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Radiological Biomarkers in MRI directed Rectal Cancer Radiotherapy Volume Delineation.

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Highlighting extramural venous invasion (EMVI) on MRI reports improves rectal cancer gross tumor volume (GTV) delineation accuracy. This enhanced MRI reporting reduces geographical misses in radiotherapy planning for rectal cancer patients.

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Area of Science:

  • Oncology
  • Radiology
  • Medical Imaging

Background:

  • Accurate delineation of gross tumor volume (GTV) is crucial for effective radiotherapy in locally advanced rectal cancer.
  • Extramural venous invasion (EMVI) and involved lymph nodes are key prognostic factors and sources of uncertainty in GTV definition.
  • Current MRI reporting systems may not consistently highlight these critical features, potentially leading to geographical misses in radiotherapy planning.

Purpose of the Study:

  • To evaluate if an MRI reporting system emphasizing contiguous and discontinuous extramural venous invasion (EMVI) improves the accuracy of gross tumor volume (GTV) delineation in rectal cancer.
  • To assess the impact of enhanced MRI reporting on reducing geographical misses in nodal and EMVI components of the GTV.
  • To refine radiotherapy practices based on improved MRI delineation for rectal cancer patients.

Main Methods:

  • Retrospective analysis of 27 locally advanced rectal cancer patients treated between 2012-2014 using a standard MRI reporting proforma.
  • Development and implementation of a modified MRI reporting system that specifically documents EMVI and lymph node status.
  • Comparison of GTV delineations based on the new system against historical radiotherapy treatment volumes to identify geographical misses.
  • Re-evaluation of radiotherapy practice in a subsequent cohort of 27 patients after implementing the modified MRI reporting system.

Main Results:

  • Initial evaluation revealed nodal GTV geographical miss in 19% (5/27) and complete EMVI GTV geographical miss in 7% (2/27) of patients.
  • After implementing the modified MRI reporting system, nodal miss decreased to 7% (2/27) and partial EMVI miss to 4% (1/27).
  • Although misses were observed in the second cohort, these areas were encompassed within the planning target volume (PTV), indicating improved management.

Conclusions:

  • Highlighting extramural venous invasion (EMVI) and involved lymph nodes on MRI is essential for improving the accuracy of gross tumor volume (GTV) delineation in rectal cancer.
  • An enhanced MRI reporting system can significantly reduce geographical misses related to EMVI and nodal involvement in radiotherapy planning.
  • Modified MRI reporting protocols contribute to more precise GTV definition, potentially improving treatment outcomes for rectal cancer patients.