| Title: |
Prospective Correlation of Magnetic Resonance Tumor Regression Grade With Pathologic Outcomes in Total Neoadjuvant Therapy for Rectal Adenocarcinoma |
| Authors: |
Hall, William A; Li, Jiahe; You, Y Nancy; Gollub, Marc J; Grajo, Joseph R; Rosen, Mark; dePrisco, Greg; Yothers, Greg; Dorth, Jennifer A; Rahma, Osama E; Russell, Marcia M; Gross, Howard M; Jacobs, Samuel A; Faller, Bryan A; George, Sagila; Al baghdadi, Tareq; Haddock, Michael G; Valicenti, Richard; Hong, Theodore S; George, Thomas J |
| Source: |
Journal of Clinical Oncology, vol 41, iss 29 |
| Publisher Information: |
eScholarship, University of California |
| Publication Year: |
2023 |
| Collection: |
University of California: eScholarship |
| Subject Terms: |
32 Biomedical and Clinical Sciences (for-2020); 3202 Clinical Sciences (for-2020); 3211 Oncology and Carcinogenesis (for-2020); Cancer (rcdc); Rare Diseases (rcdc); Clinical Research (rcdc); Biomedical Imaging (rcdc); 4.2 Evaluation of markers and technologies (hrcs-rac); Cancer (hrcs-hc); Female (mesh); Humans (mesh); Male (mesh); Middle Aged (mesh); Adenocarcinoma (mesh); Chemoradiotherapy (mesh); Magnetic Resonance Imaging (mesh); Magnetic Resonance Spectroscopy (mesh); Neoadjuvant Therapy (mesh); Neoplasm Staging (mesh); Rectal Neoplasms (mesh); Treatment Outcome (mesh); Prospective Studies (mesh); 1103 Clinical Sciences (for); 1112 Oncology and Carcinogenesis (for) |
| Time: |
4643 - 4651 |
| Description: |
PURPOSE: Total neoadjuvant therapy (TNT) is a newly established standard treatment for rectal adenocarcinoma. Current methods to communicate magnitudes of regression during TNT are subjective and imprecise. Magnetic resonance tumor regression grade (MR-TRG) is an existing, but rarely used, regression grading system. Prospective validation of MR-TRG correlation with pathologic response in patients undergoing TNT is lacking. Utility of adding diffusion-weighted imaging to MR-TRG is also unknown. METHODS: We conducted a multi-institutional prospective imaging substudy within NRG-GI002 (ClinicalTrials.gov identifier: NCT02921256) examining the ability of MR-based imaging to predict pathologic complete response (pCR) and correlate MR-TRG with the pathologic neoadjuvant response score (NAR). Serial MRIs were needed from 110 patients. Three radiologists independently, then collectively, reviewed each MRI for complete response (mriCR), which was tested for positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity with pCR. MR-TRG was examined for association with the pathologic NAR score. All team members were blinded to pathologic data. RESULTS: A total of 121 patients from 71 institutions met criteria: 28% were female (n = 34), 84% White (n = 101), and median age was 55 (24-78 years). Kappa scores for T- and N-stage after TNT were 0.38 and 0.88, reflecting fair agreement and near-perfect agreement, respectively. Calling an mriCR resulted in a kappa score of 0.82 after chemotherapy and 0.56 after TNT reflected near-perfect agreement and moderate agreement, respectively. MR-TRG scores were associated with pCR (P < .01) and NAR (P < .0001), PPV for pCR was 40% (95% CI, 26 to 53), and NPV was 84% (95% CI, 75 to 94). CONCLUSION: MRI alone is a poor tool to distinguish pCR in rectal adenocarcinoma undergoing TNT. However, the MR-TRG score presents a now validated method, correlated with pathologic NAR, which can objectively measure regression magnitude during TNT. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
unknown |
| Relation: |
qt4p48q73b; https://escholarship.org/uc/item/4p48q73b; https://escholarship.org/content/qt4p48q73b/qt4p48q73b.pdf |
| DOI: |
10.1200/jco.22.02525 |
| Availability: |
https://escholarship.org/uc/item/4p48q73b; https://escholarship.org/content/qt4p48q73b/qt4p48q73b.pdf; https://doi.org/10.1200/jco.22.02525 |
| Rights: |
public |
| Accession Number: |
edsbas.64D30C1B |
| Database: |
BASE |