Early MRI predictors of disease‐free survival in locally advanced rectal cancer from the GRECCAR 4 trial. BJS 2019; 106: 1530-1541.
Published: 22nd August 2019
Authors: S. Nougaret, F. Castan, H. Forges, H. A. Vargas, B. Gallix, S. Gourgou et al.
Tailored neoadjuvant treatment of locally advanced rectal cancer (LARC) may improve outcomes. The aim of this study was to determine early MRI prognostic parameters with which to stratify neoadjuvant treatment in patients with LARC.
All patients from a prospective, phase II, multicentre randomized study (GRECCAR4; NCT01333709) were included, and underwent rectal MRI before treatment, 4 weeks after induction chemotherapy and after completion of chemoradiotherapy (CRT). Tumour volumetry, MRI tumour regression grade (mrTRG), T and N categories, circumferential resection margin (CRM) status and extramural vascular invasion identified by MRI (mrEMVI) were evaluated.
A total of 133 randomized patients were analysed. Median follow‐up was 41·4 (95 per cent c.i. 36·6 to 45·2) months. Thirty‐one patients (23·3 per cent) developed tumour recurrence. In univariable analysis, mrEMVI at baseline was the only prognostic factor associated with poorer outcome (P = 0·015). After induction chemotherapy, a larger tumour volume on MRI (P = 0·019), tumour volume regression of 60 per cent or less (P = 0·002), involvement of the CRM (P = 0·037), mrEMVI (P = 0·026) and a poor mrTRG (P = 0·023) were associated with poor outcome. After completion of CRT, the absence of complete response on MRI (P = 0·004), mrEMVI (P = 0·038) and a poor mrTRG (P = 0·005) were associated with shorter disease‐free survival. A final multivariable model including all significant variables (baseline, after induction, after CRT) revealed that Eastern Cooperative Oncology Group performance status (P = 0·011), sphincter involvement (P = 0·009), mrEMVI at baseline (P = 0·002) and early tumour volume regression of 60 per cent or less after induction (P = 0·007) were associated with relapse.
Baseline and early post‐treatment MRI parameters are associated with prognosis in LARC. Future preoperative treatment should stratify treatment according to baseline mrEMVI status and early tumour volume regression.Full text
You may also be interested in
Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial.
Authors: B. Garlipp, P. Gibbs, G. A. Van Hazel, R. Jeyarajah, R. C. G. Martin, C. J. Bruns et al.
Population‐based study of the impact of small bowel obstruction due to adhesions on short‐ and medium‐term mortality.
Authors: R. Behman, A. B. Nathens, B. Haas, N. Look Hong, P. Pechlivanoglou, P. Karanicolas et al.
Prospective cohort study of appendicectomy for treatment of therapy‐refractory ulcerative colitis. BJS 2019; 106: 1697-1704.
Authors: M. E. Stellingwerf, S. Sahami, D. C. Winter, S. T. Martin, G. R. D'Haens, G. Cullen et al.
Long‐term follow‐up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis. BJS 2019; 106: 1542-1548.
Authors: D. Isacson, K. Smedh, M. Nikberg, A. Chabok
Pushing the boundaries of pelvic exenteration by maintaining survival at the cost of morbidity. BJS 2019; 106: 1393-1403.
Authors: R. L. Venchiarutti, M. J. Solomon, C. E. Koh, J. M. Young, D. Steffens
Meta‐analysis of the role of colonoscopy after an episode of left‐sided acute diverticulitis. BJS 2019; 106: 988-997.
Authors: S. J. Rottier, S. T. Dijk, A. A. W. Geloven, W. H. Schreurs, W. A. Draaisma, W. A. Enst et al.
Randomized clinical trial
Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer.
Authors: S. Pucciarelli, P. Del Bianco, U. Pace, F. Bianco, A. Restivo, I. Maretto et al.
Meta‐analysis of the effect of extending the interval after long‐course chemoradiotherapy before surgery in locally advanced rectal cancer. BJS 2019; 106: 1298-1310.
Authors: É. J. Ryan, D. P. O'Sullivan, M. E. Kelly, A. Z. Syed, P. C. Neary, P. R. O'Connell et al.
Randomized clinical trial
Randomized clinical trial of accelerated enhanced recovery after minimally invasive colorectal cancer surgery (RecoverMI trial). BJS 2019; 106: 1311-1318.
Authors: B. K. Bednarski, T. P. Nickerson, Y. N. You, C. A. Messick, B. Speer, V. Gottumukkala et al.
Authors: T. O. Sillo, A. D. Beggs, D. G. Morton, G. Middleton
Postoperative complications in relation to overall treatment time in patients with rectal cancer receiving neoadjuvant radiotherapy.
Authors: J. Erlandsson, D. Pettersson, B. Glimelius, T. Holm, A. Martling
Organoids from colorectal peritoneal metastases as a platform for improving hyperthermic intraperitoneal chemotherapy. BJS 2019; 106: 1404-1414.
Authors: I. Ubink, A. C. F. Bolhaqueiro, S. G. Elias, D. A. E. Raats, A. Constantinides, N. A. Peters et al.