Relationship Between Baseline Rectal Tumor Length and Magnetic Resonance Tumor Regression Grade Response to Chemoradiotherapy: A Subanalysis of the TRIGGER Feasibility Study
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Published:2022-06-30
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ISSN:1068-9265
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Container-title:Annals of Surgical Oncology
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language:en
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Short-container-title:Ann Surg Oncol
Author:
Hodges NicolaORCID, Battersby Nicholas, Rao Sheela, Brown Gina, Anandappa Gayathri, Cunningham David, Tait Diana, Tekkis Paris, Chong Irene, Aitken Katharine, Chau Ian, Rasheed Shahnawaz, Balyasnikova Svetlana, Moran Brendan, Falk Stephen, Sizer Bruce, Branagan Graham, O’Toole Lorcan, Adusumalli Madhavi, Nagtegaal Iris, Von Loga Katharina, Thrower Andrew, Jackson Andrew, Roach Huw, Hassan Hussein, Carss Michael, Bateman Andrew, Wills Mark, Martin Caroline, Evans Ceri, Robinson Emily, Zenasni Zohra, Frost Michelle, Thomas Karen, Di Fabio Francesco, Rawlani Rayesh, Cousins Hayley, Thomas Rachel, Jenkins Jessica, Strawson-Smith Thomas, Walther Axel, Spencer Timothy, Robinson Tim, Gower Elysia, Wong Newton, Short Sharon, Collins Jennifer, Driscoll Celine, Mabelin Louies, Bozas Georgios, Heeney Elaine, Hegab Mohammad, Mattocks Lehentha, West Nick, Quirke Phil, Lee Kil Yeon, Rodrigues Tania, Hiranyakai Art, Lynch Rodney, Gamage Bawantha,
Abstract
Abstract
Background
It is widely believed that small rectal tumors are more likely to have a good response to neoadjuvant treatment, which may influence the selection of patients for a ‘watch and wait’ strategy.
Objective
The aim of this study was to investigate whether there is a relationship between baseline tumor length on magnetic resonance imaging (MRI) and response to chemoradiotherapy.
Method
The 96 patients with locally advanced rectal cancer randomised (2:1–intervention:control) in the TRIGGER feasibility study where eligible. Baseline tumor length was defined as the maximal cranio-caudal length on baseline MRI (mm) and was recorded prospectively at study registration. Magnetic resonance tumor regression grade (mrTRG) assessment was performed on the post-chemoradiotherapy (CRT) MRI 4–6 weeks (no later than 10 weeks) post completion of CRT. This was routinely reported for patients in the intervention (mrTRG-directed management) arm and reported for the purposes of this study by the central radiologist in the control arm patients. Those with an mrTRG I/II response were defined as ‘good responders’ and those with an mrTRG III–V response were defined as ‘poor responders’.
Results
Overall, 94 patients had a post-CRT MRI performed and were included. Forty-three (46%) patients had a good response (mrTRG I/II) and 51 (54%) patients had a poor response (mrTRG III/IV). The median tumor length of good responders was 43 mm versus 50 mm (p < 0.001), with considerable overlap in tumor lengths between groups.
Conclusion
Baseline tumor length on MRI is not a clinically useful biomarker to predict mrTRG tumor response to CRT and therefore patient suitability for a deferral of surgery trial.
Funder
Pelican Cancer Foundation NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
Publisher
Springer Science and Business Media LLC
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