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Profiling of rectal cancers MRI in pathological complete remission states after neoadjuvant concurrent chemoradiation therapy

 H. Kim  ;  H.M. Kim  ;  W.S. Koom  ;  N.K. Kim  ;  M.-J. Kim  ;  H. Hur  ;  J.S. Lim 
 Clinical Radiology, Vol.71(3) : 250-257, 2016 
Journal Title
 Clinical Radiology 
Issue Date
Adult ; Aged ; Aged, 80 and over ; Chemoradiotherapy* ; Diffusion Magnetic Resonance Imaging ; Female ; Humans ; Lymphatic Metastasis ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Grading ; Neoplasm Staging ; Rectal Neoplasms/pathology* ; Rectal Neoplasms/therapy* ; Remission Induction ; Treatment Outcome ; Tumor Burden
AIM: To fully characterise the magnetic resonance imaging (MRI) traits of rectal cancers in a large sample of patients, each experiencing pathological complete remission (pCR) after neoadjuvant concurrent chemoradiation therapy (CCRT). MATERIALS AND METHODS: A total of 120 patients (77 male, 43 female; median age, 59.5 years; range, 32-81 years) with rectal cancers in CCRT-induced pCR states who underwent pre- and post-CCRT MRI and eventual surgery between July, 2005 and September, 2014 were retrospectively reviewed. In most (n=100), diffusion-weighted imaging was also performed. Tumour volume, tumour regression grade (TRG), T-stage, mesorectal fascia (MRF) status, and T2 signal intensity (T2-SI) were analysed. Paired t-test and McNemar's test were applied for statistical comparisons. RESULTS: Tumour volume declined sharply after CCRT (pre-CCRT, 21.5 ± 22.4 cm(3); post-CCRT, 6.6 ± 8.4 cm(3); p<0.001). TRG distribution was as follows: G1 (clinical CR), 3; G2, 38; G3, 78; G4, 1; and G5 (marked progression), 0. Downstaging of T-stage (34%,16/47) and MRF status (19.7%,13/66) did occur; but on post-CCRT MRI, 25.8% (31/120) remained at T3 ≥ 5 mm or T4 stage, and 44.2% (53/120) were MRF-positive. A majority (88.3%, 106/120) of patients displayed intermediate T2-SI prior to CCRT. Most converted to dark T2-SI after CCRT, with 12.5% (15/120) unchanged. On post-CCRT MRI, 11% (11/100) of patients showed diffusion restriction. CONCLUSION: MRI findings in CCRT-induced pCR-status rectal cancers were highly variable. Tumour volume and T2-SI mostly decreased; however, such lesions occasionally presented with unexpected atypical features, such as large residual volume and/or intermediate T2-SI.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
금웅섭(Koom, Woong Sub) ORCID logo https://orcid.org/0000-0002-9435-7750
김남규(Kim, Nam Kyu) ORCID logo https://orcid.org/0000-0003-0639-5632
김명진(Kim, Myeong Jin) ORCID logo https://orcid.org/0000-0001-7949-5402
김한솔(Kim, Hon Soul)
김혜민(Kim, Hye Min) ORCID logo https://orcid.org/0000-0002-2899-9480
김호근(Kim, Ho Keun)
임준석(Lim, Joon Seok) ORCID logo https://orcid.org/0000-0002-0334-5042
허혁(Hur, Hyuk) ORCID logo https://orcid.org/0000-0002-9864-7229
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