Sense and nonsense of yT-staging on MRI after chemoradiotherapy in rectal cancer.
magnetic resonance imaging
neoplasm staging
rectal neoplasms
Journal
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Titre abrégé: Colorectal Dis
Pays: England
ID NLM: 100883611
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
revised:
02
05
2023
received:
21
11
2022
accepted:
08
06
2023
medline:
29
9
2023
pubmed:
7
8
2023
entrez:
7
8
2023
Statut:
ppublish
Résumé
The aim of this work was to investigate the value of rectal cancer T-staging on MRI after chemoradiotherapy (ymrT-staging) in relation to the degree of fibrotic transformation of the tumour bed as assessed using the pathological tumour regression grade (pTRG) of Mandard as a standard of reference. Twenty two radiologists, including five rectal MRI experts and 17 'nonexperts' (general/abdominal radiologists), evaluated the ymrT stage on the restaging MRIs of 90 rectal cancer patients after chemoradiotherapy. The ymrT stage was compared with the final ypT stage at histopathology; the percentages of correct staging (ymrT = ypT), understaging (ymrT < ypT) and overstaging (ymrT > ypT) were calculated and compared between patients with predominant tumour at histopathology (pTRG4-5) and patients with predominant fibrosis (pTRG1-3). Interobserver agreement (IOA) was computed using Krippendorff's alpha. Average ymrT/ypT stage concordance was 48% for the experts and 43% for the nonexperts; ymrT/ypT stage concordance was significantly higher in the pTRG4-5 subgroup (58% vs. 41% for the pTRG1-3 group; p = 0.01), with the best results for the MRI experts. Overstaging was the main source of error, especially in the pTRG1-3 subgroup (average overstaging rate 38%-44% vs. 13%-55% in the pTRG4-5 subgroup). IOA was higher for the expert versus nonexpert readers (α = 0.67 vs. α = 0.39). ymrT-staging is moderately accurate; accuracy is higher in poorly responding patients with predominant tumour but low in good responders with predominant fibrosis, resulting in significant overstaging. Radiologists should shift their focus from ymrT-staging to detecting gross residual (and progressive) disease, and identifying potential candidates for organ preservation who would benefit from further clinical and endoscopic evaluation to guide final treatment planning.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1878-1887Investigateurs
Frans C H Bakers
(FCH)
Stuart Ballantyne
(S)
Perla Barros
(P)
Ferdinand Bauer
(F)
Shira H de Bie
(SH)
Nino Bogveradze
(N)
Gerlof P T Bosma
(GPT)
Joanna Brayner Dutra
(J)
Laura Buskov
(L)
Vincent C Cappendijk
(VC)
Francesca Castagnoli
(F)
Sotiriadis Charalampos
(S)
Andrea Delli Pizzi
(A)
Michael Digby
(M)
Remy W F Geenen
(RWF)
Joost J M van Griethuysen
(JJM)
Julie Lafrance
(J)
Vandana Mahajan
(V)
Sonaz Malekzadeh
(S)
Peter A Neijenhuis
(PA)
Gerald M Peterson
(GM)
Indra Pieters
(I)
Niels W Schurink
(NW)
Ruth Smit
(R)
Cornelis J Veeken
(CJ)
Roy F A Vliegen
(RFA)
Andrew Wray
(A)
Abdel-Rauf Zeina
(AR)
Informations de copyright
© 2023 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
Références
Oronsky B, Reid T, Larson C, Knox SJ. Locally advanced rectal cancer: the past, present, and future. Semin Oncol. 2020;47:85-92.
Beets-Tan RGH, Lambregts DMJ, Maas M, Bipat S, Barbaro B, Curvo-Semedo L, et al. Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 2018;28:1465-1475.
Almeida RR, Souza D, Matalon SA, Hornick JL, Lee LK, Silverman SG. Rectal MRI after neoadjuvant chemoradiation therapy: a pictorial guide to interpretation. Abdom Radiol. 2021;46:3044-3057.
Bates DDB, Shaish H, Gollub MJ, Harisinghani M, Lall C, Sheedy SP. Multi-practice survey on MR imaging practice patterns in rectal cancer in the United States. Abdom Radiol. 2022;47(1):28-37. https://doi.org/10.1007/s00261-021-03279-2
Gollub MJ, Arya S, Beets-Tan RG, Deprisco G, Gonen M, Jhaveri K, et al. Use of magnetic resonance imaging in rectal cancer patients: Society of Abdominal Radiology (SAR) rectal cancer disease-focused panel (DFP) recommendations 2017. Abdom Radiol. 2018;43:2893-2902.
Seo N, Kim H, Cho MS, Lim JS. Response assessment with MRI after chemoradiotherapy in rectal cancer: current evidences. Korean J Radiol. 2019;20:1003-1018.
Patel UB, Taylor F, Blomqvist L, George C, Evans H, Tekkis P, et al. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol. 2011;29:3753-3760.
Park JS, Park SY, Kim HJ, Cho SH, Kwak SG, Choi GS. Long-term oncologic outcomes after neoadjuvant chemoradiation followed by intersphincteric resection with coloanal anastomosis for locally advanced low rectal cancer. Dis Colon Rectum. 2019;62:408-416.
