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1
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Beets-Tan RGH, Bogveradze N. Gel for Rectal Cancer MRI: Counterpoint-The Drawbacks Outweigh the Advantages. AJR Am J Roentgenol 2025:1-2. [PMID: 39503554 DOI: 10.2214/ajr.24.31741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2025]
Affiliation(s)
- Regina G H Beets-Tan
- The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
- GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Nino Bogveradze
- The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
- GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Radiology, American Hospital Tbilisi, Tbilisi, Georgia
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2
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Hardacre C, Hibbs T, Fok M, Wiles R, Bashar N, Ahmed S, Mascarenhas Saraiva M, Zheng Y, Javed MA. Predicting Surgical Difficulty in Rectal Cancer Surgery: A Systematic Review of Artificial Intelligence Models Applied to Pre-Operative MRI. Cancers (Basel) 2025; 17:812. [PMID: 40075659 PMCID: PMC11899449 DOI: 10.3390/cancers17050812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Revised: 02/18/2025] [Accepted: 02/21/2025] [Indexed: 03/14/2025] Open
Abstract
Introduction: Following the rapid advances in minimally invasive surgery, there are a multitude of surgical modalities available for resecting rectal cancers. Robotic resections represent the current pinnacle of surgical approaches. Currently, decisions on the surgical modality depend on local resources and the expertise of the surgical team. Given limited access to robotic surgery, developing tools based on pre-operative data that can predict the difficulty of surgery would streamline the efficient utilisation of resources. This systematic review aims to appraise the existing literature on artificial intelligence (AI)-driven preoperative MRI analysis for surgical difficulty prediction to identify knowledge gaps and promising models warranting further clinical evaluation. Methods: A systematic review and narrative synthesis were undertaken in accordance with PRISMA and SWiM guidelines. Systematic searches were performed on Medline, Embase, and the CENTRAL Trials register. Studies published between 2012 and 2024 were included where AI was applied to preoperative MRI imaging of adult rectal cancer patients undergoing surgeries, of any approach, for the purpose of stratifying surgical difficulty. Data were extracted according to a pre-specified protocol to capture study characteristics and AI design; the objectives and performance outcome metrics were summarised. Results: Systematic database searches returned 568 articles, 40 ultimately included in this review. AI to support preoperative difficulty assessments were identified across eight domains (direct surgical difficulty grading, extramural vascular invasion (EMVI), lymph node metastasis (LNM), lymphovascular invasion (LVI), perineural invasion (PNI), T staging, and the requirement for multiple linear stapler firings. For each, at least one model was identified with very good performance (AUC scores of >0.80), with several showing excellent performance considerably above this threshold. Conclusions: AI tools applied to preoperative rectal MRI to support preoperative difficulty assessment for rectal cancer surgeries are emerging, with the progressing development and strong performance of many promising models. These warrant further clinical evaluation, which can aid personalised surgical approaches and ensure the adequate utilisation of limited resources.
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Affiliation(s)
- Conor Hardacre
- University Hospitals of Liverpool Group, Liverpool L7 8YE, UK (N.B.); (M.A.J.)
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZX, UK;
| | - Thomas Hibbs
- University Hospitals of Liverpool Group, Liverpool L7 8YE, UK (N.B.); (M.A.J.)
| | - Matthew Fok
- University Hospitals of Liverpool Group, Liverpool L7 8YE, UK (N.B.); (M.A.J.)
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZX, UK;
| | - Rebecca Wiles
- University Hospitals of Liverpool Group, Liverpool L7 8YE, UK (N.B.); (M.A.J.)
| | - Nada Bashar
- University Hospitals of Liverpool Group, Liverpool L7 8YE, UK (N.B.); (M.A.J.)
| | - Shakil Ahmed
- University Hospitals of Liverpool Group, Liverpool L7 8YE, UK (N.B.); (M.A.J.)
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZX, UK;
| | - Miguel Mascarenhas Saraiva
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, 4200-427 Porto, Portugal;
| | - Yalin Zheng
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZX, UK;
| | - Muhammad Ahsan Javed
- University Hospitals of Liverpool Group, Liverpool L7 8YE, UK (N.B.); (M.A.J.)
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZX, UK;
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 7TX, UK
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3
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Williams H, Lee C, Garcia-Aguilar J. Nonoperative management of rectal cancer. Front Oncol 2024; 14:1477510. [PMID: 39711959 PMCID: PMC11659252 DOI: 10.3389/fonc.2024.1477510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 11/21/2024] [Indexed: 12/24/2024] Open
Abstract
The management of locally advanced rectal cancer has changed drastically in the last few decades due to improved surgical techniques, development of multimodal treatment approaches and the introduction of a watch and wait (WW) strategy. For patients with a complete response to neoadjuvant treatment, WW offers an opportunity to avoid the morbidity associated with total mesorectal excision in favor of organ preservation. Despite growing interest in WW, prospective data on the safety and efficacy of nonoperative management are limited. Challenges remain in optimizing multimodal treatment regimens to maximize tumor regression and in improving the accuracy of patient selection for WW. This review summarizes the history of treatment for rectal cancer and the development of a WW strategy. It also provides an overview of clinical considerations for patients interested in nonoperative management, including restaging strategies, WW selection criteria, surveillance protocols and long-term oncologic outcomes.
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Affiliation(s)
| | | | - Julio Garcia-Aguilar
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer
Center, New York, NY, United States
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4
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Petkovska I, Alus O, Rodriguez L, El Homsi M, Golia Pernicka JS, Fernandes MC, Zheng J, Capanu M, Otazo R. Clinical evaluation of accelerated diffusion-weighted imaging of rectal cancer using a denoising neural network. Eur J Radiol 2024; 181:111802. [PMID: 39467396 PMCID: PMC11614684 DOI: 10.1016/j.ejrad.2024.111802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 10/10/2024] [Accepted: 10/22/2024] [Indexed: 10/30/2024]
Abstract
BACKGROUND To evaluate the effectiveness of a deep learning denoising approach to accelerate diffusion-weighted imaging (DWI) and thus improve diagnostic accuracy and image quality in restaging rectal MRI following total neoadjuvant therapy (TNT). METHODS This retrospective single-center study included patients with locally advanced rectal cancer who underwent restaging rectal MRI between December 30, 2021, and June 1, 2022, following TNT. A convolutional neural network trained with DWI data was employed to denoise accelerated DWI acquisitions (i.e., acquisitions performed with a reduced number of repetitions compared to standard acquisitions). Image characteristics and residual disease were independently assessed by two radiologists across original and denoised images. Statistical analyses included the Wilcoxon signed-rank test to compare image quality scores across denoised and original images, weighted kappa statistics for inter-reader agreement assessment, and the calculation of measures of diagnostic accuracy. RESULTS In 46 patients (median age, 60 years [IQR: 47-72]; 37 men and 9 women), 8- and 16-fold accelerated images maintained or exhibited enhanced lesion visibility and image quality compared with original images that were performed 16 repetitions. Denoised images maintained diagnostic accuracy, with conditional specificities of up to 96 %. Moderate-to-high inter-reader agreement indicated reliable image and diagnostic assessment. The overall test yield for denoised DWI reconstructions ranged from 76-98 %, demonstrating a reduction in equivocal interpretations. CONCLUSION Applying a denoising network to accelerate rectal DWI acquisitions can reduce scan times and enhance image quality while maintaining diagnostic accuracy, presenting a potential pathway for more efficient rectal cancer management.
