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Article ; Online: New Opportunities for Minimizing Toxicity in Rectal Cancer Management.

Couwenberg, Alice M / Varvoglis, Dimitrios N / Grieb, Brian C / Marijnen, Corrie A M / Ciombor, Kristen K / Guillem, Jose G

American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting

2023 Volume 43, Page(s) e389558

Abstract: Advances in multimodal management of locally advanced rectal cancer (LARC), consisting of preoperative chemotherapy and/or radiotherapy followed by surgery with or without adjuvant chemotherapy, have improved local disease control and patient survival ... ...

Abstract	Advances in multimodal management of locally advanced rectal cancer (LARC), consisting of preoperative chemotherapy and/or radiotherapy followed by surgery with or without adjuvant chemotherapy, have improved local disease control and patient survival but are associated with significant risk for acute and long-term morbidity. Recently published trials, evaluating treatment dose intensification via the addition of preoperative induction or consolidation chemotherapy (total neoadjuvant therapy [TNT]), have demonstrated improved tumor response rates while maintaining acceptable toxicity. In addition, TNT has led to an increased number of patients achieving a clinical complete response and thus eligible to pursue a nonoperative, organ-preserving, watch and wait approach, thereby avoiding toxicities associated with surgery, such as bowel dysfunction and stoma-related complications. Ongoing trials using immune checkpoint inhibitors in patients with mismatch repair-deficient tumors suggest that this subgroup of patients with LARC could potentially be treated with immunotherapy alone, sparing them the toxicity associated with preoperative treatment and surgery. However, the majority of rectal cancers are mismatch repair-proficient and less responsive to immune checkpoint inhibitors and require multimodal management. The synergy noted in preclinical studies between immunotherapy and radiotherapy on immunogenic tumor cell death has led to the design of ongoing clinical trials that explore the benefit of combining radiotherapy, chemotherapy, and immunotherapy (mainly of immune checkpoint inhibitors) and aim to increase the number of patients eligible for organ preservation.
MeSH term(s)	Humans ; Immune Checkpoint Inhibitors ; Rectal Neoplasms ; Immunotherapy ; Brain Neoplasms ; Chemotherapy, Adjuvant ; Neoplasms, Second Primary
Chemical Substances	Immune Checkpoint Inhibitors
Language	English
Publishing date	2023-06-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2431126-1
ISSN	1548-8756 ; 1548-8748
ISSN (online)	1548-8756
ISSN	1548-8748
DOI	10.1200/EDBK_389558
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Article ; Online: Impact of the new rectal cancer definition on multimodality treatment and interhospital variability: Results from a nationwide cross-sectional study.

Hazen, Sanne-Marije J A / Sluckin, Tania C / Horsthuis, Karin / Lambregts, Doenja M J / Beets-Tan, Regina G H / Hompes, Roel / Buffart, Tineke E / Marijnen, Corrie A M / Tanis, Pieter J / Kusters, Miranda

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2024

Abstract: Aim: This study aimed to determine the consequences of the new definition of rectal cancer for decision-making in multidisciplinary team meetings (MDT). The new definition of rectal cancer, the lower border of the tumour is located below the sigmoid ... ...

Abstract	Aim: This study aimed to determine the consequences of the new definition of rectal cancer for decision-making in multidisciplinary team meetings (MDT). The new definition of rectal cancer, the lower border of the tumour is located below the sigmoid take-off (STO), was implemented in the Dutch guideline in 2019 after an international Delphi consensus meeting to reduce interhospital variations. Method: All patients with rectal cancer according to the local MDT, who underwent resection in 2016 in the Netherlands were eligible for this nationwide collaborative cross-sectional study. MRI-images were rereviewed, and the tumours were classified as above or on/below the STO. Results: This study registered 3107 of the eligible 3178 patients (98%), of which 2784 patients had an evaluable MRI. In 314 patients, the tumour was located above the STO (11%), with interhospital variation between 0% and 36%. Based on TN-stage, 175 reclassified patients with colon cancer (6%) would have received different treatment (e.g., omitting neoadjuvant radiotherapy, candidate for adjuvant chemotherapy). Tumour location above the STO was independently associated with lower risk of 4-year locoregional recurrence (HR 0.529; p = 0.030) and higher 4-year overall survival (HR 0.732; p = 0.037) compared to location under the STO. Conclusion: By using the STO, 11% of the prior MDT-based diagnosis of rectal cancer were redefined as sigmoid cancer, with potential implications for multimodality treatment and prognostic value. Given the substantial interhospital variation in proportion of redefined cancers, the use of the STO will contribute to standardisation and comparability of outcomes in both daily practice and trial settings.
Language	English
Publishing date	2024-04-29
Publishing country	England
Document type	Journal Article
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.17002
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Article ; Online: Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment.

