MRI criteria for "good-prognosis" patients in rectal cancer

  • Kennedy ED & al.
  • JAMA Oncol
  • 11 Apr 2019

  • curated by Emily Willingham, PhD
  • Univadis Clinical Summaries
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Takeaway

  • MRI criteria effectively select “good-prognosis” patients with rectal cancer who could have primary surgery and forgo preoperative chemoradiotherapy.
  • The authors say that preoperative chemoradiotherapy might not be needed for all stage II/III rectal cancer.

Why this matters

  • Current recommendation is chemoradiotherapy before surgery for stage II/III rectal cancer, which decreases risk for local recurrence but offers no survival or functional outcome improvement.

Study design

  • Prospective, nonrandomized, multicenter phase 2 Quicksilver study ; 82 patients with new diagnosis, Canada, September 30, 2014 to October 21, 2016.
  • MRI criteria for “good prognosis” lesions:
    • distance to mesorectal fascia >1 mm;
    • definite T2, T2/early T3, definite T3
    • absent or equivocal extramural venous invasion.
  • Patients identified as having “good-prognosis” tumors had only primary surgery.
  • Outcome: proportion in study with positive circumferential margin rate.
  • Funding: Mount Sinai Hospital-University Health Network Academic Medical Organization Innovation Fund.

Key results

  • The final pathology for tumors identified using MRI criteria:
    • 91% T2 or greater;
    • 29% node-positive;
    • 59% stage II/III.
  • Positive circumferential margin rate: 4 of 82 (4.9%; 95% CI, 0.2%-9.6%).
  • 88% with stage II/III received no form of chemotherapy.

Limitations

  • High-volume centers, highly experienced clinicians, generalizability unclear.

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