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Affiliation(s)
- Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Or Alus
- Department of Medical Physics, Memorial Sloan Kettering Cancer Cencer, New York, NY, USA
| | - Lee Rodriguez
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ricardo Otazo
- Department of Medical Physics, Memorial Sloan Kettering Cancer Cencer, New York, NY, USA
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5
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Khasawneh H, Khatri G, Sheedy SP, Nougaret S, Lambregts DMJ, Santiago I, Kaur H, Smith JJ, Horvat N. MRI for Rectal Cancer: Updates and Controversies- AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024. [PMID: 39320354 DOI: 10.2214/ajr.24.31523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
Rectal MRI is a critical tool in the care of patients with rectal cancer, having established roles for primary staging, restaging, and surveillance. The comprehensive diagnostic and prognostic information provided by MRI helps to optimize treatment decision-making. However, challenges persist in the standardization and interpretation of rectal MRI, particularly in the context of rapidly evolving treatment paradigms, including growing acceptance of nonoperative management. In this AJR Expert Panel Narrative Review, we address recent advances and key areas of contention relating to the use of MRI for rectal cancer. Our objectives include: to discuss concepts regarding anatomic localization of rectal tumors; review the evolving rectal cancer treatment paradigm and implications for MRI assessment; discuss updates and controversies regarding rectal MRI for locoregional staging, restaging, and surveillance; review current rectal MRI acquisition protocols; and discuss challenges in homogenizing and optimizing acquisition parameters.
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Affiliation(s)
- Hala Khasawneh
- Department of Radiology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Shannon P Sheedy
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, Montpellier, France; Montpellier Research Cancer Institute, PINKcc Lab, U1194, Montpellier, France
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Inês Santiago
- Department of Radiology, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650 Lisbon, Portugal
| | - Harmeet Kaur
- Department of Diagnostic Radiology, MD Anderson Cancer Center, 1400 Pressler St, Unit 1473, Houston, TX 77030
| | - J Joshua Smith
- Department of Surgery, Associate Member, Associate Attending Surgeon Colorectal Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Natally Horvat
- Department of Radiology, University of Sao Paulo, R. Dr. Ovidio Pires de Campos, 75-Cerqueira Cesar, Sao Paulo, 05403-010, SP, Brazil
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Luengo Gómez D, Salmerón Ruiz Á, Medina Benítez A, Láinez Ramos-Bossini A. Papel de la resonancia magnética en la evaluación del cáncer de recto tras terapia neoadyuvante. RADIOLOGIA 2024. [DOI: 10.1016/j.rx.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2024]
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Williams H, Omer DM, Thompson HM, Lin ST, Verheij FS, Miranda J, Yuval JB, Buckley J, Marco MR, Qin LX, Dombroski DA, Kedar R, Oto A, Korngold E, Veniero JC, Gandhi S, Krishnaraj A, Jagtiani M, Ohanian K, Vu D, Hope TA, Lee S, Wasnik AP, Madhuripan N, Gollub MJ, Garcia-Aguilar J. MRI Predicts Residual Disease and Outcomes in Watch-and-Wait Patients with Rectal Cancer. Radiology 2024; 312:e232748. [PMID: 39225603 PMCID: PMC11427875 DOI: 10.1148/radiol.232748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Background MRI plays a crucial role in restaging locally advanced rectal cancer treated with total neoadjuvant therapy (TNT); however, prospective studies have not evaluated its ability to accurately select patients for nonoperative management. Purpose To evaluate the ability of restaging MRI to predict oncologic outcomes and identify imaging features associated with residual disease (RD) after TNT. Materials and Methods This was a secondary analysis of the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial, which randomized participants from April 2014 to March 2020 with stages II or III rectal adenocarcinoma to undergo either induction or consolidation TNT. Participants enrolled in the OPRA trial who underwent restaging MRI were eligible for inclusion in the present study. Radiologists classified participants as having clinical complete response (cCR), near-complete clinical response (nCR), or incomplete clinical response (iCR) based on restaging MRI at a mean of 8 weeks ± 4 (SD) after treatment. Oncologic outcomes according to MRI response category were assessed using Kaplan-Meier curves. Logistic regression analysis was performed to identify imaging characteristics associated with RD. Results A total of 277 participants (median age, 58 years [IQR, 17 years]; 179 male) who were randomized in the OPRA trial had restaging MRI forms completed. The median follow-up duration was 4.1 years. Participants with cCR had higher rates of organ preservation compared with those with nCR (65.3% vs 41.6%, log-rank P < .001). Five-year disease-free survival for participants with cCR, nCR, and iCR was 81.8%, 67.6%, and 49.6%, respectively (log-rank P < .001). The MRI response category also predicted overall survival (log-rank P < .001), distant recurrence-free survival (log-rank P = .005), and local regrowth (log-rank P = .02). Among the 266 participants with at least 2 years of follow-up, 129 (48.5%) had RD. At multivariable analysis, the presence of restricted diffusion (odds ratio, 2.50; 95% CI: 1.22, 5.24) and abnormal nodal morphologic features (odds ratio, 5.04; 95% CI: 1.43, 23.9) remained independently associated with RD. Conclusion The MRI response category was predictive of organ preservation and survival. Restricted diffusion and abnormal nodal morphologic features on restaging MRI scans were associated with increased likelihood of residual tumor. ClinicalTrials.gov identifier: NCT02008656 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Milot in this issue.
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Affiliation(s)
- Hannah Williams
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Dana M Omer
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Hannah M Thompson
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Sabrina T Lin
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Floris S Verheij
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Joao Miranda
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Jonathan B Yuval
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - James Buckley
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Michael R Marco
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Li-Xuan Qin
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - David A Dombroski
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Rajendra Kedar
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Aytekin Oto
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Elena Korngold
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Joseph C Veniero
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Sunil Gandhi
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Arun Krishnaraj
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Minal Jagtiani
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Kirk Ohanian
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Dan Vu
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Thomas A Hope
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Sonia Lee
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Ashish P Wasnik
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Nikhil Madhuripan
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Marc J Gollub
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
| | - Julio Garcia-Aguilar
- From the Departments of Surgery, Colorectal Service (H.W., D.M.O., H.M.T., F.S.V., J.B.Y., J.B., M.R.M., J.G.A.), Epidemiology and Biostatistics (S.T.L., L.X.Q.), and Radiology (J.M., M.J.G.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Rochester Medical Center, Rochester, NY (D.A.D.); Department of Radiology, University of South Florida, Tampa, Fla (R.K.); Department of Radiology, University of Chicago, Chicago, Ill (A.O.); Department of Radiology, Oregon Health and Science University, Portland, Ore (E.K.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (J.C.V.); Department of Radiology, John Muir Health, Walnut Creek, Calif (S.G.); Department of Radiology, University of Virginia, Charlottesville, Va (A.K.); Department of Radiology, University of Washington, Seattle, Wash (M.J.); Department of Radiology, St Joseph Hospital Orange County, Orange, Calif (K.O., D.V.); Department of Radiology, University of California San Francisco, San Francisco, Calif (T.A.H.); Department of Radiology, University of California Irvine, Irvine, Calif (S.L.); Department of Radiology, University of Michigan, Ann Arbor, Mich (A.P.W.); and Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (N.M.)
