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MRI in local advanced rectal

J X Zhang, Z Yang, P Fan, J J Zhang, L Xin, L N Hou, X S Du, X T Yang
Objective: To evaluate the predictive value of MRI features and pathological parameters on local recurrence, metastasis and progression free survival (PFS) for locally advanced rectal cancer after neoadjuvant chemoradiotherapy and subsequent total mesorectal excision surgery. Methods: A retrospective analysis of 95 patients with locally advanced rectal adenocarcinoma who underwent total mesorectal excision after neoadjuvant chemoradiotherapy was performed. Univariate and multivariate analyses were performed to evaluate the predictive value of MRI features before chemoradiation and postoperative pathological parameters on progression free survival...
February 23, 2018: Zhonghua Zhong Liu za Zhi [Chinese Journal of Oncology]
A Palmisano, A Esposito, A Di Chiara, A Ambrosi, P Passoni, N Slim, C Fiorino, L Albarello, N Di Muzio, R Calandrino, R Rosati, A Del Maschio, F De Cobelli
AIM: To investigate the potential role of an additional magnetic resonance imaging (MRI) examination performed during neoadjuvant chemoradiation therapy (CRT) in the prediction of pathological response in locally advanced rectal cancer (LARC). MATERIAL AND METHODS: Forty-eight consecutive patients with LARC underwent neoadjuvant CRT. MRI studies at 1.5 T, including high-resolution T2-weighted sequences that were acquired parallel and perpendicular to the main axis of the tumour were performed before (preMRI), during (midMRI), and 6-8 weeks after the end of CRT (postMRI)...
February 17, 2018: Clinical Radiology
Chongda Zhang, Feng Ye, Yuan Liu, Han Ouyang, Xinming Zhao, Hongmei Zhang
Purpose: To evaluate the value of morphological parameters that can be obtained conveniently by MRI for predicting pathologically complete response (pCR) in patients with rectal cancer. Materials and Methods: A cohort of 101 patients was examined using MRI before and after Neoadjuvant chemoradiotherapy (nCRT). Morphological parameters including maximum tumor area (MTA), maximum tumor length (MTL) and maximum tumor thickness (MTT), as well as cylindrical approximated tumor volume (CATV), distance to anal verge (DTA), and the reduction rates were evaluated by two experienced readers independently...
January 12, 2018: Oncotarget
Susana Roselló, Federica Papaccio, Desamparados Roda, Noelia Tarazona, Andrés Cervantes
Curative treatment of rectal cancer depends on an optimal surgical resection, with the addition of neoadjuvant radiotherapy (RT) with or without concomitant chemotherapy (ChT) in more advanced tumors. The role of adjuvant ChT is controversial and a more intensified neoadjuvant approach with the addition of ChT before or after RT, or even as single modality, is currently being explored in trials. A systematic review selecting randomised phase II and III trials on the role of ChT in localized rectal cancer was performed...
February 2018: Cancer Treatment Reviews
Sachiyo Okayama, Kazuhiko Yoshimatsu, Hajime Yokomizo, Yuki Yano, Yasufumi Yamada, Masaya Satake, Akiko Sakuma, Atsuo Matsumoto, Takashi Fujimoto, Takefumi Usui, Kentaro Yamaguchi, Shunichi Shiozawa, Takeshi Shimakawa, Takao Katsube, Yoshihiko Naritaka
We report a case of an advanced rectal cancer recurrence that responded completely to chemo-radiotherapy. The patient was an 80-year-old woman. Low anterior resection with D2(prxD3)lymph node dissection was performed. Sixteen months after operation, CEA level elevated but no recurrence foci were found in any image tests. Administration of TS-1 was initiated since recurrence was highly suspected. Twenty seven months after operation, PET-CT detected local recurrence in the posterior wall of the vagina. After construction colostomy, chemo-radiotherapy(60 Gy+oral UFT)was performed and CEA level dropped promptly to the normal value...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
A Crawford, J Firtell, A Caycedo-Marulanda
INTRODUCTION: Locally advanced rectal cancers are most often treated with neoadjuvant chemoradiation followed by surgical resection. However, there are differing opinions surrounding management of rectal cancer, including a lack of consensus on the optimal time interval between chemoradiation and surgery, and the management of patients with complete clinical response following neoadjuvant therapy. This study seeks to summarize management trends for rectal cancer among a sample of Canadian surgeons...
February 1, 2018: Journal of Gastrointestinal Cancer
Masatoshi Hotta, Ryogo Minamimoto, Hideaki Yano, Yoshimasa Gohda, Yasutaka Shuno
BACKGROUND: Accurate staging is crucial for treatment selection and prognosis prediction in patients with rectal cancer. Point spread function (PSF) reconstruction can improve spatial resolution and signal-to-noise ratio of PET imaging. The aim of this study was to evaluate the effectiveness of 18F-FDG PET/CT with PSF reconstruction for initial staging in rectal cancer compared with conventional PET/CT and pelvic MRI. METHODS: A total of 59 patients with rectal cancer underwent preoperative 18F-FDG PET/CT and pelvic MRI...
