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Impact of consolidation chemotherapy in poor responders to neoadjuvant radiation therapy: magnetic resonance imaging-based clinical-radiological correlation in high-risk rectal cancers.
Patel, Swapnil; Ankathi, Suman; Haria, Purvi; Kazi, Mufaddal; Desouza, Ashwin L; Saklani, Avanish.
Afiliación
  • Patel S; Department of Surgical Oncology, MPMMCC & HBCH, Tata Memorial Centre, Varanasi, India.
  • Ankathi S; Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India.
  • Haria P; Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India.
  • Kazi M; Colorectal Division, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
  • Desouza AL; Colorectal Division, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
  • Saklani A; Colorectal Division, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
Ann Coloproctol ; 39(6): 474-483, 2023 Dec.
Article en En | MEDLINE | ID: mdl-38124365
ABSTRACT

PURPOSE:

The current study was conducted to examine the role of consolidation chemotherapy after neoadjuvant radiation therapy (NART) in decreasing the involvement of the mesorectal fascia (MRF) in high-risk locally advanced rectal cancers (LARCs).

METHODS:

In total, 46 patients who received consolidation chemotherapy after NART due to persistent MRF involvement were identified from a database. A team of 2 radiologists, blinded to the clinical data, studied sequential magnetic resonance imaging (MRI) scans to assess the tumor response and then predict a surgical plan. This prediction was then correlated with the actual procedure conducted as well as histopathological details to assess the impact of consolidation chemotherapy.

RESULTS:

The comparison of MRI-based parameters of sequential images showed significant downstaging of T2 signal intensity, tumor height, MRF involvement, diffusion restriction, and N category between sequential MRIs (P < 0.05). However, clinically relevant downstaging (standardized mean difference, > 0.3) was observed for only T2 signal intensity and diffusion restriction on diffusion-weighted imaging. No clinically relevant changes occurred in the remaining parameters; thus, no change was noted in the extent of surgery predicted by MRI. Weak agreement (Cohen κ coefficient, 0.375) and correlation (Spearman rank coefficient, 0.231) were found between MRI-predicted surgery and the actual procedure performed. The comparison of MRI-based and pathological tumor response grading also showed a poor correlation.

CONCLUSION:

Evidence is lacking regarding the use of consolidation chemotherapy in reducing MRF involvement in LARCs. The benefit of additional chemotherapy after NART in decreasing the extent of planned surgery by reducing margin involvement requires prospective research.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Ann Coloproctol Año: 2023 Tipo del documento: Article País de afiliación: India Pais de publicación:
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Ann Coloproctol Año: 2023 Tipo del documento: Article País de afiliación: India Pais de publicación: