Relationship Between Baseline Rectal Tumor Length and Magnetic Resonance Tumor Regression Grade Response to Chemoradiotherapy: A Subanalysis of the TRIGGER Feasibility Study

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 baseli...

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Published in:	Annals of surgical oncology 2023-08, Vol.30 (8), p.4729-4735
Main Authors:	Hodges, Nicola, Battersby, Nicholas, Rao, Sheela, Brown, Gina
Format:	Article
Language:	eng
Subjects:	Chemoradiotherapy Chemoradiotherapy - methods Chemotherapy Colorectal Cancer Feasibility Studies Humans Magnetic resonance imaging Magnetic Resonance Imaging - methods Magnetic Resonance Spectroscopy Medicine Medicine & Public Health Neoadjuvant Therapy Oncology Patients Radiation therapy Rectal Neoplasms - diagnostic imaging Rectal Neoplasms - pathology Rectal Neoplasms - therapy Rectum Retrospective Studies Surgery Surgical Oncology Treatment Outcome Tumors
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Summary:	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
ISSN:	1068-9265 1534-4681