Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomized multicenter trial

M P Engbersen; C J V Rijsemus; J Nederend; A G J Aalbers; I H J T de Hingh; V Retel; D M J Lambregts; E J R J Van der Hoeven; D Boerma; M J Wiezer; M De Vries; E V E Madsen; A R M Brandt-Kerkhof; S Van Koeverden; P R De Reuver; R G H Beets-Tan; N F M Kok; M J Lahaye

doi:10.1186/s12885-021-08168-x

Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomized multicenter trial

M P Engbersen^*, C J V Rijsemus, J Nederend, A G J Aalbers, I H J T de Hingh, V Retel, D M J Lambregts, E J R J Van der Hoeven, D Boerma, M J Wiezer, M De Vries, E V E Madsen, A R M Brandt-Kerkhof, S Van Koeverden, P R De Reuver, R G H Beets-Tan, N F M Kok, M J Lahaye

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: Selecting patients with peritoneal metastases from colorectal cancer (CRCPM) who might benefit from cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is challenging. Computed tomography generally underestimates the peritoneal tumor load. Diagnostic laparoscopy is often used to determine whether patients are amenable for surgery. Magnetic resonance imaging (MRI) has shown to be accurate in predicting completeness of CRS. The aim of this study is to determine whether MRI can effectively reduce the need for surgical staging.

METHODS: The study is designed as a multicenter randomized controlled trial (RCT) of colorectal cancer patients who are deemed eligible for CRS-HIPEC after conventional CT staging. Patients are randomly assigned to either MRI based staging (arm A) or to standard surgical staging with or without laparoscopy (arm B). In arm A, MRI assessment will determine whether patients are eligible for CRS-HIPEC. In borderline cases, an additional diagnostic laparoscopy is advised. The primary outcome is the number of unnecessary surgical procedures in both arms defined as: all surgeries in patients with definitely inoperable disease (PCI > 24) or explorative surgeries in patients with limited disease (PCI < 15). Secondary outcomes include correlations between surgical findings and MRI findings, cost-effectiveness, and quality of life (QOL) analysis.

CONCLUSION: This randomized trial determines whether MRI can effectively replace surgical staging in patients with CRCPM considered for CRS-HIPEC.

TRIAL REGISTRATION: Registered in the clinical trials registry of U.S. National Library of Medicine under NCT04231175 .

Original language	English
Article number	464
Journal	BMC Cancer
Volume	21
Issue number	1
DOIs	https://doi.org/10.1186/s12885-021-08168-x
Publication status	Published - 26 Apr 2021

Bibliographical note

Funding Information:
Funding is provided by the Dutch organization for health research and healthcare innovation, ZonMw (The Hague, NL) (project number: 852002003). The funder’s role is limited to grant application review and approval.

Publisher Copyright:
© 2021, The Author(s).

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Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomized multicenter trialFinal published version, 759 KBLicence: CC BY

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Engbersen, M. P., Rijsemus, C. J. V., Nederend, J., Aalbers, A. G. J., de Hingh, I. H. J. T., Retel, V., Lambregts, D. M. J., Van der Hoeven, E. J. R. J., Boerma, D., Wiezer, M. J., De Vries, M., Madsen, E. V. E., Brandt-Kerkhof, A. R. M., Van Koeverden, S., De Reuver, P. R., Beets-Tan, R. G. H., Kok, N. F. M., & Lahaye, M. J. (2021). Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomized multicenter trial. BMC Cancer, 21(1), Article 464. https://doi.org/10.1186/s12885-021-08168-x

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title = "Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomized multicenter trial",

abstract = "BACKGROUND: Selecting patients with peritoneal metastases from colorectal cancer (CRCPM) who might benefit from cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is challenging. Computed tomography generally underestimates the peritoneal tumor load. Diagnostic laparoscopy is often used to determine whether patients are amenable for surgery. Magnetic resonance imaging (MRI) has shown to be accurate in predicting completeness of CRS. The aim of this study is to determine whether MRI can effectively reduce the need for surgical staging.METHODS: The study is designed as a multicenter randomized controlled trial (RCT) of colorectal cancer patients who are deemed eligible for CRS-HIPEC after conventional CT staging. Patients are randomly assigned to either MRI based staging (arm A) or to standard surgical staging with or without laparoscopy (arm B). In arm A, MRI assessment will determine whether patients are eligible for CRS-HIPEC. In borderline cases, an additional diagnostic laparoscopy is advised. The primary outcome is the number of unnecessary surgical procedures in both arms defined as: all surgeries in patients with definitely inoperable disease (PCI > 24) or explorative surgeries in patients with limited disease (PCI < 15). Secondary outcomes include correlations between surgical findings and MRI findings, cost-effectiveness, and quality of life (QOL) analysis.CONCLUSION: This randomized trial determines whether MRI can effectively replace surgical staging in patients with CRCPM considered for CRS-HIPEC.TRIAL REGISTRATION: Registered in the clinical trials registry of U.S. National Library of Medicine under NCT04231175 .",

author = "Engbersen, {M P} and Rijsemus, {C J V} and J Nederend and Aalbers, {A G J} and {de Hingh}, {I H J T} and V Retel and Lambregts, {D M J} and {Van der Hoeven}, {E J R J} and D Boerma and Wiezer, {M J} and {De Vries}, M and Madsen, {E V E} and Brandt-Kerkhof, {A R M} and {Van Koeverden}, S and {De Reuver}, {P R} and Beets-Tan, {R G H} and Kok, {N F M} and Lahaye, {M J}",

note = "Funding Information: Funding is provided by the Dutch organization for health research and healthcare innovation, ZonMw (The Hague, NL) (project number: 852002003). The funder{\textquoteright}s role is limited to grant application review and approval. Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2021",

month = apr,

day = "26",

doi = "10.1186/s12885-021-08168-x",

language = "English",

volume = "21",

journal = "BMC Cancer",

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Engbersen, MP, Rijsemus, CJV, Nederend, J, Aalbers, AGJ, de Hingh, IHJT, Retel, V, Lambregts, DMJ, Van der Hoeven, EJRJ, Boerma, D, Wiezer, MJ, De Vries, M, Madsen, EVE , Brandt-Kerkhof, ARM, Van Koeverden, S, De Reuver, PR, Beets-Tan, RGH, Kok, NFM & Lahaye, MJ 2021, 'Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomized multicenter trial', BMC Cancer, vol. 21, no. 1, 464. https://doi.org/10.1186/s12885-021-08168-x

TY - JOUR

T1 - Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomized multicenter trial

AU - Engbersen, M P

AU - Rijsemus, C J V

AU - Nederend, J

AU - Aalbers, A G J

AU - de Hingh, I H J T

AU - Retel, V

AU - Lambregts, D M J

AU - Van der Hoeven, E J R J

AU - Boerma, D

AU - Wiezer, M J

AU - De Vries, M

AU - Madsen, E V E

AU - Brandt-Kerkhof, A R M

AU - Van Koeverden, S

AU - De Reuver, P R

AU - Beets-Tan, R G H

AU - Kok, N F M

AU - Lahaye, M J

N1 - Funding Information: Funding is provided by the Dutch organization for health research and healthcare innovation, ZonMw (The Hague, NL) (project number: 852002003). The funder’s role is limited to grant application review and approval. Publisher Copyright: © 2021, The Author(s).

PY - 2021/4/26

Y1 - 2021/4/26

N2 - BACKGROUND: Selecting patients with peritoneal metastases from colorectal cancer (CRCPM) who might benefit from cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is challenging. Computed tomography generally underestimates the peritoneal tumor load. Diagnostic laparoscopy is often used to determine whether patients are amenable for surgery. Magnetic resonance imaging (MRI) has shown to be accurate in predicting completeness of CRS. The aim of this study is to determine whether MRI can effectively reduce the need for surgical staging.METHODS: The study is designed as a multicenter randomized controlled trial (RCT) of colorectal cancer patients who are deemed eligible for CRS-HIPEC after conventional CT staging. Patients are randomly assigned to either MRI based staging (arm A) or to standard surgical staging with or without laparoscopy (arm B). In arm A, MRI assessment will determine whether patients are eligible for CRS-HIPEC. In borderline cases, an additional diagnostic laparoscopy is advised. The primary outcome is the number of unnecessary surgical procedures in both arms defined as: all surgeries in patients with definitely inoperable disease (PCI > 24) or explorative surgeries in patients with limited disease (PCI < 15). Secondary outcomes include correlations between surgical findings and MRI findings, cost-effectiveness, and quality of life (QOL) analysis.CONCLUSION: This randomized trial determines whether MRI can effectively replace surgical staging in patients with CRCPM considered for CRS-HIPEC.TRIAL REGISTRATION: Registered in the clinical trials registry of U.S. National Library of Medicine under NCT04231175 .

AB - BACKGROUND: Selecting patients with peritoneal metastases from colorectal cancer (CRCPM) who might benefit from cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is challenging. Computed tomography generally underestimates the peritoneal tumor load. Diagnostic laparoscopy is often used to determine whether patients are amenable for surgery. Magnetic resonance imaging (MRI) has shown to be accurate in predicting completeness of CRS. The aim of this study is to determine whether MRI can effectively reduce the need for surgical staging.METHODS: The study is designed as a multicenter randomized controlled trial (RCT) of colorectal cancer patients who are deemed eligible for CRS-HIPEC after conventional CT staging. Patients are randomly assigned to either MRI based staging (arm A) or to standard surgical staging with or without laparoscopy (arm B). In arm A, MRI assessment will determine whether patients are eligible for CRS-HIPEC. In borderline cases, an additional diagnostic laparoscopy is advised. The primary outcome is the number of unnecessary surgical procedures in both arms defined as: all surgeries in patients with definitely inoperable disease (PCI > 24) or explorative surgeries in patients with limited disease (PCI < 15). Secondary outcomes include correlations between surgical findings and MRI findings, cost-effectiveness, and quality of life (QOL) analysis.CONCLUSION: This randomized trial determines whether MRI can effectively replace surgical staging in patients with CRCPM considered for CRS-HIPEC.TRIAL REGISTRATION: Registered in the clinical trials registry of U.S. National Library of Medicine under NCT04231175 .

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U2 - 10.1186/s12885-021-08168-x

DO - 10.1186/s12885-021-08168-x

M3 - Article

C2 - 33902498

SN - 1471-2407

VL - 21

JO - BMC Cancer

JF - BMC Cancer

IS - 1

M1 - 464

ER -

Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomized multicenter trial

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