Maas M, Lambregts DMJ, Nelemans PJ, Heijnen LA, Martens MH, Leijtens JWA, et al. Assessment of clinical complete response after chemoradiation for rectal cancer with digital rectal examination, endoscopy, and MRI: selection for organ-saving treatment. Ann Surg Oncol. 2015;22:3873-3880.
van der Valk MJM, Hilling DE, Bastiaannet E, Meershoek-Klein Kranenbarg E, Beets GL, Figueiredo NL, et al. Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study. Lancet. 2018;391(10139):2537-2545. https://doi.org/10.1016/S0140-6736(18)31078-X
Rullier E, Vendrely V, Asselineau J, Rouanet P, Tuech JJ, Valverde A, et al. Organ preservation with chemoradiotherapy plus local excision for rectal cancer: 5-year results of the GRECCAR 2 randomised trial. Lancet Gastroenterol Hepatol. 2020;5:465-474.
van der Paardt MP, Zagers MB, Beets-Tan RGH, Stoker J, Bipat S. Patients who undergo preoperative chemoradiotherapy for locally advanced rectal cancer restaged by using diagnostic MR imaging: a systematic review and meta-analysis. Radiology. 2013;269:101-112.
Fernandes MC, Gollub MJ, Brown G. The importance of MRI for rectal cancer evaluation. Surg Oncol. 2022;43:101739.
Schurink NW, van Kranen SR, Roberti S, van Griethuysen JJM, Bogveradze N, Castagnoli F, et al. Sources of variation in multicenter rectal MRI data and their effect on radiomics feature reproducibility. Eur Radiol. 2022;32:1506-1516.
Bogveradze N, el Khababi N, Schurink NW, van Griethuysen JJM, de Bie S, Bosma G, et al. Evolutions in rectal cancer MRI staging and risk stratification in The Netherlands. Abdom Radiol. 2022;47(1):38-47. https://doi.org/10.1007/s00261-021-03281-8
Siddiqui MRS, Gormly KL, Bhoday J, Balyansikova S, Battersby NJ, Chand M, et al. Interobserver agreement of radiologists assessing the response of rectal cancers to preoperative chemoradiation using the MRI tumour regression grading (mrTRG). Clin Radiol. 2016;71:854-862.
Mandard A-M, Dalibard F, Mandard J-C, Marnay J, Henry-Amar M, Petiot JF, et al. Pathologic assessment of tumor regression after preoperative Chemoradiotherapy of esophageal carcinoma clinicopathologic correlations. Cancer. 1994;73(11):2680-2686. https://doi.org/10.1002/1097-0142(19940601)73:11<2680::aid-cncr2820731105>3.0.co;2-c
Zhao R, Wang H, Zhou Z, Zhou Q, Mulholland MW. Restaging of locally advanced rectal cancer with magnetic resonance imaging and endoluminal ultrasound after preoperative chemoradiotherapy: a systemic review and meta-analysis. Dis Colon Rectum. 2014;57:388-395.
Lambregts DMJ, Pizzi AD, Lahaye MJ, van Griethuysen JJM, Maas M, Beets GL, et al. A pattern-based approach combining tumor morphology on MRI with distinct signal patterns on diffusion-weighted imaging to assess response of rectal tumors after chemoradiotherapy. Dis Colon Rectum. 2018;61:328-337.
Santiago I, Barata M, Figueiredo N, Parés O, Henriques V, Galzerano A, et al. The split scar sign as an indicator of sustained complete response after neoadjuvant therapy in rectal cancer. Eur Radiol. 2020;30:224-238.
Lee MA, Cho SH, Seo AN, Kim HJ, Shin KM, Kim SH, et al. Modified 3-point MRI-based tumor regression grade incorporating DWI for locally advanced rectal cancer. Am J Roentgenol. 2017;209:1247-1255.
Haak HE, Maas M, Lahaye MJ, Boellaard TN, Delli Pizzi A, Mihl C, et al. Selection of patients for organ preservation after chemoradiotherapy: MRI identifies poor responders who can go straight for surgery. Ann Surg Oncol. 2020;27:2732-2739.
Nagtegaal ID, Glynne-Jones R. How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement. Cancer Treat Rev. 2020;84:101964.
van den Broek JJ, van der Wolf FSW, Lahaye MJ, Heijnen LA, Meischl C, Heitbrink MA, et al. Accuracy of MRI in restaging locally advanced rectal cancer after preoperative chemoradiation. Dis Colon Rectum. 2017;60:274-283.
Sclafani F, Brown G, Cunningham D, Wotherspoon A, Mendes LST, Balyasnikova S, et al. Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer. Br J Cancer. 2017;117:1478-1485.
Memon S, Lynch AC, Bressel M, Wise AG, Heriot AG. Systematic review and meta-analysis of the accuracy of MRI and endorectal ultrasound in the restaging and response assessment of rectal cancer following neoadjuvant therapy. Color Dis. 2015;17:748-761.
Patel UB, Brown G, Rutten H, West N, Sebag-Montefiore D, Glynne-Jones R, et al. Comparison of magnetic resonance imaging and histopathological response to chemoradiotherapy in locally advanced rectal cancer. Ann Surg Oncol. 2012;19:2842-2852.
Schurink NW, Lambregts DMJ, Beets-Tan RGH. Diffusion-weighted imaging in rectal cancer: current applications and future perspectives. Br J Radiol. 2019;92(1096):20180655. https://doi.org/10.1259/bjr.20180655