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Gaetani RS, Ladin K, Abelson JS. Journey through the Decades: The Evolution in Treatment and Shared Decision Making for Locally Advanced Rectal Cancer. Cancers (Basel) 2024; 16:2807. [PMID: 39199579 PMCID: PMC11353159 DOI: 10.3390/cancers16162807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/03/2024] [Accepted: 08/06/2024] [Indexed: 09/01/2024] Open
Abstract
The management of locally advanced rectal cancer has undergone significant transformations over the decades and optimal treatment approaches continue to evolve. There have been numerous advances in surgery, chemotherapy, and radiation therapy from the first description of the abdominoperineal resection in 1908, timing of chemotherapy and radiation therapy in the late 20th and early 21st century, and most recently, the introduction of organ preservation or nonoperative management in 2004. Alongside these advancements, the concept of shared decision making in medicine has evolved, prompting a focus on patient-centered care. This evolution in practice has been fueled by a growing recognition of the importance of patient autonomy and the alignment of treatment options with patients' values and preferences. With the growing number of possible treatment options, variability in patient counseling exists, highlighting the need for a standardized approach to shared decision making in locally advanced rectal cancer. This narrative review will describe the evolution of treatment options of locally advanced rectal cancer as well as the concept of shared decision making and decision aids, and will introduce a decision aid for patients with locally advanced rectal cancer who have achieved a complete clinical response and are eligible for watch and wait.
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Affiliation(s)
- Racquel S. Gaetani
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA;
| | - Keren Ladin
- Department of Community Health, Tufts University, Medford, MA 02155, USA
| | - Jonathan S. Abelson
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA;
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González Del Portillo E, Couñago F, López-Campos F. Neoadjuvant treatment of rectal cancer: Where we are and where we are going. World J Clin Oncol 2024; 15:790-795. [PMID: 39071468 PMCID: PMC11271721 DOI: 10.5306/wjco.v15.i7.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/28/2024] [Accepted: 05/17/2024] [Indexed: 07/16/2024] Open
Abstract
Locally advanced rectal cancer requires a multidisciplinary approach based on total neoadjuvant treatment with radiotherapy (RT) and chemotherapy (ChT), followed by deferred surgery. Currently, alternatives to the standard total neoadjuvant therapy (TNT) are being explored, such as new ChT regimens or the introduction of immunotherapy. With standard TNT, up to a third of patients may achieve a complete pathological response (CPR), potentially avoiding surgery. However, as of now, we lack predictive markers of response that would allow us to define criteria for a conservative organ strategy. The presence of mutations, genes, or new imaging tests is helping to define these criteria. An example of this is the diffusion coefficient in the diffusion-weighted sequence of magnetic resonance imaging and the integration of this imaging technique into RT treatment. This allows for the monitoring of the evolution of this coefficient over successive RT sessions, helping to determine which patients will achieve CPR or those who may require intensification of neoadjuvant therapy.
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Affiliation(s)
| | - Felipe Couñago
- Department of Radiation Oncology, GenesisCare Madrid, Madrid 28010, Spain
| | - Fernando López-Campos
- Department of Radiation Oncology, Hospital Universitario Ramón Y Cajal, Madrid 28034, Spain
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Barbaro B, Carafa MRPI, Minordi LM, Testa P, Tatulli G, Carano D, Fiorillo C, Chiloiro G, Romano A, Valentini V, Gambacorta MA. Magnetic resonance imaging for assessment of rectal cancer nodes after chemoradiotherapy: A single center experience. Radiother Oncol 2024; 193:110124. [PMID: 38309586 DOI: 10.1016/j.radonc.2024.110124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/14/2024] [Accepted: 01/30/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Accurate nodal restaging is becoming clinically more important in patients with locally advanced rectal cancer (LARC) with the emergence of organ-preserving treatment after a good response to neoadjuvant chemoradiotherapy (nCRT). PURPOSE To evaluate the accuracy of MRI in identifying negative N status (ypN0 patients) in LARC after nCRT. MATERIAL AND METHODS 191 patients with LARC underwent MRI before and 6-8 weeks after nCRT and subsequent total mesorectal excision. Short-axis diameter of mesorectal lymph nodes was evaluated on the high resolution T2-weighted images to compare MRI restaging with histopathology.. RESULTS 146 and 45 patients had a negative N status (ypN0) and positive N status (ypN + ), respectively. On restaging MRI, the 70 % reduction in size of the largest node was associated with an area under the curve (AUC) of 0.818 to predict ypN0 stage, with a sensitivity of 93.3 % and a negative predictive value (NPV) of 95.4 %. No nodes were observed in 38 pts (37 pts ypN0 and 1 patient ypN + ), with sensitivity and NPV of nodes disappearance for ypN0 stage of 93.3 % and 92.5 % respectively. A 2.2 mm cut-off in short-axis diameter was associated with an AUC of 0.83 for the prediction of ypN0 nodal stage, with sensitivity and NPV of 79,5% and 91.1 % respectively. CONCLUSION A reduction in size of 70 % of the largest limph-node on MRI at rectal cancer restaging has high sensitivity and NPV for prediction of ypN0 stage after nCRT. The high NPV of node disappearance and of a ≤ 2.2 mm short-axis diameter is confirmed.
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Affiliation(s)
- Brunella Barbaro
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maria Rachele PIa Carafa
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Maria Minordi
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Priscilla Testa
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Tatulli
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Davide Carano
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giuditta Chiloiro
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Angela Romano
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maria Antonietta Gambacorta
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology. Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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11
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Zhong X, Zeng G, Zhang L, You S, Fu Y, He W, Liao G. Prediction of pathologic complete response to neoadjuvant chemoradiation in locally advanced rectal cancer. Front Oncol 2024; 14:1361300. [PMID: 38529385 PMCID: PMC10961458 DOI: 10.3389/fonc.2024.1361300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/19/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose To investigate the predictive factors of pathologic complete response (pCR) in locally advanced rectal cancer (LARC) patients who had been treated with neoadjuvant chemoradiation (nCRT). Methods and materials For this retrospective study, 53 LARC patients (37 males and 16 females; age range 25 to 79 years) were selected. Clinical characteristics, baseline mrTNM staging, MR gross tumor volumes (GTV), and pCR were evaluated. The diagnostic accuracy of GTV for predicting pCR was calculated. Results Among 53 LARC patients, 15 patients achieved pCR (28.3%), while 38 patients achieved non-pCR. Only three (5.7%) out of 53 patients did not downstage after nCRT. GTV and tumor differentiation were the significant prognostic parameters for predicting pCR. A tumor volume threshold of 21.1 cm3 was determined as a predictor for pCR, with a sensitivity of 84% and specificity of 47%. In addition, GTV was associated with mrN stage, circumferential resection margin (CRM) status, extramural vascular invasion (EMVI) status, and pretreatment serum CEA level. Conclusion Tumor volume and tumor differentiation have significant predictive values in preoperative assessment of pCR among LARC patients. These findings aid clinicians to discriminate those patients who may likely benefit from preoperative regimens and to make optimal treatment plans.
