caa a22 4500 44533536X CHVBK 20190328074407.0 cr unu---uuuuu 170323e20111001xx s 000 0 eng 10.1245/s10434-011-1704-5 doi (NATIONALLICENCE)springer-10.1245/s10434-011-1704-5 MRI-Based Indications for Neoadjuvant Radiochemotherapy in Rectal Carcinoma: Interim Results of a Prospective Multicenter Observational Study [Elektronische Daten] [Joachim Strassburg, Reinhard Ruppert, Henry Ptok, Christoph Maurer, Theodor Junginger, Susanne Merkel, Paul Hermanek] Background: This study evaluated use of circumferential resection margin status in preoperative MRI (mrCRM) as an indication for neoadjuvant radiochemotherapy (nRCT) in rectal carcinoma patients. Materials and Methods: In a multicenter prospective study, nRCT was given to patients with carcinoma of the middle rectum with positive mrCRM (≤1mm), with cT3 low rectal carcinoma, and all patients with cT4 tumors. The short-term endpoints were pathologic pCRM (≤1mm) as a strong predictor of local recurrence rate and the quality of total mesorectal excision according to the plane of surgery. These endpoints were compared in patients with and without nRCT. Results: Of 230 patients that met the inclusion criteria, 96 (41.7%) received a long course of nRCT and 134 (58.3%) were primarily operated on. The pCRM was positive in 13 of 230 (5.7%) (primarily operated on, 2 of 134 [1.5%]; after nRCT, 11 of 96 [11%]). In 1 of 134 (0.7%) case, the mrCRM was falsely negative. Patients at participating centers varied in terms of preoperative stage but not in pCRM positivity (0%-13%, P=.340). The plane of surgery was mesorectal (good) in 209 of 230 (90.9%), intramesorectal (moderate) in 16 of 230 (7%), and the muscularis propria plane (poor) in 2.2% (5 of 230). Conclusions: Low pCRM positivity and the high quality of mesorectal excision support use of MRI-based nRCT in rectal carcinoma. nRCT was avoidable in 45% of patients with stage II and III disease without significant risk of undertreatment. Preoperative MRI thus allows identification of patients with high risk of local recurrence and use of selective nRCT. Society of Surgical Oncology, 2011 Strassburg Joachim General and Visceral Surgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany aut Ruppert Reinhard General and Visceral Surgery, Endocrine Surgery, and Coloproctology, The Municipal Hospital of Munich-Neuperlach, Munich, Germany aut Ptok Henry Department of Surgery, Carl-Thiem-Klinik, Cottbus, Germany aut Maurer Christoph Department of General, Visceral, and Transplantation Surgery, Kantonsspital, Liestal, Switzerland aut Junginger Theodor General and Abdominal Surgery, University Hospital, Mainz, Germany aut Merkel Susanne Surgery, University Hospital, Erlangen, Germany aut Hermanek Paul Surgery, University Hospital, Erlangen, Germany aut Annals of Surgical Oncology Springer-Verlag 18/10(2011-10-01), 2790-2799 1068-9265 18:10<2790 2011 18 10434 https://doi.org/10.1245/s10434-011-1704-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-011-1704-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Strassburg Joachim General and Visceral Surgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany aut NATIONALLICENCE 700 1- Ruppert Reinhard General and Visceral Surgery, Endocrine Surgery, and Coloproctology, The Municipal Hospital of Munich-Neuperlach, Munich, Germany aut NATIONALLICENCE 700 1- Ptok Henry Department of Surgery, Carl-Thiem-Klinik, Cottbus, Germany aut NATIONALLICENCE 700 1- Maurer Christoph Department of General, Visceral, and Transplantation Surgery, Kantonsspital, Liestal, Switzerland aut NATIONALLICENCE 700 1- Junginger Theodor General and Abdominal Surgery, University Hospital, Mainz, Germany aut NATIONALLICENCE 700 1- Merkel Susanne Surgery, University Hospital, Erlangen, Germany aut NATIONALLICENCE 700 1- Hermanek Paul Surgery, University Hospital, Erlangen, Germany aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/10(2011-10-01), 2790-2799 1068-9265 18:10<2790 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer