atlas-based algorithm focusing on bone tissue identification to create a pseudo-CT image from conventional MRI sequences and evaluate its performance against the conventional MRI segmentation technique and a recently proposed multi-atlas approach...
September 7, 2016: Physics in Medicine and Biology
Pietro Valerio Foti, Giuseppe Privitera, Sebastiano Piana, Stefano Palmucci, Corrado Spatola, Roberta Bevilacqua, Luigi Raffaele, Vincenzo Salamone, Rosario Caltabiano, Gaetano Magro, Giovanni Li Destri, Pietro Milone, Giovanni Carlo Ettorre
PURPOSE: to investigate the added value of qualitative and quantitative evaluation of diffusion weighted (DW) magnetic resonance (MR) imaging in response assessment after neoadjuvant chemo-radiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). METHODS: 31 patients with LARC (stage ≥ T3) were enrolled in the study. All patients underwent conventional MRI and DWI before starting therapy and after neoadjuvant CRT. All patients underwent surgery; pathologic staging represented the reference standard...
2016: European Journal of Radiology Open
Claudio Belluco, Marco Forlin, Matteo Olivieri, Renato Cannizzaro, Vincenzo Canzonieri, Angela Buonadonna, Ettore Bidoli, Fabio Matrone, Giulio Bertola, Antonino De Paoli
BACKGROUND: Organ preservation strategies are under investigation for patients with locally advanced rectal cancer (LARC) who achieve a complete pathologic response in the primary tumor (ypT0) after neoadjuvant chemoradiation therapy (CRT). This study explored the value of this approach for cN+ patients. METHODS: Data were retrieved from our institutional prospective rectal cancer database. Tumors with mesorectal lymph nodes larger than 5 mm shown on endorectal ultrasonography, pelvic magnetic resonance imaging, or both were staged as cN+...
August 3, 2016: Annals of Surgical Oncology
Seraina Faes, Olivier Gié, Nicolas Demartines, Dieter Hahnloser
Treatment of patients with locally advanced rectal cancer remains challenging. Preoperative imaging with pelvic MRI allows to identify patients for multimodal treatment including induction chemothe- rapy or neoadjuvant radio-chemotherapy and an extended surgical resection. With multidisciplinary approach and an experienced team, excellent oncologic results may be achieved, as well as a good function and quality of life, even with preservation of the anus in the majority of patients.
June 15, 2016: Revue Médicale Suisse
Kirsten L Gormly, Claudio Coscia, Tim Wells, Niall Tebbutt, Jennifer A Harvey, Kate Wilson, Hans-Joachim Schmoll, Timothy Price
INTRODUCTION: An MRI audit substudy was conducted in patients who underwent an MRI prior to treatment in Australia and New Zealand as part of the PETACC-6 trial in locally advanced rectal cancer. METHODS: A total of 82 patients from 15 centres had rectal MRI scans reviewed for technique, data included in reports and comparison of reports with blinded central reporting by two experienced radiologists. RESULTS: In total, 82% performed minimum T2 sagittal and T2 axial oblique sequences...
July 11, 2016: Journal of Medical Imaging and Radiation Oncology
Renaud Mazeron, Lars U Fokdal, Kathrin Kirchheiner, Petra Georg, Noha Jastaniyah, Barbara Šegedin, Umesh Mahantshetty, Peter Hoskin, Ina Jürgenliemk-Schulz, Christian Kirisists, Jacob C Lindegaard, Wolfgang Dörr, Christine Haie-Meder, Kari Tanderup, Richard Pötter
PURPOSE: To establish dose volume-effect relationships predicting late rectal morbidity in cervix cancer patients treated with concomitant chemoradiation and MRI-guided adaptive brachytherapy (IBABT) within the prospective EMBRACE study. MATERIAL AND METHOD: All patients were treated with curative intent according to institutional protocols with chemoradiation and IGABT. Reporting followed the GEC-ESTRO recommendations ( [Formula: see text] , [Formula: see text] ), applying bioeffect modeling (linear quadratic model) with equieffective doses (EQD23)...