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Affiliation(s)
- Xiaoling Zhong
- Department of Radiology, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, the First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Guohua Zeng
- Department of Radiology, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, the First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Lixiang Zhang
- Department of Radiology, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, the First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Shuyuan You
- Department of Pathology, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, the First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Yuxiang Fu
- Department of Gastrointestinal surgery, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, the First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Wan He
- Department of Oncology, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, the First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Guixiang Liao
- Department of Radiation Oncology, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University, the First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
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12
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Patra A, Lakhani A, Augustine A, Mohapatra P, Eapen A, Singh A, Masih D, Ram TS, Jesudason MR, Mittal R, Chandramohan A. Predicting Positive Radial Margin on Restaging MRI of Patients with Low Rectal Cancer: Can We Do Better? Indian J Radiol Imaging 2024; 34:85-94. [PMID: 38106864 PMCID: PMC10723970 DOI: 10.1055/s-0043-1774300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Objective The aim of this study was to characterize the tissue involving the margin and study if this information will affect margin prediction on restaging magnetic resonance imaging (MRI) in low rectal adenocarcinoma (LRC) patients treated with neoadjuvant long-course chemoradiotherapy (LCCRT). Methods In this retrospective study of nonmetastatic LRC (distal margin <5 cm from the anal verge) treated with LCCRT followed by surgery, a radiologist blinded to outcome reread the restaging MRI and documented if the radial margin was involved by tumor, fibrosis, or mucin reaction using T2 high-resolution (HR) and diffusion-weighted imaging (DWI). The diagnostic performance of tumor-involving margin on restaging MRI was assessed using surgical histopathology as a reference. Interobserver agreement between three independent radiologists was assessed in a subset. Results We included 133 patients (80 males and 53 females) with a mean (range) age of 44.7 (21-86) years and 82% of them had well or moderately differentiated adenocarcinoma. Baseline MRI showed T3 ( n = 58) or T4 ( n = 60) disease in 89% of the patients. The pathological margin was positive in 21% ( n = 28) cases. In restaging MRI, the circumferential resection margin (CRM) ≤1 mm in 75.1% ( n = 100) cases and MRI predicted tumor, fibrosis, and mucin reaction at the margin in 60, 34, and 6%, respectively, and histopathology showed tumor cells in 33, 14.7, and 16.6% of them, respectively. LRC with tumor-involving margin and bad response (MR tumor regression grade [mr-TRG] 3-5) on restaging MRI had fourfold increased risk of positive pathological circumferential resection margin (pCRM). There was moderate and fair inter-reader agreement for the tissue type involving the CRM ( κ = 0.471) and mr-TRG ( κ = 0.266), p < 0.05. The use of both distance criteria and tumor-involving margins improved the diagnostic accuracy for margin prediction from 39 to 66% on restaging MRI. Conclusions Margin prediction on restaging MRI can be improved by characterizing the tissue type involving the margin in low rectal cancer patients. The inter-reader agreement was moderate for determining the tissue type.
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Affiliation(s)
- Anurima Patra
- Department of Radiology, Christian Medical College, Vellore, India
| | - Aisha Lakhani
- Department of Radiology, Christian Medical College, Vellore, India
| | - Antony Augustine
- Department of Radiology, Christian Medical College, Vellore, India
| | | | - Anu Eapen
- Department of Radiology, Christian Medical College, Vellore, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | - Dipti Masih
- Department of Pathology, Christian Medical College, Vellore, India
| | - Thomas S. Ram
- Department of Radiation Oncology, Christian Medical College, Vellore, India
| | - Mark R. Jesudason
- Department of Colorectal Surgery, Christian Medical College, Vellore, India
| | - Rohin Mittal
- Department of Colorectal Surgery, Christian Medical College, Vellore, India
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Horvat N, Miranda J, Kinochita F, de Carvalho TL, Torri GB, Lopes TJP, Nomura CH. Restaging magnetic resonance imaging of the rectum after neoadjuvant therapy: a practical guide. Radiol Bras 2024; 57:e20240004. [PMID: 39050261 PMCID: PMC11268099 DOI: 10.1590/0100-3984.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/26/2024] [Accepted: 04/18/2024] [Indexed: 07/27/2024] Open
Abstract
Colorectal cancer is the third most common cancer and the second leading cause of cancer-related death. Rectal cancer accounts for approximately one-third of new colorectal cancer cases, with adenocarcinoma as the predominant subtype. Despite an overall decline in colorectal cancer incidence and mortality, due to advancements in screening, early diagnosis, and treatment options, there is a concerning increase in incidence rates among young patients. Recent significant advances in managing locally advanced rectal cancer, such as the establishment of different surgical approaches, neoadjuvant treatment using different protocols for high-risk cases, and the adoption of organ-preservation strategies, have increased the importance of the role played by radiologists in locoregional assessment on magnetic resonance imaging at baseline, at restaging, and during active surveillance of patients with rectal cancer. In this article, we review the role of restaging rectal magnetic resonance imaging after neoadjuvant therapy, providing radiologists with a practical, step-by-step guide for assessing treatment response.
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Affiliation(s)
- Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY, USA
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
São Paulo, SP, Brazil
| | - João Miranda
- Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY, USA
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
São Paulo, SP, Brazil
| | - Fernanda Kinochita
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
São Paulo, SP, Brazil
| | - Tiago Lins de Carvalho
- Department of Radiology, Brigham and Women’s Hospital, Harvard
Medical School, Boston, MA, USA
| | - Giovanni Brondani Torri
- Department of Radiology and Diagnostic Imaging, Universidade
Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | | | - Cesar Higa Nomura
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
São Paulo, SP, Brazil
- Department of Radiology, Hospital Sírio-Libanês,
São Paulo, SP, Brazil
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14
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Miranda J, Causa Andrieu P, Nincevic J, Gomes de Farias LDP, Khasawneh H, Arita Y, Stanietzky N, Fernandes MC, De Castria TB, Horvat N. Advances in MRI-Based Assessment of Rectal Cancer Post-Neoadjuvant Therapy: A Comprehensive Review. J Clin Med 2023; 13:172. [PMID: 38202179 PMCID: PMC10780006 DOI: 10.3390/jcm13010172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Rectal cancer presents significant diagnostic and therapeutic challenges, with neoadjuvant therapy playing a pivotal role in improving resectability and patient outcomes. MRI serves as a critical tool in assessing treatment response. However, differentiating viable tumor tissue from therapy-induced changes on MRI remains a complex task. In this comprehensive review, we explore treatment options for rectal cancer based on resectability status, focusing on the role of MRI in guiding therapeutic decisions. We delve into the nuances of MRI-based evaluation of treatment response following neoadjuvant therapy, paying particular attention to emerging techniques like radiomics. Drawing from our insights based on the literature, we provide essential recommendations for post-neoadjuvant therapy management of rectal cancer, all within the context of MRI-based findings.
