MRI-based guidelines for selective neoadjuvant treatment in rectal cancer: Does MRI adequately predict the indication for radiotherapy in daily practice in a large teaching hospital
Autor: | Janneke J. C. Tersteeg, Ilse Niers-Stobbe, Dorothee E. Arnold, Rogier M. P. H. Crolla, Jennifer M. J. Schreinemakers, Paul D. Gobardhan, Tom Rozema, Peter A. M. Kint, Leandra J. M. Boonman–de Winter |
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Rok vydání: | 2019 |
Předmět: |
medicine.medical_specialty
Colorectal cancer medicine.medical_treatment Concordance Sensitivity and Specificity 03 medical and health sciences 0302 clinical medicine Neoadjuvant treatment Daily practice medicine Humans Mesentery Hospitals Teaching Lymph node Neoadjuvant therapy Neoplasm Staging Netherlands Retrospective Studies Proctectomy Radiotherapy business.industry Rectal Neoplasms Patient Selection Tumour staging medicine.disease Magnetic Resonance Imaging Neoadjuvant Therapy Radiation therapy medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis Lymphatic Metastasis Practice Guidelines as Topic Radiology Lymph Nodes business |
Zdroj: | European journal of cancer careREFERENCES. 29(2) |
ISSN: | 1365-2354 |
Popis: | Objectives According to new Dutch guidelines for rectal cancer, MRI-defined tumour stage determines whether preoperative radiotherapy is indicated. Therefore, we sought to evaluate if preoperative MRI accurately predicts the indication for neoadjuvant treatment in rectal cancer cases in daily practice according to the new Dutch guidelines. Methods Data for all rectal cancer patients who underwent mesorectal excision in our hospital, between January 2011 and January 2018 were collected retrospectively. We compared histopathologic outcome with tumour staging on preoperative MRI for patients who received no radiotherapy prior to resection or short-course radiotherapy directly followed by resection. Results Of 223 patients treated according to the old guidelines, 94% received neoadjuvant therapy. Of 301 patients treated according to the new guidelines, only 49% did. Under the old guidelines, MRI predicted lymph node metastases with a sensitivity of 74.2% and a specificity of 52.6%. With the new guidelines, sensitivity was 47.5% and specificity was 77.3%. The new guidelines resulted in 45% more patients not being exposed to disadvantages of radiotherapy, but 13% of all patients were undertreated. Conclusions Concordance between clinical lymph node staging on preoperative MRI and histopathologic staging is limited, resulting in many rectal cancer patients not receiving adequate neoadjuvant therapy. |
Databáze: | OpenAIRE |
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