Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy.

Li Jen Kuo, Ming Chih Chern, Mei Hua Tsou, Mei Ching Liu, James Jer Min Jian, Chung Ming Chen, Yih Lin Chung, Wei Tse Fang

Research output: Contribution to journalArticle

136 Citations (Scopus)

Abstract

PURPOSE: Neoadjuvant concomitant chemoradiotherapy has been used in cases of locally advanced rectal cancer to preserve sphincter function, decrease local recurrence, and improve survival. Preoperative staging is essential for planning and providing optimal therapy. The purpose of this study is to determine the accuracy of staging with magnetic resonance imaging and to define any factors that interfere in interpretation of images obtained after preoperative chemoradiation therapy. METHODS: Thirty-six patients with biopsy-proven, locally advanced rectal cancer were treated with preoperative concomitant 5-fluorouracil-based chemotherapy and radiation, followed six to eight weeks later by radical surgery. Preoperative magnetic resonance images were reinterpreted by one radiologist and the results compared with histopathologic staging. RESULTS: T-level downstaging occurred in 10 of 36 patients (28 percent), and N-level downstaging occurred in 29 of 36 patients (80 percent) after completion of chemoradiation therapy. Pathologic complete remission after chemoradiotherapy occurred in five patients (12 percent). Of the 36 patients, 17 (47 percent) were overstaged and 2 (6 percent) were understaged in T-level, whereas 10 patients (28 percent) were overstaged and 3 patients (8 percent) were understaged in N-level. The accuracy of magnetic resonance imaging for determining depth of wall invasion was 47 percent, with 64 percent accuracy for nodal staging. CONCLUSIONS: Magnetic resonance imaging is commonly used in staging of pelvic malignancies because of its fine resolution, but chemoradiotherapy may decrease its accuracy. Thickening of the rectal wall after radiation by marked fibrosis, and peritumoral infiltration of inflammatory cells and vascular proliferation may contribute to overestimation of stage. By contrast, pathologic residual cancer beneath normal mural structure after chemoradiation therapy may result in understaging of rectal cancer.

Original languageEnglish
Pages (from-to)23-28
Number of pages6
JournalDiseases of the Colon & Rectum
Volume48
Issue number1
Publication statusPublished - Jan 2005
Externally publishedYes

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Magnetic Resonance Imaging
Carcinoma
Chemoradiotherapy
Rectal Neoplasms
Therapeutics
Radiation Pneumonitis
Residual Neoplasm
Fluorouracil
Blood Vessels
Magnetic Resonance Spectroscopy
Cell Proliferation
Radiation
Biopsy
Recurrence
Drug Therapy
Survival
Neoplasms

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Kuo, L. J., Chern, M. C., Tsou, M. H., Liu, M. C., Jian, J. J. M., Chen, C. M., ... Fang, W. T. (2005). Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy. Diseases of the Colon & Rectum, 48(1), 23-28.

Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy. / Kuo, Li Jen; Chern, Ming Chih; Tsou, Mei Hua; Liu, Mei Ching; Jian, James Jer Min; Chen, Chung Ming; Chung, Yih Lin; Fang, Wei Tse.

In: Diseases of the Colon & Rectum, Vol. 48, No. 1, 01.2005, p. 23-28.

Research output: Contribution to journalArticle

Kuo, LJ, Chern, MC, Tsou, MH, Liu, MC, Jian, JJM, Chen, CM, Chung, YL & Fang, WT 2005, 'Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy.', Diseases of the Colon & Rectum, vol. 48, no. 1, pp. 23-28.
Kuo, Li Jen ; Chern, Ming Chih ; Tsou, Mei Hua ; Liu, Mei Ching ; Jian, James Jer Min ; Chen, Chung Ming ; Chung, Yih Lin ; Fang, Wei Tse. / Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy. In: Diseases of the Colon & Rectum. 2005 ; Vol. 48, No. 1. pp. 23-28.
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