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Affiliation(s)
- Joao Miranda
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
- Department of Radiology, University of Sao Paulo, R. Dr. Ovidio Pires de Campos, 75 Cerqueira Cesar, Sao Paulo 05403-010, Brazil
| | - Pamela Causa Andrieu
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;
| | - Josip Nincevic
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
| | - Lucas de Padua Gomes de Farias
- Department of Radiology, Hospital Sirio-Libanes, Rua Dona Adma Jafet, 91—Bela Vista, Sao Paulo 01308-050, Brazil;
- Department of Radiology, Allianca Saude, Av. Pres. Juscelino Kubitschek, 1830, Sao Paulo 01308-050, Brazil
| | - Hala Khasawneh
- Department of Radiology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390, USA;
| | - Yuki Arita
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Nir Stanietzky
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Maria Clara Fernandes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
| | - Tiago Biachi De Castria
- Department of Gastrointestinal Oncology, Moffit Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
- Morsani College of Medicine, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (J.N.); (Y.A.); (M.C.F.)
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15
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Amintas S, Giraud N, Fernandez B, Dupin C, Denost Q, Garant A, Frulio N, Smith D, Rullier A, Rullier E, Vuong T, Dabernat S, Vendrely V. The Crying Need for a Better Response Assessment in Rectal Cancer. Curr Treat Options Oncol 2023; 24:1507-1523. [PMID: 37702885 PMCID: PMC10643426 DOI: 10.1007/s11864-023-01125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 09/14/2023]
Abstract
OPINION STATEMENT Since total neoadjuvant treatment achieves almost 30% pathologic complete response, organ preservation has been increasingly debated for good responders after neoadjuvant treatment for patients diagnosed with rectal cancer. Two organ preservation strategies are available: a watch and wait strategy and a local excision strategy including patients with a near clinical complete response. A major issue is the selection of patients according to the initial tumor staging or the response assessment. Despite modern imaging improvement, identifying complete response remains challenging. A better selection could be possible by radiomics analyses, exploiting numerous image features to feed data characterization algorithms. The subsequent step is to include baseline and/or pre-therapeutic MRI, PET-CT, and CT radiomics added to the patients' clinicopathological data, inside machine learning (ML) prediction models, with predictive or prognostic purposes. These models could be further improved by the addition of new biomarkers such as circulating tumor biomarkers, molecular profiling, or pathological immune biomarkers.
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Affiliation(s)
- Samuel Amintas
- Tumor Biology and Tumor Bank Laboratory, CHU Bordeaux, F-33600, Pessac, France.
- BRIC (BoRdeaux Institute of onCology), UMR1312, INSERM, University of Bordeaux, F-33000, Bordeaux, France.
| | - Nicolas Giraud
- Department of Radiation Oncology, CHU Bordeaux, F-33000, Bordeaux, France
| | | | - Charles Dupin
- BRIC (BoRdeaux Institute of onCology), UMR1312, INSERM, University of Bordeaux, F-33000, Bordeaux, France
- Department of Radiation Oncology, CHU Bordeaux, F-33000, Bordeaux, France
| | - Quentin Denost
- Bordeaux Colorectal Institute, F-33000, Bordeaux, France
| | - Aurelie Garant
- UT Southwestern Department of Radiation Oncology, Dallas, USA
| | - Nora Frulio
- Radiology Department, CHU Bordeaux, F-33600, Pessac, France
| | - Denis Smith
- Department of Digestive Oncology, CHU Bordeaux, F-33600, Pessac, France
| | - Anne Rullier
- Histology Department, CHU Bordeaux, F-33000, Bordeaux, France
| | - Eric Rullier
- BRIC (BoRdeaux Institute of onCology), UMR1312, INSERM, University of Bordeaux, F-33000, Bordeaux, France
- Surgery Department, CHU Bordeaux, F-33600, Pessac, France
| | - Te Vuong
- Department of Radiation Oncology, McGill University, Jewish General Hospital, Montreal, Canada
| | - Sandrine Dabernat
- BRIC (BoRdeaux Institute of onCology), UMR1312, INSERM, University of Bordeaux, F-33000, Bordeaux, France
- Biochemistry Department, CHU Bordeaux, F-33000, Bordeaux, France
| | - Véronique Vendrely
- BRIC (BoRdeaux Institute of onCology), UMR1312, INSERM, University of Bordeaux, F-33000, Bordeaux, France
- Department of Radiation Oncology, CHU Bordeaux, F-33000, Bordeaux, France
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16
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Karbhari A, Baheti AD, Ankathi SK, Haria PD, Choudhari A, Katdare A, Guha A, Kulkarni S, Saklani A, Engineer R, Kazi M, Ostwal V. MRI in rectal cancer patients on 'watch and wait': patterns of response and their evolution. Abdom Radiol (NY) 2023; 48:3287-3296. [PMID: 37450019 DOI: 10.1007/s00261-023-04003-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Evaluate MR patterns of response and their evolution in rectal cancer patients on watch and wait (WW). METHODS We retrospectively reviewed 337 MRIs of 60 patients (median follow-up: 12 months; range: 6-49 months). Baseline MRIs (available in 34/60 patients) were evaluated for tumor morphology, location, thickness, circumferential involvement, nodal status and EMVI. First post-treatment MRIs (in all patients) were additionally evaluated for pattern of response on T2 and DWI. Change in post-treatment scar thickness and scar depth angle between the first and second post-treatment scans was also evaluated. Evolution of the response pattern/recurrence were evaluated till the last available scan. RESULTS On the baseline scans, 20/34 (59%) patients had polypoidal tumor with 12/20 having ≤ 25% circumferential wall involvement. We saw five patterns of response-normalized rectal wall (2/60-3%), minimal fibrosis (23/60-38%), full thickness fibrosis (16/60-27%), irregular fibrosis (11/60-18%) and split scar (6/60-10%), with 2/60 (3%) showing possible residual disease. On the first post-treatment scans, 12/60 (20%) had restricted diffusion, with 3/12 having persistent restriction till last follow-up. Post-treatment fibrosis/split scar remained stable in 44/60 (73%) cases and improved further in the rest. 9/60 (15%) patients developed regrowth/recurrence. Patients with recurrence had < 10 mm scar thickness and < 21° change in scar angle between the first and second post-treatment MRIs. CONCLUSION Most patients on WW protocol developed minimal or full thickness fibrosis, majority of which remained stable on follow-up.
