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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

  • M.A. West
    Correspondence
    Corresponding author. Academic Unit of Cancer Sciences, Faculty of Medicine, University Surgery, University Hospital Southampton, Tremona Road, Southampton, United Kingdom. Tel.: +44 02381205308.
    Affiliations
    Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom

    Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, United Kingdom
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  • B.D. Dimitrov
    Affiliations
    Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
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  • H.E. Moyses
    Affiliations
    National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom

    National Institute for Health Research, Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
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  • G.J. Kemp
    Affiliations
    Department of Musculoskeletal Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
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  • L. Loughney
    Affiliations
    Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, United Kingdom

    Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, United Kingdom

    Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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  • D. White
    Affiliations
    Department of Radiology, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
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  • M.P.W. Grocott
    Affiliations
    Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, United Kingdom

    Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, United Kingdom

    Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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  • S. Jack
    Affiliations
    Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, United Kingdom

    Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, United Kingdom

    Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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  • G. Brown
    Affiliations
    Department of Radiology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Published:April 25, 2016DOI:https://doi.org/10.1016/j.ejso.2016.04.003

      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.
      Trial Registration Number: NCT01325909

      Keywords

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      References

      1. Office for National Statistics, Cancer Registration Statistics, England, 2012. http://www.ons.gov.uk/ons/rel/vsob1/cancer-statistics-registrations–england–series-mb1-/no–42–2011/stb-cancer-statistics-registrations-2011.html (accessed April 2015).

      2. Office for National Statistics, Mortality Statistics: Colorectal Cancer, England, 2014 http://www.ons.gov.uk/ons/rel/cancer-unit/bowel-cancer-in-england/2009/sumcolorectal.html (accessed April 2015).

      3. National Bowel Cancer Audit Report. Annual Report 2014 (accessed April 2013).

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