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Ann Surg. 2014 Apr;259(4):723-7. doi: 10.1097/SLA.0b013e31828f6c91.

Multicenter Evaluation of Rectal cancer ReImaging pOst Neoadjuvant (MERRION) Therapy.

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1
*Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin, Ireland †Beaumont Hospital, Dublin, Ireland ‡University of Minnesota Medical Center, Minnesota, Minneapolis, MN.

Abstract

OBJECTIVE:

The aim of this study was to evaluate the utility of reimaging rectal cancer post-CRT (chemoradiotherapy) with magnetic resonance (MR) imaging of the pelvis for local staging and computed tomography of thorax, abdomen, and pelvis (CT TAP) to identify distant metastases.

BACKGROUND:

The success of neoadjuvant CRT for locally advanced rectal cancer has changed an already complex management algorithm. There is no consensus whether patients should be restaged before surgery.

METHODS:

Data from 5 institutions with prospectively maintained databases including patients who received neoadjuvant CRT for locally advanced rectal cancer were acquired. Only patients who had been staged pre- and post-CRT with MR imaging and CT TAP were included. MR findings were correlated with histopathological stage using weighted κ (kappa) statistics to test agreement, where a κ value of less than 0.5 was deemed unacceptable.

RESULTS:

A total of 285 patients fulfilled the criteria for the study; 84% had American Joint Committee for Cancer stage 3 disease pre-CRT, and the remainder had stage 2 disease. Fourteen patients did not proceed to surgery post-CRT-2 were observed as "complete responders," and the remainder either had unresectable disease or were unfit for surgery. MR imaging could not predict T stage (κ = 0.212) or nodal involvement (κ = 0.336). Most pertinently, MR imaging was unable to detect a complete pathological response (κ = 0.021), nor could it discriminate T4 disease (κ = 0.445). CT TAP restaging altered management in 6.7% of patients, who had metastatic disease.

CONCLUSIONS:

MR reimaging using standard protocols is of limited value in determining surgical approaches; a better modality of local restaging is required.

PMID:
23744576
DOI:
10.1097/SLA.0b013e31828f6c91
[Indexed for MEDLINE]
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