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Affiliation(s)
- Aashna Karbhari
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India
| | - Akshay D Baheti
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India.
| | - Suman K Ankathi
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India
| | - Purvi D Haria
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India
| | - Amit Choudhari
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India
| | - Aparna Katdare
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India
| | - Amrita Guha
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India
| | - Suyash Kulkarni
- Department of Radiology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India
| | - Avnish Saklani
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India
| | - Mufaddal Kazi
- Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India
| | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India
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17
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Yuval JB, Patil S, Gangai N, Omer DM, Akselrod DG, Fung A, Harmath CB, Kampalath R, Krehbiel K, Lee S, Liu PS, Millet JD, O'Malley RB, Purysko AS, Veniero JC, Wasnik AP, Garcia-Aguilar J, Gollub MJ. MRI assessment of rectal cancer response to neoadjuvant therapy: a multireader study. Eur Radiol 2023; 33:5761-5768. [PMID: 36814032 PMCID: PMC10394731 DOI: 10.1007/s00330-023-09480-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 12/05/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES A watch and wait strategy with the goal of organ preservation is an emerging treatment paradigm for rectal cancer following neoadjuvant treatment. However, the selection of appropriate patients remains a challenge. Most previous efforts to measure the accuracy of MRI in assessing rectal cancer response used a small number of radiologists and did not report variability among them. METHODS Twelve radiologists from 8 institutions assessed baseline and restaging MRI scans of 39 patients. The participating radiologists were asked to assess MRI features and to categorize the overall response as complete or incomplete. The reference standard was pathological complete response or a sustained clinical response for > 2 years. RESULTS We measured the accuracy and described the interobserver variability of interpretation of rectal cancer response between radiologists at different medical centers. Overall accuracy was 64%, with a sensitivity of 65% for detecting complete response and specificity of 63% for detecting residual tumor. Interpretation of the overall response was more accurate than the interpretation of any individual feature. Variability of interpretation was dependent on the patient and imaging feature investigated. In general, variability and accuracy were inversely correlated. CONCLUSIONS MRI-based evaluation of response at restaging is insufficiently accurate and has substantial variability of interpretation. Although some patients' response to neoadjuvant treatment on MRI may be easily recognizable, as seen by high accuracy and low variability, that is not the case for most patients. KEY POINTS • The overall accuracy of MRI-based response assessment is low and radiologists differed in their interpretation of key imaging features. • Some patients' scans were interpreted with high accuracy and low variability, suggesting that these patients' pattern of response is easier to interpret. • The most accurate assessments were those of the overall response, which took into consideration both T2W and DWI sequences and the assessment of both the primary tumor and the lymph nodes.
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Affiliation(s)
- Jonathan B Yuval
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sujata Patil
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Dana M Omer
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
| | | | - Alice Fung
- Department of Radiology, Oregon Health & Sciences University, Portland, USA
| | - Carla B Harmath
- Department of Radiology, University of Chicago, Chicago, USA
| | - Rony Kampalath
- Department of Radiology, University of California Irvine, Irvine, USA
| | - Kyle Krehbiel
- Department of Radiology, Creighton University Medical Center - Bergan Mercy, Omaha, USA
| | - Sonia Lee
- Department of Radiology, University of California Irvine, Irvine, USA
| | - Peter S Liu
- Department of Radiology, Cleveland Clinic, Cleveland, USA
| | - John D Millet
- Department of Radiology, University of Michigan, Ann Arbor, USA
| | - Ryan B O'Malley
- Department of Radiology, University of Washington, Seattle, USA
| | | | | | - Ashish P Wasnik
- Department of Radiology, University of Michigan, Ann Arbor, USA
| | - Julio Garcia-Aguilar
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, NY, USA.
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Nougaret S, Rousset P, Lambregts DMJ, Maas M, Gormly K, Lucidarme O, Brunelle S, Milot L, Arrivé L, Salut C, Pilleul F, Hordonneau C, Baudin G, Soyer P, Brun V, Laurent V, Savoye-Collet C, Petkovska I, Gerard JP, Cotte E, Rouanet P, Catalano O, Denost Q, Tan RB, Frulio N, Hoeffel C. MRI restaging of rectal cancer: The RAC (Response-Anal canal-CRM) analysis joint consensus guidelines of the GRERCAR and GRECCAR groups. Diagn Interv Imaging 2023; 104:311-322. [PMID: 36949002 DOI: 10.1016/j.diii.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/09/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To develop guidelines by international experts to standardize data acquisition, image interpretation, and reporting in rectal cancer restaging with magnetic resonance imaging (MRI). MATERIALS AND METHODS Evidence-based data and experts' opinions were combined using the RAND-UCLA Appropriateness Method to attain consensus guidelines. Experts provided recommendations for reporting template and protocol for data acquisition were collected; responses were analysed and classified as "RECOMMENDED" versus "NOT RECOMMENDED" (if ≥ 80% consensus among experts) or uncertain (if < 80% consensus among experts). RESULTS Consensus regarding patient preparation, MRI sequences, staging and reporting was attained using the RAND-UCLA Appropriateness Method. A consensus was reached for each reporting template item among the experts. Tailored MRI protocol and standardized report were proposed. CONCLUSION These consensus recommendations should be used as a guide for rectal cancer restaging with MRI.
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Affiliation(s)
- Stephanie Nougaret
- Department of Radiology IRCM, Montpellier Cancer Research Institute, 34000 Montpellier, France; INSERM, U1194, University of Montpellier, 34295, Montpellier, France.
| | - Pascal Rousset
- Department of Radiology, CHU Lyon-Sud, EMR 3738 CICLY, Université Claude-Bernard Lyon 1, 69495 Pierre-Benite, France
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Kirsten Gormly
- Jones Radiology, Kurralta Park, 5037, Australia; University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - Oliver Lucidarme
- Department of Radiology, Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, Sorbonne Université, 75013 Paris, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Laurent Milot
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Lionel Arrivé
- Department of Radiology, Hôpital Saint-Antoine, AP-HP, 75012 Paris, France; Sorbonne Université, 75013 Paris, France
| | - Celine Salut
- CHU de Bordeaux, Department of Radiology, Université de Bordeaux, 33000 Bordeaux, France
| | - Franck Pilleul
- Department of Radiology, Centre Léon Bérard, Lyon, France Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621, Lyon, France
| | | | - Guillaume Baudin
- Department of Radiology, Centre Antoine Lacassagne, 06100 Nice, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Vanessa Brun
- Department of Radiology, CHU Hôpital Pontchaillou, 35000 Rennes, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jean-Pierre Gerard
- Department of Radiotherapy, Centre Antoine Lacassagne, 06000 Nice, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hospices Civils de Lyon, Lyon Sud University Hospital, 69310 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Philippe Rouanet
- Department of Surgery, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France
| | - Onofrio Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Quentin Denost
- Department of Digestive Surgery, Hôpital Haut-Lévèque, Université de Bordeaux, 33000 Bordeaux, France
| | - Regina Beets Tan
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Nora Frulio
- CHU de Bordeaux, Department of Radiology, Université de Bordeaux, 33000 Bordeaux, France
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré & CRESTIC, URCA, 51092 Reims, France
