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磁共振容积评估在预测可切除直肠癌患者术前同步放化疗反应中的应用价值

Usefulness of magnetic resonance volumetric evaluation in predicting response to preoperative concurrent chemoradiotherapy in patients with resectable rectal cancer.

作者信息

Kim Young Hoon, Kim Dae Yong, Kim Tae Hyun, Jung Kyung Hae, Chang Hee Jin, Jeong Seung-Yong, Sohn Dae Kyung, Choi Hyo Seong, Ahn Joong Bae, Kim Dae Hyun, Lim Seok-Byung, Lee Jong Seok, Park Jae-Gahb

机构信息

Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, South Korea.

出版信息

Int J Radiat Oncol Biol Phys. 2005 Jul 1;62(3):761-8. doi: 10.1016/j.ijrobp.2004.11.005.

Abstract

PURPOSE

We performed magnetic resonance (MR) volumetry before and after neoadjuvant chemoradiation for evaluating response to therapy in T3 and T4 rectal cancer. To investigate the utility of MR volumetry for predicting the response to neoadjuvant chemoradiation, we compared results from MR volumetry before chemoradiation with those after chemoradiation.

METHODS AND MATERIALS

A total 112 patients with T3 or T4 rectal cancer who successfully underwent MR volumetry and completed neoadjuvant chemoradiation followed by radical resection for cure were identified. MR volumetries were performed before and after chemoradiation. We compared pre- and postchemoradiation tumor volume and % volume reduction rates of patients whose tumors were down-staged with those of patients that were not down-staged. The same analyses were also performed between those patients having a complete histologic regression and those with residual disease in the operative specimen. We assessed the difference of % volume reduction rate according to Dworak's rectal cancer regression grades.

RESULTS

Fifty-seven patients (50.9%) demonstrated a tumor down-staging after chemoradiation therapy. Both pre- and posttreatment MR tumor volumes were significantly less in patients whose tumors were down-staged than in patients that were not down-staged (p = 0.04, 0.031), and % volume reduction rates were significantly higher in patients whose tumors were down-staged (p = 0.024). Sixteen patients (14.3%) showed pathologically complete tumor regression. The differences of MR tumor volumes before and after chemoradiation and % volume reduction rates were not significantly different between patients having a complete histologic regression and those with residual disease (p = 0.688, 0.451, and 0.480). The differences of % volume reduction rates according to Dworak's grades were statistically significant (p = 0.03).

CONCLUSION

The MR volumetric examinations before and after chemoradiation demonstrated the significant difference of tumor volume and % volume reduction rate between patients whose tumors were down-staged and those that were not down-staged. The volume reduction rates were significantly different among groups according to Dworak's grades. However, the MR volumetric evaluation could not identify any differences between those patients having a complete histologic regression and those with residual disease.

摘要

目的

我们在新辅助放化疗前后进行了磁共振(MR)容积测量,以评估T3和T4期直肠癌的治疗反应。为了研究MR容积测量在预测新辅助放化疗反应方面的效用,我们比较了放化疗前MR容积测量结果与放化疗后的结果。

方法和材料

共确定了112例成功接受MR容积测量并完成新辅助放化疗后行根治性切除术的T3或T4期直肠癌患者。在放化疗前后进行MR容积测量。我们比较了肿瘤降期患者与未降期患者放化疗前后的肿瘤体积和体积缩小率百分比。对手术标本中出现组织学完全消退的患者和有残留疾病的患者也进行了同样的分析。我们根据德沃拉克(Dworak)直肠癌消退分级评估了体积缩小率百分比的差异。

结果

57例患者(50.9%)在放化疗后出现肿瘤降期。肿瘤降期患者放化疗前后的MR肿瘤体积均显著小于未降期患者(p = 0.04,0.031),且肿瘤降期患者的体积缩小率百分比显著更高(p = 0.024)。16例患者(14.3%)显示病理上肿瘤完全消退。组织学完全消退的患者与有残留疾病的患者放化疗前后的MR肿瘤体积差异及体积缩小率百分比差异均无统计学意义(p = 0.688、0.451和0.480)。根据德沃拉克分级的体积缩小率百分比差异具有统计学意义(p = 0.03)。

结论

放化疗前后的MR容积检查显示,肿瘤降期患者与未降期患者之间的肿瘤体积和体积缩小率百分比存在显著差异。根据德沃拉克分级,各亚组之间的体积缩小率存在显著差异。然而,MR容积评估无法识别组织学完全消退的患者与有残留疾病的患者之间的任何差异。

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