Improving outcomes in Sigmoid Colon cancer through better use of pre-operative imaging
File(s)
Author(s)
Day, Nigel
Type
Thesis
Abstract
Introduction
I hypothesised that better use of pre-operative imaging could significantly improve outcomes in Sigmoid Colon Cancer. Patients with this condition should benefit from the same bespoke treatment planning that occurs in rectal cancer.
Methods
I investigated the burden of local recurrence for sigmoid cancer patients, identifying important prognostic variables through radiology and pathology assessment. I designed an alternative CT staging proforma giving appropriate weight to those variables with the greatest prognostic significance. I investigated the relationship between extra nodal tumour deposits and local anastomotic recurrence and performed a systematic review to assess the heterogeneity in definitions used in published literature. I performed a retrospective audit of national data to assess the use of Magnetic Resonance Imaging in the pre-operative setting and its association with treatment decision making and survival.
Results
Local occurrence occurred in 12.6% of the 414 cases of non-metastatic Sigmoid Colon cancer. CT identifiable prognostic variables such as T stage, EMVI and tumour deposits were identified to be of particular significance. And these can be used in a more effective CT reporting proforma. The corelation between radiology and pathology findings in cases of anastomotic recurrence was over 70% and recognising tumour deposits distant to the primary tumour is crucial when planning surgical resections. It is theoretically possible to consider an alternative radiotherapy field to target non-resectable lesions. There is significant heterogeneity in the use of the term ‘anastomotic recurrence’ in published literature. MRI imaging is only used pre-operatively in 1.5% of the 184,000 cases of Sigmoid/Rectosigmoid Colon cancer. There is a 7% survival advantage for T4 tumour patients with MRI use which equates to 1292 additional lives saved in the time period in question.
Conclusion
Giving greater emphasis to existing imaging modalities is likely to significantly improve outcomes in Sigmoid Colon cancer through more bespoke treatment planning.
I hypothesised that better use of pre-operative imaging could significantly improve outcomes in Sigmoid Colon Cancer. Patients with this condition should benefit from the same bespoke treatment planning that occurs in rectal cancer.
Methods
I investigated the burden of local recurrence for sigmoid cancer patients, identifying important prognostic variables through radiology and pathology assessment. I designed an alternative CT staging proforma giving appropriate weight to those variables with the greatest prognostic significance. I investigated the relationship between extra nodal tumour deposits and local anastomotic recurrence and performed a systematic review to assess the heterogeneity in definitions used in published literature. I performed a retrospective audit of national data to assess the use of Magnetic Resonance Imaging in the pre-operative setting and its association with treatment decision making and survival.
Results
Local occurrence occurred in 12.6% of the 414 cases of non-metastatic Sigmoid Colon cancer. CT identifiable prognostic variables such as T stage, EMVI and tumour deposits were identified to be of particular significance. And these can be used in a more effective CT reporting proforma. The corelation between radiology and pathology findings in cases of anastomotic recurrence was over 70% and recognising tumour deposits distant to the primary tumour is crucial when planning surgical resections. It is theoretically possible to consider an alternative radiotherapy field to target non-resectable lesions. There is significant heterogeneity in the use of the term ‘anastomotic recurrence’ in published literature. MRI imaging is only used pre-operatively in 1.5% of the 184,000 cases of Sigmoid/Rectosigmoid Colon cancer. There is a 7% survival advantage for T4 tumour patients with MRI use which equates to 1292 additional lives saved in the time period in question.
Conclusion
Giving greater emphasis to existing imaging modalities is likely to significantly improve outcomes in Sigmoid Colon cancer through more bespoke treatment planning.
Version
Open Access
Date Issued
2023-07
Date Awarded
2024-03
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Brown, Gina
Swift, Robert
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Medicine (Research) MD (Res)