BMJ  2006;333:808 (14 October), doi:10.1136/bmj.333.7572.808

Letter

MRI in predicting curative resection of rectal cancer

New dilemma in multidisciplinary team management

The first 150 words of the full text of this article appear below.

EDITOR—Tumour shrinkage by preoperative chemoradiotherapy is now an everyday reality, and pathological complete responses are not uncommon.1 A "new dilemma" is posed by the apparent complete disappearance of cancer on magnetic resonance imaging, and often clinically, after chemoradiotherapy. A delay of six to 10 weeks is usual before operating—a time perceived as a "window of opportunity," as regrowth in the irradiated area is believed inevitable.

This concept has been challenged by a series by Habr-Gama et al.2 Altogether 360 patients with T3 and T4 rectal cancer (or T2 when considered for abdominoperineal resection) were treated with preoperative chemoradiotherapy.3 Ninety nine patients (28%) classified as clinical complete responders at eight weeks after completion of chemoradiotherapy were managed by surveillance alone. Only 2% in this observation group have died of cancer in a follow-up extending for up to 10 years, whereas local recurrence occurred in just five patients, all amenable . . . [Full text of this article]

R J Heald, surgical director1, Brian D P O'Neill, clinical oncology research fellow2, Brendan Moran, consultant surgeon2, Gina Brown, consultant radiologist3, Ara W Darzi, honorary consultant3, Andrew C Wotherspoon, consultant histopathologist3, David Cunningham, consultant medical oncologist3, Diana M Tait, consultant medical oncologist3

1 Pelican Cancer Foundation, Basingstoke RG24 9NA Completeresponse@pelicancancer.org, 2 Pelican Cancer Foundation, Basingstoke RG24 9NA, 3 Royal Marsden NHS Foundation Trust, London SW3 6JJ


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Relevant Article

Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study
MERCURY Study Group
BMJ 2006 333: 779. [Abstract] [Full Text] [PDF]

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  • JOHNSTON, D F, LAWRENCE, K M, SIZER, B F, ARULAMPALAM, T H A, MOTSON, R W, DOVE, E, LACEY, N (2009). Locally advanced rectal cancer: histopathological correlation and predictive accuracy of serial MRI after neoadjuvant chemotherapy. Br. J. Radiol. 82: 332-336 [Abstract] [Full text]  
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