Geffen, Eline G M van / Nederend, Joost / Sluckin, Tania C / Hazen, Sanne-Marije J A / Horsthuis, Karin / Beets-Tan, Regina G H / Marijnen, Corrie A M / Tanis, Pieter J / Kusters, Miranda

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2024 Volume 50, Issue 6, Page(s) 108307

Abstract: Background: Detection of grade 3-4 extra mural venous invasion (mrEMVI) on magnetic resonance imaging (MRI) is associated with an increased distant metastases (DM)-rate. This study aimed to determine the impact of different grades of mrEMVI and their ... ...

Abstract	Background: Detection of grade 3-4 extra mural venous invasion (mrEMVI) on magnetic resonance imaging (MRI) is associated with an increased distant metastases (DM)-rate. This study aimed to determine the impact of different grades of mrEMVI and their disappearance after neoadjuvant therapy. Methods: A Dutch national retrospective cross-sectional study was conducted, including patients who underwent resection for rectal cancer in 2016 from 60/69 hospitals performing rectal surgery. Patients with a cT3-4 tumour ≤8 cm from the anorectal junction were selected and their MRI-scans were reassessed by trained abdominal radiologists. Positive mrEMVI grades (3 and 4) were analyzed in regard to 4-year local recurrence (LR), DM, disease-free survival (DFS) and overall survival (OS). Results: The 1213 included patients had a median follow-up of 48 months (IQR 30-54). Positive mrEMVI was present in 324 patients (27%); 161 had grade 3 and 163 had grade 4. A higher mrEMVI stage (grade 4 vs grade 3 vs no mrEMVI) increased LR-risk (21% vs 18% vs 7%, <0.001) and DM-risk (49% vs 30% vs 21%, p < 0.001) and decreased DFS (42% vs 55% vs 69%, p < 0.001) and OS (62% vs 76% vs 81%, p < 0.001), which remained independently associated in multivariable analysis. When mrEMVI had disappeared on restaging MRI, DM-rate was comparable to initial absence of mrEMVI (both 26%), whereas LR-rate remained high (22% vs 9%, p = 0.006). Conclusion: The negative oncological impact of mrEMVI on recurrence and survival rates was dependent on grading. Disappearance of mrEMVI on restaging MRI decreased the risk of DM, but not of LR.
Language	English
Publishing date	2024-03-29
Publishing country	England
Document type	Journal Article
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2024.108307
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Zs.A 1149: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Value of Size and Malignant Features of Lateral Lymph Nodes in Risk Stratification at Lateral Local Recurrence of Rectal Cancer: A National Cohort Study.

van Geffen, Eline G M / Sluckin, Tania C / Hazen, Sanne-Marije J A / Horsthuis, Karin / Beets-Tan, Regina G H / van Dieren, Susan / Marijnen, Corrie A M / Tanis, Pieter J / Kusters, Miranda

Journal of the National Comprehensive Cancer Network : JNCCN

2024 Volume 22, Issue 1, Page(s) 17–25

Abstract: Background: Patients with rectal cancer who have enlarged lateral lymph nodes (LLNs) have an increased risk of lateral local recurrence (LLR). However, little is known about prognostic implications of malignant features (internal heterogeneity, ... ...

Abstract	Background: Patients with rectal cancer who have enlarged lateral lymph nodes (LLNs) have an increased risk of lateral local recurrence (LLR). However, little is known about prognostic implications of malignant features (internal heterogeneity, irregular margins, loss of fatty hilum, and round shape) on MRI and number of enlarged LLNs, in addition to LLN size. Methods: Of the 3,057 patients with rectal cancer included in this national, retrospective, cross-sectional cohort study, 284 with a cT3-4 tumor located ≤8 cm from the anorectal junction who received neoadjuvant treatment and who had visible LLNs on MRI were selected. Imaging was reassessed by trained radiologists. LLNs were categorized based on size. Influence of malignant features and the number of LLNs on LLR was investigated. Results: Of 284 patients with at least 1 visible LLN, 122 (43%) had an enlarged node (≥7.0 mm) and 157 (55%) had malignant features. Of the 122 patients with enlarged nodes, 25 had multiple (≥2). In patients with a single enlarged node (n=97), a single malignant feature was associated with a 4-year LLR rate of 0% and multiple malignant features was associated with a rate of 17% (P=.060). In the group with multiple malignant features, their disappearance on restaging was associated with an LLR rate of 13% compared with an LLR rate of 20% for persistent malignant features (P=.532). The presence of intermediate-size LLNs (5.0-6.9 mm) with at least 1 malignant feature was associated with a 4-year LLR rate of 8%; the 4-year LLR rate was 13% when the malignant features persisted on restaging MRI (P=.409). Patients with multiple enlarged LLNs had a 4-year LLR rate of 28% compared with 11% for those with a single enlarged LLN (P=.059). Conclusions: The presence of multiple enlarged LLNs (≥7.0 mm), as well as multiple malignant features in an enlarged node contribute to the risk of developing an LLR. These radiologic features can be used for clinical decision-making regarding the potential benefit of LLN dissection.
MeSH term(s)	Humans ; Cohort Studies ; Retrospective Studies ; Cross-Sectional Studies ; Lymph Nodes/pathology ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/epidemiology ; Rectal Neoplasms/therapy ; Risk Assessment ; Lymph Node Excision/methods ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/pathology ; Neoplasm Staging
Language	English
Publishing date	2024-02-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2250759-0
ISSN	1540-1413 ; 1540-1405
ISSN (online)	1540-1413
ISSN	1540-1405
DOI	10.6004/jnccn.2023.7081
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Article ; Online: Letter to the editor regarding "A systematic review comparing radiation toxicity after various endorectal techniques".

Rijkmans, Eva C / Nout, Remi A / Marijnen, Corrie A M

Brachytherapy

2019 Volume 18, Issue 4, Page(s) 564

MeSH term(s)	Brachytherapy ; Humans ; Radiation Injuries ; Rectal Neoplasms
Language	English
Publishing date	2019-04-09
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2098608-7
ISSN	1873-1449 ; 1538-4721
ISSN (online)	1873-1449
ISSN	1538-4721
DOI	10.1016/j.brachy.2019.02.006
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Article ; Online: Corrigendum to "Master protocol trial design for technical feasibility of MR-guided radiotherapy" [Radiother. Oncol. 166 (2022) 33-36].

Couwenberg, Alice / Van der Heide, Uulke / Janssen, Tomas / Van Triest, Baukelien / Remeijer, Peter / Marijnen, Corrie / Sonke, Jan-Jakob / Nowee, Marlies

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

2023 Volume 184, Page(s) 109693

Language	English
Publishing date	2023-05-17
Publishing country	Ireland
Document type	Published Erratum
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2023.109693
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Article ; Online: Authors' reply-Does the RAPIDO trial suggest a benefit of post-operative chemotherapy after preoperative chemoradiation in rectal cancer? No, it does not.

Zwart, W H / Dijkstra, E A / Putter, H / Marijnen, C A M / Nilsson, P J / van de Velde, C J H / van Etten, B / Hospers, G A P / Glimelius, B

ESMO open

2023 Volume 8, Issue 5, Page(s) 101645

Language	English
Publishing date	2023-09-14
Publishing country	England
Document type	Letter
ISSN	2059-7029
ISSN (online)	2059-7029
DOI	10.1016/j.esmoop.2023.101645
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Article ; Online: Corrigendum to "Authors' reply-Does the RAPIDO trial suggest a benefit of post-operative chemotherapy after preoperative chemoradiation in rectal cancer? No, it does not": [ESMO Open 8 (2023) 101645].

Zwart, W H / Dijkstra, E A / Putter, H / Marijnen, C A M / Nilsson, P J / van de Velde, C J H / van Etten, B / Hospers, G A P / Glimelius, B

ESMO open

2023 Volume 8, Issue 6, Page(s) 102042

Language	English
Publishing date	2023-10-20
Publishing country	England
Document type	Published Erratum
ISSN	2059-7029
ISSN (online)	2059-7029
DOI	10.1016/j.esmoop.2023.102042
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Article: Retrospective evaluation of national MRI reporting quality for lateral lymph nodes in rectal cancer patients and concordance with prospective re-evaluation following additional training.

Sluckin, Tania C / Hazen, Sanne-Marije J A / Horsthuis, Karin / Beets-Tan, Regina G H / Marijnen, Corrie A M / Tanis, Pieter J / Kusters, Miranda

Insights into imaging

2022 Volume 13, Issue 1, Page(s) 171

Abstract: Objectives: The presence and size of lateral lymph nodes (LLNs) are important factors influencing treatment decisions for rectal cancer. Awareness of the clinical relevance and describing LLNs in MRI reports is therefore essential. This study assessed ... ...