July 7, 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Lijun Shen, Zhen Zhang
Recently, treatment strategy optimization for neoadjuvant therapy of rectal cancer includes two aspects: (1) Increasing treatment intensity may improve pathological complete response rate, including increasing radiation dose or concurrent chemotherapy intensity, or shifting adjuvant chemotherapy; (2) Short-course radiotherapy or neoadjuvant chemotherapy which can promise treatment efficacy will decrease toxicity and lead to better tolerance. Long-course chemoradiotherapy is the recent treatment standard for locally advanced rectal cancer...
June 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Elsa Iannicelli, Marco Di Pietropaolo, Emanuela Pilozzi, Mattia Falchetto Osti, Maria Valentino, Luigi Masoni, Mario Ferri
PURPOSE: The aim of our study was to assess the performance value of magnetic resonance imaging (MRI) in the restaging of locally advanced rectal cancer after neoadjuvant chemoradiotherapy (CRT) and in the identification of good vs. poor responders to neoadjuvant therapy. MATERIALS AND METHODS: A total of 34 patients with locally advanced rectal cancer underwent MRI prior to and after CRT. T stage and tumor regression grade (TRG) on post-CRT MRI was compared with the pathological staging ypT and TRG...
October 2016: Abdominal Radiology
M Kusters, A Slater, M Betts, R Hompes, R J Guy, O M Jones, B D George, I Lindsey, N J Mortensen, D R James, C Cunningham
AIM: Outcomes following treatment for low rectal cancers still remain inferior to those for upper rectal cancers. A clear definition of 'low' rectal cancer is lacking and consensus is more likely using a definition based on MRI criteria. This study aimed to determine disease presentation and treatment outcome of low rectal cancer based on a strict anatomical definition. METHOD: A low rectal cancer was defined as one with a lower border below the pelvic attachment of the levator muscles on sagittal MRI...
June 17, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Nitin Singhal, Karthik Vallam, Reena Engineer, Vikas Ostwal, Supreeta Arya, Avanish Saklani
BACKGROUND: Neoadjuvant chemoradiation is the standard of care for locally advanced rectal cancer. However, there is no clarity regarding the necessity for restaging scans to rule out systemic progression of disease post chemoradiation with existing literature being divided on the need for the same. METHODS: Data from a prospectively maintained database was retrospectively analysed. All locally advanced rectal cancers (node positive/T4/T3 with threatened or involved CRM) were included...
June 2016: Journal of Gastrointestinal Oncology
Vishwas D Pai, Sudhir Jatal, Vikas Ostwal, Reena Engineer, Supreeta Arya, Prachi Patil, Munita Bal, Avanish P Saklani
BACKGROUND: Locally advanced rectal cancers (LARCs) involve one or more of the adjacent organs in upto 10-20% patients. The cause of the adhesions may be inflammatory or neoplastic, and the exact causes cannot be determined pre- or intra-operatively. To achieve complete resection, partial or total mesorectal excision (TME) en bloc with the involved organs is essential. The primary objective of this study is to determine short-term oncological and clinical outcomes in these patients undergoing multivisceral resections (MVRs)...
June 2016: Journal of Gastrointestinal Oncology
Manfred P Lutz, John R Zalcberg, Rob Glynne-Jones, Theo Ruers, Michel Ducreux, Dirk Arnold, Daniela Aust, Gina Brown, Krzysztof Bujko, Christopher Cunningham, Serge Evrard, Gunnar Folprecht, Jean-Pierre Gerard, Angelita Habr-Gama, Karin Haustermans, Torbjörn Holm, Koert F Kuhlmann, Florian Lordick, Gilles Mentha, Markus Moehler, Iris D Nagtegaal, Alessio Pigazzi, Salvatore Puciarelli, Arnaud Roth, Harm Rutten, Hans-Joachim Schmoll, Halfdan Sorbye, Eric Van Cutsem, Jürgen Weitz, Florian Otto
Primary treatment of rectal cancer was the focus of the second St. Gallen European Organisation for Research and Treatment of Cancer (EORTC) Gastrointestinal Cancer Conference. In the context of the conference, a multidisciplinary international expert panel discussed and voted on controversial issues which could not be easily answered using published evidence. Main topics included optimal pretherapeutic imaging, indication and type of neoadjuvant treatment, and the treatment strategies in advanced tumours. Here we report the key recommendations and summarise the related evidence...
August 2016: European Journal of Cancer
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