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MRI CRITERIA FOR SELECTING PATIENTS FOR PREOPERATIVE RADIOTHERAPY IN RECTAL CANCER
Author(s) -
Bissett I. P.,
Shan D. E.,
Bates N.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04915_10.x
Subject(s) - medicine , colorectal cancer , radiation therapy , radiation oncologist , radiology , cancer , surgery
Purpose: Preoperative radiotherapy (PRT) reduces the risk of local pelvic recurrence (LR) after rectal cancer surgery but is associated with considerable side‐effects. This study aims to identify the LR rate associated with the present MRI based selection criterion for PRT (tumour threatening the fascia propria on MRI) at Auckland City Hospital (ACH), and to assess the likely influence on LR rates of a regimen using a PRT selection criterion based on a 5 mm clearance of the fascia propria. Methodology: All patients with rectal cancer treated at ACH from 1997–2005 who had preoperative MRI scans were identified from the National Cancer Registry. Details of demographics, MRI results, treatment and outcome were collated. Long‐term outcomes were obtained from digital records, GPs, patient contact and death‐certificates. All MRIs were re‐reported using the new criterion of 5 mm clearance for the fascia propria. Results: There were 126 patients eligible patients, 20 were excluded with lack of MRI or follow‐up. 106 patients (mean age 66.5 years, 67% male) were followed‐up for a minimum 2 years (med 3 years). Using the present MRI based ACH criteria for PRT 29 (27%) patients were irradiated. Using a 5 mm tumour free margin 80 (75%) of patients would have been offered PRT. Overall 7 (6.6%) patients developed LR, 6 of these did not receive PRT, 4 of these fulfilled the new criterion and only 2 of these patients had a resection with curative intent. Conclusion: Selective PRT based on threatened fascia propria involvement on MRI lead to low PRT and LR rates. The use of a 5 mm tumour free lateral margin on MRI would result in three times as many patients receiving PRT and is likely to reduce the local recurrence rate by about 2%.