Treatment Based on Magnetic Resonance Imaging Leads to 95% Complete Resection Rate in Primary Rectal Cancer: Presented at ESSO

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Title: Treatment Based on Magnetic Resonance Imaging Leads to 95% Complete Resection Rate in Primary Rectal Cancer: Presented at ESSO
URL: http://www.pslgroup.com/dg/22BE82.htm
Doctor's Guide
September 11, 2008

By Shazia Qureshi

THE HAGUE, Netherlands -- September 11, 2008 -- Using preoperative magnetic resonance imaging (MRI) to guide treatment decisions results in complete resection in 95% of patients with primary rectal cancer, according to research findings presented here at the 14th Congress of the European Society of Surgical Oncology (ESSO).

The prospective multicentre study was presented on September 11 by Sanne Engelen, MD, Department of Surgery, University Hospital of Maastricht, Maastricht, Netherlands.

She noted that the complete resection rate of 95% compared very well with the 84% found in the Dutch Total Mesorectal Excision (TME) trial (Kapiteijn E et al. N Engl J Med. 2001; 345:638-646), in which there was no standardised properative imaging.

Dr. Engelen and colleagues enrolled 322 patients with primary rectal cancer. They performed MRI in all patients using the lymph node-specific ultra-small superparamagnetic particles of iron oxide (USPIO) as a contrast agent. The MRI scan was interpreted twice -- first by the local oncologist and then by an independent expert.

The investigators used the MRI results to evaluate each patient's circumferential resection margin (CRM) status as well as tumour and node (TN) status. Patients were stratified accordingly into 1 of 3 treatment groups.

The first group included patients with a wide CRM and N0 status. These were called early tumours, and the treatment was TME surgery alone or local excision. The second group, which consisted of patients with nonlocally-advanced tumours, received preoperative radiation therapy (5 doses of 5 Gy) plus TME. Patients with locally-advanced tumours constituted the third treatment group, with a CRM that was close or involved and either N2 status or distal tumours. These patients received a long course of chemoradiotherapy followed by surgery.

Treatment with curative intent was administered in 235 patients, and histopathological results are available for 202 patients. Of these, 35 patients had early tumours, 85 had nonlocally-advanced tumours, and 82 had locally-advanced tumours. Of the 35 early tumours, 14 were treated by local excision and 21 by TME.

Histopathological findings showed that there were 192 complete resections (95%) and 10 incomplete resections (5%), according to Engelen.

To date, the median follow-up is 18.7 months and 3 local recurrences have been seen.

The relatively high proportion of tumours classified as being locally advanced was "a striking finding," Engelen noted.

"The high negative predictive value of USPIO MRI for nodal disease makes local excision of superficial tumours with N0 status possible," she concluded.

[Presentation title: Tailored Treatment of Primary Rectal Cancer Based on MRI: Does It Reduce the Number of Incomplete Resections? Abstract 92]

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