Magnetic resonance imaging performed before and after preoperative chemoradiotherapy in rectal cancer: predictive factor
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HOLLOW ORGAN GI
Magnetic resonance imaging performed before and after preoperative chemoradiotherapy in rectal cancer: predictive factors of recurrence and prognostic significance of MR-detected extramural venous invasion Francesco Prampolini1 • Stefania Taschini1 • Annarita Pecchi1 • Francesco Sani1 Andrea Spallanzani2 • Fabio Gelsomino2 • Shaniko Kaleci3 • Pietro Torricelli1
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Published online: 27 November 2018 Ó Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Purpose To evaluate the role of magnetic resonance imaging (MRI) performed before and after neoadjuvant chemoradiotherapy (nCRT) in predicting risk of recurrence in rectal cancer and to investigate the prognostic significance of MRdetected extramural venous invasion (mr-EMVI) and of its regression after nCRT. Methods During 2005–2016, 87 patients with rectal cancer underwent pre- and post-nCRT MRI before surgery. Two radiologists independently reviewed MR examinations retrospectively, assessing T stage, nodal involvement, circumferential resection margin (CRM) status, and mr-EMVI. All four parameters assessed in pre- and post-nCRT MRI were correlated with the risk of recurrence. Correlation with disease-free survival (DFS) was investigated for significant predictive factors in pre-nCRT MRI and for mr-EMVI and its possible regression in post-nCRT MRI. Results 15 of 87 patients developed recurrence, with a relapse-rate of 17.2%. Statistical analysis showed a significant correlation between CRM involvement and mr-EMVI assessed in pre-nCRT MRI and the risk of recurrence; 3 years-DFS in patients positive for these two parameters was significantly shorter compared with negatives. In post-nCRT MRI, all four parameters correlated significantly with recurrence: mr-EMVI affected significantly 3 years-DFS and its regression after nCRT correlated with a trend toward improvement of survival outcomes, although not statistically significant. Conclusions CRM involvement and mr-EMVI assessed in pre-nCRT MRI should be considered early predictive factors of recurrence in rectal cancer. MRI performed after nCRT has a significant value in predicting risk of recurrence: mr-EMVI confirmed to be a poor prognosis predictor and its regression or persistence after nCRT could have influences on treatment and follow-up strategies. Keywords Rectal cancer Extramural venous invasion (EMVI) MRI Predictive factors Preoperative chemoradiotherapy
Introduction & Francesco Prampolini [email protected] 1
Department of Radiology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
2
Department of Oncology and Haematology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
3
Department of Clinical and Experimental Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
In recent times, magnetic resonance imaging (MRI) has become an essential tool in the management of patients with rectal cancer because of its accu
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