Navigation Links
MRI predicts survival in locally advanced rectal cancer

A new study has shown that magnetic resonance imaging (MRI) used to evaluate responses to pre-surgery (neo-adjuvant) chemotherapy or radiation may predict survival among patients with advanced rectal cancer. The findings suggest that MRI-assessed tumor responses to neoadjuvant therapy can help physicians to better plan their patients' subsequent treatments.

MRI prior to surgery could help in the management of patients in a number of ways, including offering more intense therapy or alternative chemotherapy to those patients who appear initially resistant to chemotherapy, or changing the surgical plan.

"This is the first time that MRI has been shown to predict outcome for patients with rectal cancer who have completed initial chemoradiation therapy," said lead author Gina Brown, MBBS, MD, consultant radiologist and honorary senior lecturer in the Department of Radiology at the Royal Marsden Hospital NHS Trust in Sutton, UK. "MRI staging and reassessment of rectal cancers before and after chemoradiotherapy are not routinely done for all patients. We've shown that using MRI this way can help change the course of patient care, perhaps enabling physicians to choose a more effective chemotherapy drug or even in some cases ultimately avoid surgery."

In the study - called MERCURY - researchers used MRI to measure tumor shrinkage in 111 patients who had previously undergone preoperative radiotherapy or both chemotherapy and radiation (chemoradiation) for locally advanced rectal cancer. The group - part of a larger study of MRI use in improving rectal cancer staging begun in 2002 - was followed for five years. The researchers measured tumor response in terms of "tumor regression grade (TRG)," which measures the degree of tumor shrinkage after therapy, and the involvement of "circumferential resection margin (CRM)," which refers to the remaining cancer at the tumor edges after treatment, or predicted to remain after surgery. Patients were broadly designated either a "good" or "poor" responder to chemoradiation, according to MRI, and researchers compared survival of the two groups.

Investigators found that 72 percent of good responders to chemotherapy/radiation were alive after five years compared to 27 percent of those who were poor responders. The disease-free survival for those with good responses was 64 percent versus 31 percent for the poor responders. In addition, local recurrence rates at five years for those patients for whom there was MRI-predicted CRM involvement was 28 percent compared to 12 percent for patients with predicted cancer-free tumor margins.

Rectal cancer is commonly found in advanced stages, and as a result, neoadjuvant chemoradiation is frequently given to try to shrink tumors and make them easier to remove. While surgeons attempt to completely remove the cancer in order to minimize the chances of cancer returning, advanced tumors are more difficult to completely remove and more likely to have unseen cancer remaining at the edges of tissue at the surgery site. A positive surgical margin (tumor that remains at the borders of the surgical resection) is considered a strong predictor of local recurrence.

Of the 111 patients in the study, 73 percent (81 patients) were expected to have cancer left in the surgical margins prior to initial treatment. After neoadjuvant therapy, only 42 percent (47 patients) were predicted to have disease left in the surgery margins, meaning this group was still at risk for recurrence prior to surgery.

"The next step is to take these tumor response grades and decide what the best treatment approach could be based on the degree of responses," Brown said.

She noted that future trials investigating neoadjuvant chemotherapy followed by chemoradiotherapy may be able to identify a subgroup of patients that has a good response and for whom chemotherapy alone might be enough, while also identifying those who needed further therapy prior to surgery. In some cases, the preoperative treatment removed all evidence of the tumor, leading some physicians to question the need for surgery. The investigators have begun a trial to study what happens to those individuals who appear to not have any remaining cancer with chemoradiation alone and have deferred surgery. In some cases, this has resulted in long-term deferral with anal sphincter preservation. Other trials may also be designed to use MRI results in regard to treatment efficacy.

ASCO Perspective: Morton Kahlenberg, MD, ASCO Cancer Communications Committee member and surgical oncology specialist

"This work has significant scientific and clinical importance because it shows that performing MRI following initial chemoradiation therapy and before surgery may predict long-term outcome and identify patients who could benefit from more aggressive therapy prior to surgery. This could change the standard of care for these patients, since using MRI may suggest the need for further treatment before surgery. Clinical trials are needed to address this important question."


Contact: Nicole Fernandes
American Society of Clinical Oncology

Related medicine news :

1. Carnegie Mellon develops iPhone app that predicts when bus will arrive
2. Benign or cancerous? Gene test predicts cancer potential in pancreatic cysts
3. Hormone test predicts ovarian function after chemotherapy for breast cancer
4. Earlier PSA Test Best Predicts Risk of Dying From Prostate Cancer: Study
5. VCU Massey Cancer Center finds new biomarker that predicts breast cancer relapse
6. Gene expression predicts chemotherapy sensitivity of triple-negative breast cancer
7. Climate change analysis predicts increased fatalities from heat waves
8. HIV rate in SF could be cut sharply with expanded treatment, study predicts
9. New lung cancer staging system (TNM 7) better predicts local/regional recurrence, study shows
10. Interest in toys predicts effectiveness of autism treatment in toddlers
11. New online tool predicts probability of death from stroke
Post Your Comments:
(Date:12/1/2015)... , ... December 01, 2015 , ... According to an ... groups has filed a discrimination claim against the U.S. Department of Health and Human ... Affordable Care Act (ACA) plans are breaking the clause in the law prohibiting the ...
(Date:12/1/2015)... ... December 01, 2015 , ... Califia Farms , one ... its iconic bottle has won top honors in Beverage World Magazine’s Global Packaging Design ... announced that it has been selected as a 2015 U.S.A. Taste Champion in the ...
(Date:12/1/2015)... ... , ... Growth in medical payments per workers’ compensation claim in Louisiana slowed ... nonhospital care, according to a recent study by the Workers Compensation Research Institute (WCRI). ... medical payments per claim with more than seven days of lost time continued to ...
(Date:12/1/2015)... ... December 01, 2015 , ... CloudLIMS today announced ... Bridge Business Awards under the New Products and Services category for its innovative ... sample management software that helps labs organize data and track samples with ...
(Date:12/1/2015)... ... December 01, 2015 , ... Diabetic foot wounds ... Podiatrists are well aware that psychology-based patient non-compliance (disobedience of a health care ... to diseases of the diabetic foot. The American Board of Multiple Specialties ...
Breaking Medicine News(10 mins):
(Date:12/1/2015)... 1, 2015 --> ... report "Nucleic Acid Labeling Market by Product (Reagents & ... Primer, In Vitro Transcription, Reverse Transcription, End Labeling), by ... The global market is expected to reach USD 1,925.7 ... growing at a CAGR of 8.65%. Browse ...
(Date:12/1/2015)... Russia has always been a country of choice for ... Europe in 2015 were tested in phase II-III ... has always been a country of choice for global multi-center phase ... in 2015 were tested in phase II-III clinical trials ... always been a country of choice for global multi-center phase III clinical ...
(Date:12/1/2015)... Dec. 1, 2015 Relmada Therapeutics, Inc. (OTCQB: RLMD), ... chronic pain, announced today that the company will present at ... December 1-3 at the Luxe Sunset Boulevard Hotel in ... CEO of Relmada Therapeutics, will present on Thursday, December 3, ... . Please register at least 10 minutes prior ...
Breaking Medicine Technology: