Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy
Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy
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DOI：
10.1007/s10350-004-0787-5
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发表时间：
2005-01-01
影响因子：
3.9
通讯作者：
Fang, WT
中科院分区：
文献类型：
--
作者：
Kuo, LJ;Chern, MC;Fang, WT
目得：新辅助同步放化疗已被用于局部进展期直肠癌病例，以保护括约肌功能，减少局部复发，提高生存率。术前分期对于计划和提供最佳治疗至关重要。本研究的目的是确定与磁共振成像分期的准确性，并定义任何干扰的因素，在解释后获得的图像术前chemoradiation therapy.METHODS：36例活检证实，局部晚期直肠癌术前伴随5-氟尿嘧啶为基础的化疗和放疗，随后6至8周后，根治性手术治疗。术前磁共振图像重新解释一个放射科医生和结果相比，组织病理staging.Results：T级降级发生在10 36例（28%），和N级降级发生在29 36例（80%）完成放化疗治疗后。5例患者（12%）在放化疗后病理完全缓解。在36例患者中，17例（47%）在T级过度分期，2例（6%）在N级欠分期，而10例（28%）在N级过度分期，3例（8%）在N级欠分期。磁共振成像的准确性，以确定壁侵入的深度为47%，64%的准确性为nodal staging.CONCLUSIONS：磁共振成像是常用的盆腔恶性肿瘤分期，因为它的精细分辨率，但放化疗可能会降低其准确性。放射治疗后直肠壁增厚，纤维化明显，瘤周炎性细胞浸润和血管增生可能有助于高估分期。相反，放化疗后正常壁结构下的病理残留癌可能导致直肠癌分期过低。
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.