Use of Preoperative Magnetic Resonance Imaging to Select Patients with Rectal Cancer for Neoadjuvant Chemoradiation-Interim Analysis of the German OCUM Trial (NCT01325649)

Kreis ME, Ruppert R, Ptok H, Strassburg J, Brosi P, Lewin A, Schoen MR, Sauer J, Junginger T, Merkel S, Hermanek P (2016)

Publication Type: Journal article

Publication year: 2016

Journal

Journal of Gastrointestinal Surgery Elsevier / Springer Verlag (Germany)

Book Volume: 20

Pages Range: 25-33

Journal Issue: 1

DOI: 10.1007/s11605-015-3011-0

Abstract

Introduction of total mesorectal excision (TME) surgery for rectal cancer decreased local recurrence dramatically. Additional neoadjuvant chemoradiation (nCR) is frequently given in UICC II and III tumors based on TNM staging which is of limited accuracy. We aimed to evaluate determination of circumferential margin by magnetic resonance imaging (mrCRM) as an alternative criterium for nCR.Multicenter prospective cohort study which enrolled 642 patients in 13 centers with non-metastasized rectal adenocarcinoma. Patients with T4 tumors or patients with a mrCRM of 1 mm or less were treated by neoadjuvant chemoradiation. All others proceeded directly to surgery when inclusion criteria and no exclusion criteria were met. Quality of TME and accuracy of mrCRM determination were assessed during pathology workup.TME was complete in 381 of 389 patients after surgery without nCR (97.9 %) and in 245 of 253 patients (96.8 %) after nCR. Negative pathology circumferential margins (pCRM) were seen in 97.4 % without nCR and in 89 % of patients after nCR. Negative pCRM was predicted by negative mrCRM in 98.3 % of rectal cancers. NCR was given to 253 of 642 patients (39.5 %). Lymph node count was 23 (range 7-79; median/range) for surgery without nCR and 19 (range 2-56) for surgery after nCR.Surgical quality determined by pathology workup of specimen was very good in this study. Magnetic resonance imaging guided indication for nCR allows to achieve superb results concerning surrogate parameters for good oncological outcome. Thus, use of neoadjuvant chemoradiation with its potential detrimental side effects may be substantially reduced in selected patients.

Authors with CRIS profile

Susanne Merkel Department of Surgery

Involved external institutions

Kantonsspital Baselland CH Switzerland (CH) Klinikum Arnsberg DE Germany (DE) Städtisches Klinikum Karlsruhe DE Germany (DE) Vivantes - Netzwerk für Gesundheit GmbH DE Germany (DE) Carl-Thiem-Klinikum DE Germany (DE) Charité - Universitätsmedizin Berlin DE Germany (DE) Klinikum Neuperlach DE Germany (DE) Universitätsmedizin der Johannes Gutenberg-Universität Mainz DE Germany (DE) Sana Klinikum Lichtenberg DE Germany (DE)

How to cite

APA:

Kreis, M.E., Ruppert, R., Ptok, H., Strassburg, J., Brosi, P., Lewin, A.,... Hermanek, P. (2016). Use of Preoperative Magnetic Resonance Imaging to Select Patients with Rectal Cancer for Neoadjuvant Chemoradiation-Interim Analysis of the German OCUM Trial (NCT01325649). Journal of Gastrointestinal Surgery, 20(1), 25-33. https://doi.org/10.1007/s11605-015-3011-0

MLA:

Kreis, Martin E., et al. "Use of Preoperative Magnetic Resonance Imaging to Select Patients with Rectal Cancer for Neoadjuvant Chemoradiation-Interim Analysis of the German OCUM Trial (NCT01325649)." Journal of Gastrointestinal Surgery 20.1 (2016): 25-33.

BibTeX: Download