van der Sande, ME, Beets, GL, Hupkens, BJP et al. (7 more authors) (2019) Response assessment after (chemo)radiotherapy for rectal cancer: Why are we missing complete responses with MRI and endoscopy? European Journal of Surgical Oncology, 45 (6). pp. 1011-1017. ISSN 0748-7983
Abstract
Purpose
To evaluate what features on restaging MRI and endoscopy led to a false clinical diagnosis of residual tumour in patients with a pathological complete response after rectal cancer surgery.
Methods
Patients with an unrecognized complete response after (chemo)radiotherapy were selected in a tertiary referral centre for rectal cancer treatment. An unrecognized complete response was defined as a clinical incomplete response at MRI and/or endoscopy with a pathological complete response of the primary tumour after surgery. The morphology of the tumour bed and the lymph nodes were evaluated on post-CRT T2-weighted MRI (T2-MRI) and diffusion weighted imaging (DWI). Post-CRT endoscopy images were evaluated for residual mucosal abnormalities. MRI and endoscopy features were correlated with histopathology.
Results
Thirty-six patients with an unrecognized complete response were included. Mucosal abnormalities were present at restaging endoscopy in 84%, mixed signal intensity on T2-MRI in 53%, an irregular aspect of the former tumour location on T2-MRI in 69%, diffusion restriction on DWI in 51% and suspicious lymph nodes in 25%.
Conclusions
Overstaging of residual tumour after (chemo)radiotherapy in rectal cancer is mainly due to residual mucosal abnormalities at endoscopy, mixed signal intensity or irregular fibrosis at T2-MRI, diffusion restriction at DWI and residual suspicious lymph nodes. Presence of these features is not definitely associated with residual tumour and in selected cases an extended waiting interval can be considered.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved. This is an author produced version of a paper published in European Journal of Surgical Oncology. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Rectal cancer; Organ preservation; Complete response; Magnetic resonance imaging; Endoscopy |
Dates: |
|
Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cancer and Pathology (LICAP) > Pathology & Tumour Biology (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 04 Dec 2018 13:43 |
Last Modified: | 24 Nov 2019 01:38 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.ejso.2018.11.019 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:139519 |
Download
Filename: accepted manuscriptPIIS0748798318320171.pdf
Licence: CC-BY-NC-ND 4.0