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Circumferential resection margin positivity after preoperative chemoradiotherapy based on magnetic resonance imaging for locally advanced rectal cancer: implication of boost radiotherapy to the involved mesorectal fascia

Authors
 Kyung Hwan Kim  ;  Min Jung Park  ;  Joon Seok Lim  ;  Nam Kyu Kim  ;  Byung Soh Min  ;  Joong Bae Ahn  ;  Tae Il Kim  ;  Ho Geun Kim  ;  Woong Sub Koom 
Citation
 Japanese Journal of Clinical Oncology, Vol.46(4) : 316-322, 2016 
Journal Title
 Japanese Journal of Clinical Oncology 
ISSN
 0368-2811 
Issue Date
2016
MeSH
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Chemoradiotherapy* ; Fascia/pathology* ; Female ; Humans ; Magnetic Resonance Imaging* ; Male ; Middle Aged ; Neoadjuvant Therapy/methods* ; Neoplasm, Residual/pathology* ; Rectal Neoplasms/pathology* ; Rectal Neoplasms/radiotherapy ; Rectal Neoplasms/surgery ; Rectal Neoplasms/therapy* ; Retreatment ; Sensitivity and Specificity
Keywords
chemoradiotherapy ; circumferential resection margin ; magnetic resonance imaging ; mesorectal fascia ; rectal cancer
Abstract
OBJECTIVE: To identify patients who are at a higher risk of pathologic circumferential resection margin involvement using preoperative magnetic resonance imaging. METHODS: Between October 2008 and November 2012, 165 patients with locally advanced rectal cancer (cT4 or cT3 with <2 mm distance from tumour to mesorectal fascia) who received preoperative chemoradiotherapy were analysed. The morphologic patterns on post-chemoradiotherapy magnetic resonance imaging were categorized into five patterns from Pattern A (most-likely negative pathologic circumferential resection margin) to Pattern E (most-likely positive pathologic circumferential resection margin). In addition, the location of mesorectal fascia involvement was classified as lateral, posterior and anterior. The diagnostic accuracy of the morphologic criteria was calculated using receiver operating characteristic curve analysis. RESULTS: Pathologic circumferential resection margin involvement was identified in 17 patients (10.3%). The diagnostic accuracy of predicting pathologic circumferential resection margin involvement was 0.73 using the five-scale magnetic resonance imaging pattern. The sensitivity, specificity, positive predictive value and negative predictive value for predicting pathologic circumferential resection margin involvement were 76.5, 65.5, 20.3 and 96.0%, respectively, when cut-off was set between Patterns C and D. On multivariate logistic regression, the magnetic resonance imaging patterns D and E (P= 0.005) and posterior or lateral mesorectal fascia involvement (P= 0.017) were independently associated with increased probability of pathologic circumferential resection margin involvement. The rate of pathologic circumferential resection margin involvement was 30.0% when the patient had Pattern D or E with posterior or lateral mesorectal fascia involvement. CONCLUSIONS: Patients who are at a higher risk of pathologic circumferential resection margin involvement can be identified using preoperative magnetic resonance imaging although the predictability is moderate.
Full Text
http://jjco.oxfordjournals.org/content/46/4/316
DOI
10.1093/jjco/hyv208
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 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
김태일(Kim, Tae Il) ORCID logo https://orcid.org/0000-0003-4807-890X
김호근(Kim, Ho Keun)
민병소(Min, Byung Soh)
안중배(Ahn, Joong Bae) ORCID logo https://orcid.org/0000-0001-6787-1503
임준석(Lim, Joon Seok) ORCID logo https://orcid.org/0000-0002-0334-5042
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146640
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