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Prognostic Implications of MRI-Detected EMVI and Tumor Deposits and Their Response to Neoadjuvant Therapy in cT3 and cT4 Rectal Cancer.

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Bibliographic Details
Title:	Prognostic Implications of MRI-Detected EMVI and Tumor Deposits and Their Response to Neoadjuvant Therapy in cT3 and cT4 Rectal Cancer.
Authors:	Schaap, Dennis P.¹ (AUTHOR), Voogt, Eva L.K.¹ (AUTHOR), Burger, Jacobus W.A.¹ (AUTHOR), Cnossen, Jeltsje S.² (AUTHOR), Creemers, Geert-Jan M.³ (AUTHOR), van Lijnschoten, Ineke⁴ (AUTHOR), Nieuwenhuijzen, Grard A.P.¹ (AUTHOR), Rutten, Harm J.T.^1,5 (AUTHOR), Daniels-Gooszen, Alette W.⁶ (AUTHOR), Nederend, Joost⁶ (AUTHOR), Kusters, Miranda^1,7 (AUTHOR) m.kusters@amsterdamumc.nl
Source:	International Journal of Radiation Oncology, Biology, Physics. Nov2021, Vol. 111 Issue 3, p816-825. 10p.
Subjects:	Rectal cancer, Oncologic surgery, Magnetic resonance, Cancer treatment, Tumors, Rectum tumors, Cancer invasiveness, Prognosis, Retrospective studies, Magnetic resonance imaging, Combined modality therapy
Abstract:	Purpose: Magnetic resonance imaging-detected extramural venous invasion (mrEMVI) and tumor deposits (TDs) are risk factors for the development of local recurrence and distant metastases (DMs) in rectal cancer. However, little is known about their response to neoadjuvant treatment and its relation to oncologic outcomes. This study evaluated the incidence and features of mrEMVI and TDs before and after neoadjuvant treatment in relation to the development of local recurrence and DMs.Methods and Materials: Patients with cT3/4 rectal cancer without synchronous metastases who underwent surgery in a tertiary referral hospital were retrospectively analyzed. MRI scans were re-evaluated for the presence of mrEMVI, the occurrence of TDs, and response to neoadjuvant therapy (mr-vTRG).Results: In total, 277 patients were included, of whom 163 (58.8%) presented with mrEMVI. TDs were present in 56.4% of mrEMVI-positive and 9.6% of mrEMVI-negative patients (P < .001). The 5-year DM rate was significantly higher in mrEMVI-positive patients with and without TDs (45.2% and 35.9%, respectively) compared with mrEMVI-negative patients (25.7%; P = .012). After neoadjuvant treatment, the 5-year DM rate of patients with mr-vTRG 3-5 was 46.1%, whereas good responders (mr-vTRG 1-2) had a DM rate similar to mrEMVI-negative patients (25.7% and 25.7%, respectively; P = .002). The occurrence of TDs and larger mrEMVI size resulted in a lower likelihood of regression of mrEMVI.Conclusions: The prevalence of mrEMVI and TDs in cT3-4 rectal cancer is high and is associated with worsened oncologic outcomes. mrEMVI regression (mr-vTRG 1-2), which occured in 25% of the cases, leads to oncologic outcomes similar to those in patients without mrEMVI on baseline MRI. [ABSTRACT FROM AUTHOR]
	Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database:	Engineering Source

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