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Deidda S, Spolverato G, Capelli G, Bao RQ, Bettoni L, Crimì F, Zorcolo L, Pucciarelli S, Restivo A. Limits of Clinical Restaging in Detecting Responders After Neoadjuvant Therapies for Rectal Cancer. Dis Colon Rectum 2023; 66:957-964. [PMID: 36538694 PMCID: PMC11584182 DOI: 10.1097/dcr.0000000000002450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Accurate clinical restaging is required to select patients who respond to neoadjuvant chemoradiotherapy for locally advanced rectal cancer and who may benefit from an organ preservation strategy. OBJECTIVE The purpose of this study was to review our experience with the clinical restaging of rectal cancer after neoadjuvant therapy to assess its accuracy in detecting major and pathological complete response to treatment. DESIGN This was a retrospective cohort study. SETTING This study was conducted at 2 high-volume Italian centers for Colorectal Surgery. PATIENTS Data were included from all consecutive patients who underwent neoadjuvant therapy and surgery for locally advanced rectal cancer from January 2012 to July 2020. Criteria to define clinical response were no palpable mass, a superficial ulcer <2 cm (major response), or no mucosal abnormality (complete response) at endoscopy and no metastatic nodes at MRI. MAIN OUTCOME MEASURES The main outcome measures were sensitivity, specificity, positive predictive values, and negative predictive values of clinical restaging in detecting pathological complete response (ypT0) or major pathological response (ypT0-1) after neoadjuvant therapy. RESULTS A total of 333 patients were included; 81 (24.3%) had a complete response whereas 115 (34.5%) had a pathological major response. Accuracy for clinical complete response was 80.8% and for major clinical response was 72.9%. Sensitivity was low for both clinical complete response (37.5%) in detecting ypT0 and clinical major response (59.3%) in detecting ypT0-1. Positive predictive value was 68.2% for ypT0 and 60.4% for ypT0-1. LIMITATIONS The main limitation of the study its retrospective nature. CONCLUSION Accuracy of actual clinical criteria to define pathological complete response or pathological major response is poor. Failure to achieve good sensitivity and precision is a major limiting factor in the clinical setting. Current clinical assessments need to be revised to account for indications for rectal preservation after neoadjuvant chemoradiotherapy. See Video Abstract at http://links.lww.com/DCR/C63 . LMITES DE LA REESTADIFICACIN CLNICA EN LA DETECCIN DE RESPONDEDORES DESPUS DE TERAPIAS NEOADYUVANTES PARA EL CNCER DE RECTO ANTECEDENTES:Se requiere una nueva reestadificación clínica precisa para seleccionar pacientes que respondan a la quimiorradioterapia neoadyuvante para el cáncer de recto localmente avanzado y que puedan beneficiarse de una estrategia de preservación de órganos.OBJETIVO:El propósito de este estudio fue revisar nuestra experiencia con la reestadificación clínica del cáncer de recto después de la terapia neoadyuvante para evaluar su precisión en la detección de una respuesta patológica importante y completa al tratamiento.DISEÑO:Estudio de cohorte retrospectivo.AJUSTE:Este estudio se realizó en dos centros italianos de alto volumen para cirugía colorrectal.PACIENTES:Incluimos datos de todos los pacientes consecutivos que se sometieron a terapia neoadyuvante y cirugía por cáncer de recto localmente avanzado desde enero de 2012 hasta julio de 2020. Los criterios para definir la respuesta clínica fueron ausencia de masa palpable, úlcera superficial <2 cm (respuesta mayor) o ausencia de anomalías en la mucosa. (respuesta completa) en la endoscopia, y sin ganglios metastásicos en la resonancia magnética.PRINCIPALES MEDIDAS DE RESULTADO:Exploramos la sensibilidad, la especificidad, los valores predictivos positivos y negativos de la reestadificación clínica para detectar una respuesta patológica completa (ypT0) o mayor (ypT0-1) después de la terapia neoadyuvante.RESULTADOS:Se incluyeron 333 pacientes; 81 (24,3%) tuvieron una respuesta completa mientras que 115 (34,5%) tuvieron una respuesta patológica mayor. La precisión de la respuesta clínica completa y la respuesta clínica importante fue del 80,8 % y el 72,9 %, respectivamente. La sensibilidad fue baja tanto para la respuesta clínica completa (37,5 %) en la detección de ypT0 como para la respuesta clínica mayor (59,3 %) en la detección de ypT0-1. El valor predictivo positivo fue del 68,2 % para ypT0 y del 60,4 % para ypT0-1.LIMITACIONES:Nuestro estudio tiene como principal limitación su carácter retrospectivo.CONCLUSIÓNES:La precisión de los criterios clínicos reales para definir una respuesta patológica completa o mayor es pobre. El hecho de no lograr una buena sensibilidad y precisión es un factor limitante importante en el entorno clínico. La indicación para la preservación rectal después de la quimiorradioterapia neoadyuvante necesita una mejora de la evaluación clínica actual. Consulte Video Resumen en http://links.lww.com/DCR/C63 . (Traducción-Dr. Mauricio Santamaria ).
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Affiliation(s)
- Simona Deidda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Gaya Spolverato
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy
| | - Giulia Capelli
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy
| | - Riccardo Quoc Bao
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy
| | - Lorenzo Bettoni
- Department of Medicine (DIMED), Institute of Radiology, University of Padova, Padua, Italy
| | - Filippo Crimì
- Department of Medicine (DIMED), Institute of Radiology, University of Padova, Padua, Italy
| | - Luigi Zorcolo
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Salvatore Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy
| | - Angelo Restivo
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
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Habr-Gama A, São Julião GP, Ortega CD, Vailati BB, Araujo S, Jorge T, Sabbaga J, Rossi GL, D'Alpino R, Kater FR, Aguilar PB, Mattacheo A, Perez RO. A multi-centre randomized controlled trial investigating Consolidation Chemotherapy with and without oxaliplatin in distal rectal cancer and Watch & Wait. BMC Cancer 2023; 23:546. [PMID: 37316784 DOI: 10.1186/s12885-023-10984-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 05/19/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Neoadjuvant chemoradiation(nCRT) has been considered the preferred initial treatment strategy for distal rectal cancer. Advantages of this approach include improved local control after radical surgery but also the opportunity for organ preserving strategies (Watch and Wait-WW). Consolidation chemotherapy(cCT) regimens using fluoropyrimidine-based with or without oxalipatin following nCRT have demonstrated to increase complete response and organ preservation rates among these patients. However, the benefit of adding oxaliplatin to cCT compared to fluoropirimidine alone regimens in terms of primary tumor response remains unclear. Since oxalipatin-treatment may be associated with considerable toxicity, it becomes imperative to understand the benefit of its incorporation into standard cCT regimens in terms of primary tumor response. The aim of the present trial is to compare the outcomes of 2 different cCT regimens following nCRT (fluoropyrimidine-alone versus fluoropyrimidine + oxaliplatin) for patients with distal rectal cancer. METHODS In this multi-centre study, patients with magnetic resonance-defined distal rectal tumors will be randomized on a 1:1 ratio to receive long-course chemoradiation (54 Gy) followed by cCT with fluoropyrimidine alone versus fluoropyrimidine + oxaliplatin. Magnetic resonance(MR) will be analyzed centrally prior to patient inclusion and randomization. mrT2-3N0-1 tumor located no more than 1 cm above the anorectal ring determined by sagittal views on MR will be eligible for the study. Tumor response will be assessed after 12 weeks from radiotherapy(RT) completion. Patients with clinical complete response (clinical, endoscopic and radiological) may be enrolled in an organ-preservation program(WW). The primary endpoint of this trial is decision to organ-preservation surveillance (WW) at 18 weeks from RT completion. Secondary endpoints are 3-year surgery-free survival, TME-free survival, distant metastases-free survival, local regrowth-free survival and colostomy-free survival. DISCUSSION Long-course nCRT with cCT is associated with improved complete response rates and may be a very attractive alternative to increase the chances for organ-preservation strategies. Fluoropyrimidine-based cCT with or without oxaliplatin has never been investigated in the setting of a randomized trial to compare clinical response rates and the possibility of organ-preservation. The outcomes of this study may significantly impact clinical practice of patients with distal rectal cancer interested in organ-preservation. TRIAL REGISTRATION www. CLINICALTRIALS gov NCT05000697; registered on August 11th, 2021.
