1. Pretherapeutic MRI for decision-making regarding selective neoadjuvant radiochemotherapy for rectal carcinoma: interim analysis of a multicentric prospective observational study.
- Author
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Ptok H, Ruppert R, Stassburg J, Maurer CA, Oberholzer K, Junginger T, Merkel S, and Hermanek P
- Subjects
- Adult, Aged, Aged, 80 and over, Chemoradiotherapy, Adjuvant methods, Female, Germany epidemiology, Humans, Male, Middle Aged, Neoadjuvant Therapy methods, Neoadjuvant Therapy statistics & numerical data, Prevalence, Prognosis, Rectal Neoplasms epidemiology, Reproducibility of Results, Risk Factors, Sensitivity and Specificity, Treatment Outcome, Chemoradiotherapy, Adjuvant statistics & numerical data, Decision Support Techniques, Rectal Neoplasms pathology, Rectal Neoplasms therapy
- Abstract
Purpose: To study the accuracy of different cutoffs for an involved circumferential resection margin (CRM) compared with T and N categories measured by MRI as basis for selective application of neoadjuvant radiochemotherapy (nRCT) in rectal carcinoma., Materials and Methods: In a prospective multicenter observational study involving 153 primarily operated patients, the preoperative results of MRI with pathohistological findings of resected specimens were compared., Results: For a cutoff of ≤1 mm for involvement of the CRM, the accuracy of preoperative MRI was 90.9% (139/153). The negative predictive value was 98.5% (134/136). The four participating departments did not differ significantly. For a cutoff of >2 mm and >5 mm, the rates of false-positive findings increased significantly from 5% to 12% and 35% with a decrease in accuracy to 82% and 62%, respectively. In contrast, the accuracy in predicting T (69.3%) and N categories (61.4%) was much lower., Conclusion: The indication for nRCT should be based on the determination of the minimal distance of the tumor from mesorectal fascia with a cutoff point of >1 mm as measured by MRI., (Copyright © 2013 Wiley Periodicals, Inc.)
- Published
- 2013
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