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

Authors
 H. Kim  ;  H.M. Kim  ;  W.S. Koom  ;  N.K. Kim  ;  M.-J. Kim  ;  H. Hur  ;  J.S. Lim 
Citation
 CLINICAL RADIOLOGY, Vol.71(3) : 250-257, 2016 
Journal Title
CLINICAL RADIOLOGY
ISSN
 0009-9260 
Issue Date
2016
MeSH
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
Abstract
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.
Full Text
http://www.sciencedirect.com/science/article/pii/S0009926015004481
DOI
10.1016/j.crad.2015.11.011
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
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 Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Kim, Hon Soul(김한솔)
Kim, Hye Min(김혜민) ORCID logo https://orcid.org/0000-0002-2899-9480
Kim, Hogeun(김호근)
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146359
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