TY - JOUR
T1 - MRI predicts increased eligibility for sphincter preservation after CRT in low rectal cancer
AU - Krdzalic, Jasenko
AU - Beets-Tan, Regina G. H.
AU - Engelen, Sanne M. E.
AU - van Griethuysen, Joost
AU - Lahaye, Max J.
AU - Lambregts, Doenja M. J.
AU - Bakers, Frans C. H.
AU - Vliegen, Roy F. A.
AU - Beets, Geerard L.
AU - Maas, Monique
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/4
Y1 - 2020/4
N2 - Chemoradiation increases the eligibility for sphincter preservation in low rectal cancer, as assessed by MRI.We evaluated whether MRI can predict sphincter preservation after chemoradiation (CRT), and whether the feasibility of sphincter preservation increases after CRT, when compared with MRI before neoadjuvant treatment.85 patients with low rectal tumour (≤5 cm from anorectal junction (ARJ)) were included. Radiologist and a surgeon measured the tumour distance to ARJ, and assigned confidence level scores (CLS) for the feasibility of sphincter preserving surgery on MRI. Reference standard was the type of surgery, sphincter preserving vs. non-preserving.Tumour distance from the ARJ increased after CRT by 9 mm (p < 0.001). Eligibility for sphincter preservation increased by 21% for the radiologist and 25% for the surgeon, based on CLS. Cut-off for distance to the ARJ after CRT was 28 mm, aiming for optimal specificity. Diagnostic performance after CRT based on CLS yielded an AUC of 0.81 [95%CI 0.70-0.91] for the radiologist and 0.82 [95%CI 0.72-0.92] for the surgeon (p = 0.78). AUCs for tumour distance to the ARJ were 0.85 [95%CI 0.77-0.94] and 0.84 [95%CI 0.75-0.94], respectively (p = 0.84). Interobserver agreement for CLS was moderate before CRT (Κ 0.51; 95%CI 0.36-0.66) and after (K 0.54; 95%CI 0.39-0.69). Measurement of tumour distance to ARJ showed good agreement before (ICC 0.76; 95%CI 0.65-0.84) and after CRT (ICC 0.77; 95%CI 0.66-0.84).MRI can be a valuable adjunct in the decision making for sphincter preservation after CRT, with distance from the tumour to the ARJ as an accurate and reliable factor. CRT increases the tumour distance to the ARJ, leading to an estimated increase of sphincter preserving surgery in up to 21-25% of patients.Copyright © 2020 Elsevier B.V. All rights reserved.
AB - Chemoradiation increases the eligibility for sphincter preservation in low rectal cancer, as assessed by MRI.We evaluated whether MRI can predict sphincter preservation after chemoradiation (CRT), and whether the feasibility of sphincter preservation increases after CRT, when compared with MRI before neoadjuvant treatment.85 patients with low rectal tumour (≤5 cm from anorectal junction (ARJ)) were included. Radiologist and a surgeon measured the tumour distance to ARJ, and assigned confidence level scores (CLS) for the feasibility of sphincter preserving surgery on MRI. Reference standard was the type of surgery, sphincter preserving vs. non-preserving.Tumour distance from the ARJ increased after CRT by 9 mm (p < 0.001). Eligibility for sphincter preservation increased by 21% for the radiologist and 25% for the surgeon, based on CLS. Cut-off for distance to the ARJ after CRT was 28 mm, aiming for optimal specificity. Diagnostic performance after CRT based on CLS yielded an AUC of 0.81 [95%CI 0.70-0.91] for the radiologist and 0.82 [95%CI 0.72-0.92] for the surgeon (p = 0.78). AUCs for tumour distance to the ARJ were 0.85 [95%CI 0.77-0.94] and 0.84 [95%CI 0.75-0.94], respectively (p = 0.84). Interobserver agreement for CLS was moderate before CRT (Κ 0.51; 95%CI 0.36-0.66) and after (K 0.54; 95%CI 0.39-0.69). Measurement of tumour distance to ARJ showed good agreement before (ICC 0.76; 95%CI 0.65-0.84) and after CRT (ICC 0.77; 95%CI 0.66-0.84).MRI can be a valuable adjunct in the decision making for sphincter preservation after CRT, with distance from the tumour to the ARJ as an accurate and reliable factor. CRT increases the tumour distance to the ARJ, leading to an estimated increase of sphincter preserving surgery in up to 21-25% of patients.Copyright © 2020 Elsevier B.V. All rights reserved.
KW - SURGERY
KW - CHEMORADIOTHERAPY
U2 - 10.1016/j.radonc.2020.01.014
DO - 10.1016/j.radonc.2020.01.014
M3 - Article
C2 - 32065902
SN - 0167-8140
VL - 145
SP - 223
EP - 228
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -