Improving radical treatment through MRI evaluation of sigmoid cancers.
Rates of survival for bowel cancer are improving, but in contrast to previous decades this is happening more rapidly for patients with rectal cancer than colon cancers. Half of colon cancers occur in the left of the colon and the greatest proportion occurs in the sigmoid colon (an S-shaped loop situated above the rectum and below the pelvic inlet brim). Previously the MERCURY research programme, supported by Pelican, found that MRI scans before surgery can identify patients who have a higher risk of incomplete surgery in rectal cancer. This has consequently led to better pre-operative treatment and a drop in recurrence rates. Due to similar constraints of disease within the pelvis sigmoid cancer also has a high risk of recurrence but at the moment patients are not offered treatment before surgery.
This study, led by Ms Vera Tudyka and Professor Gina Brown, aims to use MRI scans, rather than CT scans which are offered at present, to stage sigmoid cancer. This will allow selection of more patients who would benefit from dedicated surgical road mapping and pre-operative treatment. 213 patients will be recruited from both existing MERCURY sites and new collaborative hospitals. This study could potentially help sigmoid cancer patients experience the benefits that have occurred in the field of rectal cancer.
References
Benson AB 3rd, Schrag D, Somerfield MR, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol. 2004 Aug 15;22(16):3408-19.
Burton S, Brown G, Bees N, et al. Accuracy of CT prediction of poor prognostic features in colonic cancer. Br J Radiol. 2008 Jan;81(961):10-9.
Burton S, Brown G, Daniels I, et al. MRI identified prognostic features of tumors in distal sigmoid, rectosigmoid, and upper rectum: treatment with radiotherapy and chemotherapy. Int J Radiat Oncol Biol Phys. 2006 Jun 1;65(2):445-51.
Cunningham D, Allum WH, Stenning SP, et al, for the MAGIC Trial Participants. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006; 355: 11–20.
Dighe S, Blake H, Koh MD, et al. Accuracy of multidetector computed tomography in identifying poor prognostic factors in colonic cancer.Br J Surg. 2010 Sep;97(9):1407-15.
Dighe S, Swift I, Magill L, et al. Accuracy of radiological staging in identifying high-risk colon cancer patients suitable for neoadjuvant chemotherapy: a multicentre experience. Colorectal Dis. 2012 Apr;14(4):438-44.
Finlay IG, Meek D, Brunton F, et al. Growth rate of hepatic metastases in colorectal carcinoma. Br J Surg 1988; 75: 641–44. 5
Foxtrot Collaborative Group. Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial. Lancet Oncol. 2012 Nov;13(11):1152-60.
Kapiteijn E, Marijnen CA, Nagtegaal ED, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345: 638–46.
Nelson H, Petrelli N, Carlin A, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 2001; 93: 583–96.
O’Neill B, Brown G, Wotherspoon A, et al. Successful downstaging of high rectal and recto-sigmoid cancer by neo-adjuvant chemo-radiotherapy. Clin Med Oncol. 2008;2:135-44.
Results of Mercury Study, Radiology. 2007 Apr;243(1):132-9.
Sebag-Montefiore D, Stephens RJ, Steele D, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 2009; 373: 811–20.
Smith NJ, Bees N, Barbachano Y, et al. Pre-operative computed tomography staging of non-metastatic colon cancer predicts outcome: implications for clinical trials. Br J Cancer 2007; 96: 1030–36.
Tanaka K, Shimada H, Miura M, et al. Metastatic tumor doubling time: most important pre-hepatectomy predictor of survival and non-recurrence of hepatic colorectal cancer metastasis. World J Surg 2004; 28: 263–70
Westlake S. Cancer incidence and mortality in the United Kingdom and constituent countries, 2004-06. Health Stat Q(43) 2009