Abstract	Objectives: The presence and size of lateral lymph nodes (LLNs) are important factors influencing treatment decisions for rectal cancer. Awareness of the clinical relevance and describing LLNs in MRI reports is therefore essential. This study assessed whether LLNs were mentioned in primary MRI reports at a national level and investigated the concordance with standardised re-review. Methods: This national, retrospective, cross-sectional cohort study included 1096 patients from 60 hospitals treated in 2016 for primary cT3-4 rectal cancer ≤ 8 cm from the anorectal junction. Abdominal radiologists re-reviewed all MR images following a 2-h training regarding LLNs. Results: Re-review of MR images identified that 41.0% of enlarged (≥ 7 mm) LLNs were not mentioned in primary MRI reports. A contradictory anatomical location was stated for 73.2% of all LLNs and a different size (≥/< 7 mm) for 41.7%. In total, 49.4% of all cases did not mention LLNs in primary MRI reports. Reporting LLNs was associated with stage (cT3N0 44.3%, T3N+/T4 52.8%, p = 0.013), cN stage (N0 44.1%, N1 48.6%, N2 59.5%, p < 0.001), hospital type (non-teaching 34.6%, teaching 52.2%, academic 53.2% p = 0.006) and annual rectal cancer resection volumes (low 34.8%, medium 47.7%, high 57.3% p < 0.001). For LLNs present according to original MRI reports (n = 226), 64.2% also mentioned a short-axis size, 52.7% an anatomical location and 25.2% whether it was deemed suspicious. Conclusions: Almost half of the primary MRI reports for rectal cancer patients treated in the Netherlands in 2016 did not mention LLNs. A significant portion of enlarged LLNs identified during re-review were also not mentioned originally, with considerable discrepancies for location and size. These results imply insufficient awareness and indicate the need for templates, education and training.
Language	English
Publishing date	2022-10-20
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2543323-4
ISSN	1869-4101
ISSN	1869-4101
DOI	10.1186/s13244-022-01303-7
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Article ; Online: Prognostic Implications of Lateral Lymph Nodes in Rectal Cancer: A Population-Based Cross-sectional Study With Standardized Radiological Evaluation After Dedicated Training.

Sluckin, Tania C / van Geffen, Eline G M / Hazen, Sanne-Marije J A / Horsthuis, Karin / Beets-Tan, Regina G H / Marijnen, Corrie A M / Tanis, Pieter J / Kusters, Miranda

Diseases of the colon and rectum

2023 Volume 67, Issue 1, Page(s) 42–53

Abstract: ... radiology departments in 60 Dutch hospitals.: Patients: A total of 3057 patients underwent rectal cancer ... surgery in 2016: 1109 had a cT3-4 tumor located ≤8 cm from the anorectal junction, of whom 891 received ... tenían tumor cT3-4 ubicado a ≤8 cm de la unión anorrectal de los cuales 890 recibieron terapia ...

