MRI identified prognostic features of tumors in distal sigmoid, rectosigmoid, and upper rectum: Treatment with radiotherapy and chemotherapy
- Division of Colorectal Surgery, Mayday University Hospital, Croydon (United Kingdom)
- Academic Department of Radiology, Royal Marsden Hospital, Sutton, Surrey (United Kingdom)
- Division of Colorectal Surgery, Epsom and St. Helier NHS Trust, Epsom (United Kingdom)
- Department of Medical Statistics and Computing, Royal Marsden Hospital, Sutton, Surrey (United Kingdom)
- Department of Histopathology, Royal Marsden Hospital, Sutton, Surrey (United Kingdom)
- Department of Clinical Oncology, Royal Marsden Hospital, Sutton, Surrey (United Kingdom)
Purpose: Neoadjuvant therapy is traditionally reserved for locally advanced mid and low rectal cancers. In tumors above this level, the need for adjuvant treatment is based on poor histopathologic features, but this approach has potential disadvantages. The aim of this study was to determine whether magnetic resonance imaging (MRI) could accurately stage tumors of the distal sigmoid, rectosigmoid, and upper rectum and help direct preoperative treatment. Materials and Methods: A total of 75 patients with distal sigmoid, rectosigmoid, and upper rectal tumors were assessed preoperatively by MRI. If tumor extended beyond the planned surgical resection plane, chemoradiotherapy was offered. Results: Of the 75 patients, 57 (76%) underwent primary surgery. Agreement between the MRI prognosis and histopathologic findings was 84% (95% confidence interval [CI], 72.6-92.7%). The other 18 patients underwent neoadjuvant chemoradiotherapy for poor prognostic features with predicted surgical resection margin involvement. The histopathologic examination confirmed tumor downstaging in 9 of the 18 patients who underwent chemoradiotherapy. The 3-year survival rate in the good prognosis group (91%; 95% CI, 77.1-97.3%) was not significantly different from that of the chemoradiotherapy group (81.4%; 95% CI, 52.4-93.6%). The poor prognosis group undergoing primary surgery had significantly worse survival (62.2%; 95% CI, 30.3-82.8%, p < 0.03). Conclusion: Our findings indicate that tumors of the distal sigmoid, rectosigmoid, and upper rectum can be staged accurately using high spatial resolution MRI and that those with poor prognostic disease may benefit from preoperative therapy.
- OSTI ID:
- 20793503
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 65, Issue 2; Other Information: DOI: 10.1016/j.ijrobp.2005.12.027; PII: S0360-3016(05)03097-X; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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