January 30, 2018: Cancer Imaging: the Official Publication of the International Cancer Imaging Society
Doenja M J Lambregts, Andrea Delli Pizzi, Max J Lahaye, Joost J M van Griethuysen, Monique Maas, Geerard L Beets, Frans C H Bakers, Regina G H Beets-Tan
BACKGROUND: Diffusion-weighted imaging is increasingly used in rectal cancer MRI to assess response after chemoradiotherapy. Certain pitfalls (eg, artefacts) may hamper diffusion-MRI assessment, leading to suboptimal diagnostic performance. Combining diffusion-weighted MRI with the underlying morphology on standard (T2-weighted) MRI may help overcome these pitfalls. OBJECTIVE: The purpose of this study was to evaluate the diagnostic performance of a pattern-based approach combining tumor morphology on T2-weighted MRI with distinct diffusion-weighted imaging signal patterns to assess response after chemoradiotherapy in rectal cancer...
March 2018: Diseases of the Colon and Rectum
Xinhua Wang, Wuteng Cao, Dechao Liu, Fangqian Li, Wenli Li, Liang Kang, Yanhong Deng, Zhiyang Zhou
OBJECTIVE: To investigate the value of MRI with CUBE sequence in early evaluation of the efficacy of neoadjuvant therapy (NAT) for locally advanced rectal cancer. METHODS: Inclusion criteria: (1) rectal cancer proven by biopsy; (2) locally advanced rectal cancer (T3-4 or positive lymph nodes) with distance from lower edge of tumor to anal verge within 12 cm diagnosed by MRI before NAT; (3) acceptance of NAT treatment regulations and completion of NAT; (4) completion of routine MRI scan and CUBE scan before and after 2-course NAT chemotherapy (including new neoadjuvant chemotherapy and chemoradiotherapy); (5) completion of surgery 6-8 weeks after NAT; (6) exclusion of any previous NAT due to rectal malignant tumor or other tumors; (7) exclusion of poor image quality of preoperative routine MRI insufficient for rectal cancer staging or of CUBE image insufficient for tumor volume measurement...
January 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Qiaoyu Xu, Yanyan Xu, Hongliang Sun, Queenie Chan, Kaining Shi, Aiping Song, Wu Wang
BACKGROUND: Many locally advanced rectal cancer (LARC) patients can benefit from neoadjuvant chemotherapy (NACT), with some achieving a pathological complete response (pCR). However, there is limited research reporting on the value of intravoxel incoherent motion (IVIM) in monitoring pCR in patients with LARC. PURPOSE: To identify whether IVIM parameters derived from whole-tumor volume (WTV) before and after NACT could accurately assess pCR in patients with LARC...
December 27, 2017: Journal of Magnetic Resonance Imaging: JMRI
Hye Jin Kim, Gyu-Seog Choi, Jun Seok Park, Soo Yeun Park, Seung Hyun Cho, Soo Jung Lee, Byung Woog Kang, Jong Gwang Kim
Background: Although lateral pelvic lymph node (LPN) metastasis is a major cause of local recurrence in patients with rectal cancer, controversy still remains on the treatment of suspected LPN metastasis, "suspicious LPN". We aimed to determine the optimal treatment strategies for suspicious LPN, in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy (CRT). Materials and Methods: Of 377 patients who received preoperative CRT for rectal cancer between 2006 and 2013, 84 (22...
November 21, 2017: Oncotarget
Necla Gurdal, Merdan Fayda, Nijat Alishev, Baris Bakir, Didem Tastekin, Faruk Aykan, Ugur Gezer, Emre Balik, Esra Kaytan Saglam, Ethem Nezih Oral, Mine Gulluoglu, Ahmet Kizir
PURPOSE: In this prospective observational study, we aimed to report the applicability and tolerability of neoadjuvant volumetric modulated arc therapy with simultaneous integrated boost (SIB-VMAT) and concurrent chemotherapy in patients with locally advanced rectal cancer (LARC), and to evaluate the correlation of pathological response with apparent diffusion coefficient (ADC) measurements on diffusion-weighted magnetic resonance imaging (DW-MRI) and apoptotic markers. METHODS: The study enrolled 30 patients with T3 to T4 and/or N+ rectal cancer who preoperatively received SIB-VMAT and concurrent chemotherapy...
December 6, 2017: Tumori
Pierre Decazes, Sébastien Thureau, Bernard Dubray, Pierre Vera
INTRODUCTION: Radiotherapy is a major treatment modality for many cancers. Tumor response after radiotherapy determines the subsequent steps of the patient's management (surveillance, adjuvant or salvage treatment and palliative care). Tumor response assessed during radiotherapy offers a promising opportunity to adapt the treatment plan to reduced / increased target volume, to specifically target sub-volumes with relevant biological characteristics (metabolism, hypoxia, proliferation ...