Abstract	Background: There is an ongoing discussion regarding the prognostic implications of the presence, short-axis diameter, and location of lateral lymph nodes. Objective: To analyze lateral lymph node characteristics, the role of downsizing on restaging MRI, and associated local recurrence rates for patients with cT3-4 rectal cancer after MRI re-review and training. Design: Retrospective population-based cross-sectional study. Settings: This collaborative project was led by local investigators from surgery and radiology departments in 60 Dutch hospitals. Patients: A total of 3057 patients underwent rectal cancer surgery in 2016: 1109 had a cT3-4 tumor located ≤8 cm from the anorectal junction, of whom 891 received neoadjuvant therapy. Main outcome measures: Local recurrence and (ipsi) lateral local recurrence rates. Results: Re-review identified 314 patients (35%) with visible lateral lymph nodes. Of these, 30 patients had either only long-stretched obturator (n = 13) or external iliac (n = 17) nodes, and both did not lead to any lateral local recurrences. The presence of internal iliac/obturator lateral lymph nodes (n = 284) resulted in 4-year local recurrence and lateral local recurrence rates of 16.4% and 8.8%, respectively. Enlarged (≥7 mm) lateral lymph nodes (n = 122) resulted in higher 4-year local recurrence (20.8%, 13.1%, 0%; p <.001) and lateral local recurrence (14.7%, 4.4%, 0%; p < 0.001) rates compared to smaller and no lateral lymph nodes, respectively. Visible lateral lymph nodes (HR 1.8 [1.1-2.8]) and enlarged lateral lymph nodes (HR 1.9 [1.1-3.5]) were independently associated with local recurrence in multivariable analysis. Enlarged lateral lymph nodes with malignant features had higher 4-year lateral local recurrence rates of 17.0%. Downsizing had no impact on lateral local recurrence rates. Enlarged lateral lymph nodes were found to be associated with higher univariate 4-year distant metastasis rates (36.4% vs 24.4%; p = 0.021), but this was not significant in multivariable analyses (HR 1.3 [0.9-1.]) and did not worsen overall survival. Limitations: This study was limited by the retrospective design and total number of patients with lateral lymph nodes. Conclusions: The risk of lateral local recurrence due to (enlarged) lateral lymph nodes was confirmed, but without the prognostic impact of downsizing after neoadjuvant therapy. These results point toward the incorporation of primary lateral lymph node size into treatment planning. See Video Abstract. Implicaciones pronsticas de los ndulos linfticos laterales en el cncer de recto un estudio transversal de base poblacional con evaluacin radiolgica estandarizada despus de un entrenamiento especfico: ANTECEDENTES:Hay una discusión en curso acerca de las implicaciones pronósticas de la presencia, el diámetro del eje corto y la ubicación de los nódulos linfáticos laterales.OBJETIVO:Analizar las características de los nódulos linfáticos laterales, el rol de la reducción de tamaño en la IRM de reestratificación y las tasas de recurrencia local asociadas para pacientes con cáncer de recto cT3-4 después de una nueva revisión y entrenamiento de IRM.DISEÑO:Estudio transversal retrospectivo poblacional.CONFIGURACIÓN:Este proyecto colaborativo fue dirigido por investigadores locales de los departamentos de cirugía y radiología en 60 hospitales holandeses.PACIENTES:3057 pacientes fueron operados de cáncer de recto en 2016: 1109 tenían tumor cT3-4 ubicado a ≤8 cm de la unión anorrectal de los cuales 890 recibieron terapia neoadyuvante.INTERVENCIONES(S):Ninguna.PRINCIPALES MEDIDAS DE RESULTADO:recurrencia local y tasas de recurrencia local ipsilateral.RESULTADOS:Una nueva revisión identificó a 314 pacientes (35%) con nódulos linfáticos laterales visibles. 30 de estos pacientes tenían solo nódulos obturadores estirados (n = 13) o ilíacos externos (n = 17) y ambos no provocaron recurrencias locales laterales. La presencia de nódulos linfáticos laterales ilíacos internos/obturadores (n = 284) dio como resultado tasas de recurrencia local y recurrencia local lateral a los 4 años del 16.4% y el 8.8%, respectivamente. Los nódulos linfáticos laterales agrandados (≥7 mm) (n = 122) resultaron en una mayor recurrencia local a los 4 años (20.8%, 13.1%, 0%, p < 0.001) y recurrencia local lateral (14.7%, 4.4%, 0%, p < 0.001) en comparación con nódulos linfáticos más pequeños y sin nódulos linfáticos laterales, respectivamente. Los nódulos linfáticos laterales visibles (índice de riesgo 1,8 (1,1-2,8)) y los nódulos linfáticos laterales agrandados (índice de riesgo 1.9 (1.1-3.5)) se asociaron de forma independiente con la recurrencia local en el análisis multivariable. Los nódulos linfáticos laterales agrandados con características malignas tuvieron tasas de recurrencia local lateral a 4 años más altas del 17.0%. La reducción de tamaño no tuvo impacto en las tasas de recurrencia local lateral. Los nódulos linfáticos laterales agrandados se asociaron con tasas univariadas más altas de metástasis a distancia a los 4 años (36.4%, 24.4%, p = 0.021), pero no en el análisis multivariable (índice de riesgo 1.3 (0.9-1.8)), y no empeoró la supervivencia general.LIMITACIONES:Este estudio estuvo limitado por el diseño retrospectivo y el número total de pacientes con nódulos linfáticos laterales.CONCLUSIONES:Se confirmó el riesgo de recurrencia local lateral debido a los nódulos linfáticos laterales (agrandados), pero sin el impacto pronóstico de la reducción después de la terapia neoadyuvante. Estos resultados apuntan hacia la incorporación del tamaño del nódulo linfático lateral primario en la planificación del tratamiento. (Traducción-Dr. Aurian Garcia Gonzalez ).
MeSH term(s)	Humans ; Cross-Sectional Studies ; Prognosis ; Retrospective Studies ; Radiology ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/therapy ; Lymph Nodes/diagnostic imaging ; Neoplasm Staging
Language	English
Publishing date	2023-06-01
Publishing country	United States
Document type	Video-Audio Media ; Journal Article
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000002752
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