November 28, 2017: Quarterly Journal of Nuclear Medicine and Molecular Imaging
Jonathan D Van Wickle, Eric S Paulson, Jerome C Landry, Beth A Erickson, William A Hall
Total mesorectal excision (TME) after neoadjuvant chemoradiotherapy (CRT) has offered superior control for patients with locally advanced rectal cancer, but can carry a quality of life cost. Fortunately, some patients achieve a complete response after CRT alone without the added morbidity caused by surgery. Efforts to increase fidelity of radiation treatment planning and delivery may allow for escalated doses of radiotherapy (RT) with limited off-target toxicity and elicit more pathological complete responses (pCR) to CRT thereby sparing more rectal cancer patients from surgery...
October 2017: Journal of Gastrointestinal Oncology
Antonella Petrillo, Roberta Fusco, Vincenza Granata, Sergio Venanzio Setola, Mario Sansone, Daniela Rega, Paolo Delrio, Francesco Bianco, Giovanni Maria Romano, Fabiana Tatangelo, Antonio Avallone, Biagio Pecori
Our aim is to assess preoperative Short Course Radiotherapy (SCR) tumor response in locally advanced rectal cancer (LARC) through Standardized Index of Shape (SIS) by DCE-MRI, apparent diffusion coefficient (ADC) and intravoxel incoherent motion-derived parameters by DW-MRI. 35 patients with LARC underwent MR scan before and after SCR followed by delayed surgery, retrospectively, were enrolled. SIS, ADC, tissue diffusion (Dt ), pseudodiffusion (Dp ), and perfusion fraction (f) were extracted by MRI for each patient before and after SCR...
November 18, 2017: Medical Oncology
P Kogler, A F DeVries, W Eisterer, J Thaler, L Sölkner, D Öfner
PURPOSE: The major goals of preoperative treatment for locally advanced rectal cancers (LARCs) are improvement of local tumor control, tumor downsizing, and downstaging. Modifications with respect to standardized chemoradiation protocol, e. g., integrating oxaliplatin, are realized with the aim of improving primary tumor response and patient outcome. PATIENTS AND METHODS: In this phase II multicenter study, patients with LARC of the mid- or lower rectum, cT3cNxcM0 as staged by MRI, were included and treated preoperatively with a combination of capecitabine and oxaliplatin following a standardized protocol during radiation...
November 10, 2017: Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft ... [et Al]
Shing Fung Lee, Chi Leung Chiang, Francis Ann Shing Lee, Yiu Wah Wong, Chi Ming Poon, Frank Chi Sing Wong, Stewart Yuk Tung
BACKGROUND: For advanced rectal cancer with involved or threatened mesorectal fascia (MRF), current standard is pre-operative long course chemoradiotherapy (PLCRT) with either capecitabine or 5-fluorouracil (5-FU). However, few Chinese data on its clinical outcome are available, especially for those with pelvic MRI staging. METHODS: Between Jan-2009 and Oct-2014, 123 consecutive patients with biopsy proven adenocarcinoma of rectum, all with pelvic MRI staging, selected for PLCRT after multi-disciplinary team discussion were recruited...
November 1, 2017: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Fabio Pomerri, Filippo Crimì, Nicola Veronese, Alessandro Perin, Carmelo Lacognata, Francesca Bergamo, Caterina Boso, Isacco Maretto
BACKGROUND: The prediction of lymph node status using MRI has an impact on the management of rectal cancer, both before and after preoperative chemoradiotherapy. OBJECTIVE: The purpose of this study was to maximize the negative predictive value and sensitivity of mesorectal lymph node imaging after chemoradiotherapy because postchemoradiation node-negative patients may be treated with rectum-sparing approaches. DESIGN: This was a retrospective study...
November 2017: Diseases of the Colon and Rectum
Min A Lee, Seung Hyun Cho, An Na Seo, Hye Jung Kim, Kyung-Min Shin, See Hyung Kim, Gyu-Seog Choi
OBJECTIVE: The purpose of this study was to evaluate the prognostic relevance of a modified 3-point MRI-based tumor regression grading system incorporating DWI for patients with locally advanced rectal cancer after preoperative chemoradiotherapy (CRT). MATERIALS AND METHODS: Between March 2012 and September 2013, 118 consecutively registered patients with middle or lower locally advanced rectal cancer who underwent CRT followed by surgery were enrolled in this retrospective study...
December 2017: AJR. American Journal of Roentgenology
Thiago Bassaneze, José Eduardo Gonçalves, Juliano Ferreira Faria, Rogério Tadeu Palma, Jaques Waisberg
BACKGROUND: The aim of the study was to evaluate the added value of the apparent diffusion coefficient (ADC) of diffusion-weighted magnetic resonance imaging (DW-MRI) in patients with rectal cancer who received neoadjuvant chemoradiotherapy (CRT). The use of DW-MRI for response evaluation in rectal cancer still remains a widely investigated issue, as the accurate detection of pathologic complete response (pCR) is critical in making therapeutic decisions. PATIENTS AND METHODS: Thirty-three patients with locally advanced rectal cancer were evaluated retrospectively by MRI in addition to diffusion-weighted images (DWI) and its ADC pre- and post-neoadjuvant CRT...
September 2017: Radiology and Oncology
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