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Affiliation(s)
- Angelita Habr-Gama
- University of São Paulo School of Medicine, São Paulo, Brazil
- Angelita and Joaquim Gama Institute, Praça Amadeu Amaral, 47 - conj.111, São Paulo, 01327-904, Brazil
- Department of Coloproctology, Hospital Alemão Oswaldo Cruz, Praça Amadeu Amaral, 47 - conj.111, São Paulo, 01327-904, Brazil
| | - Guilherme Pagin São Julião
- Angelita and Joaquim Gama Institute, Praça Amadeu Amaral, 47 - conj.111, São Paulo, 01327-904, Brazil
- Department of Coloproctology, Hospital Alemão Oswaldo Cruz, Praça Amadeu Amaral, 47 - conj.111, São Paulo, 01327-904, Brazil
- Department of Surgical Oncology, Hospital Beneficencia Portuguesa, Praça Amadeu Amaral, 47 - conj.111, São Paulo, 01327-904, Brazil
| | - Cinthia D Ortega
- Department of Radiology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
- Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Bruna Borba Vailati
- Angelita and Joaquim Gama Institute, Praça Amadeu Amaral, 47 - conj.111, São Paulo, 01327-904, Brazil
- Department of Coloproctology, Hospital Alemão Oswaldo Cruz, Praça Amadeu Amaral, 47 - conj.111, São Paulo, 01327-904, Brazil
- Department of Surgical Oncology, Hospital Beneficencia Portuguesa, Praça Amadeu Amaral, 47 - conj.111, São Paulo, 01327-904, Brazil
| | - Sergio Araujo
- Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Thiago Jorge
- Department of Medical Oncology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Jorge Sabbaga
- Department of Medical Oncology, Hospital Sírio Libanês, São Paulo, Brazil
| | - Gustavo L Rossi
- Servicio Cirugia General, Hospital Italiano de Buenos Aires, Sector de Coloproctologia, Buenos Aires, Argentina
| | | | - Fabio Roberto Kater
- Department of Medical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil
| | | | | | - Rodrigo Oliva Perez
- Angelita and Joaquim Gama Institute, Praça Amadeu Amaral, 47 - conj.111, São Paulo, 01327-904, Brazil.
- Department of Coloproctology, Hospital Alemão Oswaldo Cruz, Praça Amadeu Amaral, 47 - conj.111, São Paulo, 01327-904, Brazil.
- Department of Surgical Oncology, Hospital Beneficencia Portuguesa, Praça Amadeu Amaral, 47 - conj.111, São Paulo, 01327-904, Brazil.
- Ludwig Institute for Cancer Research, Praça Amadeu Amaral, 47 - conj.111, São Paulo, 01327-904, Brazil.
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21
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Shi J, Li J, Li Z, Li Y, Xu L, Zhang Y. Prediction of pathological response grading for esophageal squamous carcinoma after neoadjuvant chemoradiotherapy based on MRI imaging using PDX. Front Oncol 2023; 13:1160815. [PMID: 37377911 PMCID: PMC10292012 DOI: 10.3389/fonc.2023.1160815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction To confirm the efficacy of magnetic resonance-diffusion weighted imaging (MR-DWI) in esophageal squamous cell carcinoma (ESCC) early pathological response prediction and assessment to neoadjuvant chemoradiotherapy (nCRT) using patient-derived xenografts (PDXs). Methods PDX-bearing mice were randomly divided into two groups: the experimental group receiving cisplatin combined with radiotherapy, whereas the control group receiving normal saline. MRI scans were performed in treatment groups in the before, middle, and end of treatment. The correlations between tumor volumes, ADC values and tumor pathological response at different time nodes were explored. Then, expression of proliferation marker and apoptotic marker were detected using immunohistochemistry, and apoptosis rate was detected by TUNEL assay to further verify the results observed in the PDX models. Results The ADC values of the experimental group were significantly higher than the control group in the both middle and end stage of treatment (all P< 0.001), however, significant difference was only observed in tumor volume at the end stage of treatment (P< 0.001). Furthermore, the △ADCmid-pre in our study may able to identify tumors with or without pCR to nCRT at an early stage, due to these changes were prior to the changes of tumor volume after treatment. Finally, TUNEL results also showed that the apoptosis rate of the experiment groups increased the most in the middle stage of treatment, especially the groups with pCR, but the highest apoptosis rate occurred in the end of the treatment. Further, the two PDX models with pCR exhibited the highest levels of apoptotic marker (Bax), and lowest levels of proliferation marker (PCNA and Ki-67) in the both middle and end stage of the treatment. Conclusions ADC values could be used to determine the tumor's response to nCRT, especially in the middle stages of treatment and before the tumor tissue morphology changes, and further, the ADC values were consistent with the potential biomarkers reflecting histopathological changes. Therefore, we suggest that radiation oncologists could refer to the ADC values in the middle stages of treatment when predicting the tumor histopathological response to n CRT in patients with ESCC.
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Affiliation(s)
- Jingzhen Shi
- Department of Oncology, The Second Hospital of Tianjin Medical University, Tianjin, China
- School of Medicine, Shandong University, Jinan, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhenxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yankang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Liang Xu
- Department of Medical Imaging, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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22
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Cuicchi D, Castagna G, Cardelli S, Larotonda C, Petrello B, Poggioli G. Restaging rectal cancer following neoadjuvant chemoradiotherapy. World J Gastrointest Oncol 2023; 15:700-712. [PMID: 37275455 PMCID: PMC10237020 DOI: 10.4251/wjgo.v15.i5.700] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/01/2023] [Accepted: 03/29/2023] [Indexed: 05/12/2023] Open
Abstract
Correct tumour restaging is pivotal for identifying the most personalised surgical treatment for patients with locally advanced rectal cancer undergoing neoadjuvant therapy, and works to avoid both poor oncological outcome and overtreatment. Digital rectal examination, endoscopy, and pelvic magnetic resonance imaging are the recommended modalities for local tumour restaging, while chest and abdominal computed tomography are utilised for the assessment of distant disease. The optimal length of time between neoadjuvant treatment and restaging, in terms of both oncological safety and clinical effectiveness of treatment, remains unclear, especially for patients receiving prolonged total neoadjuvant therapy. The timely identification of patients who are radioresistant and at risk of disease progression remains challenging.
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Affiliation(s)
- Dajana Cuicchi
- Department of Medical and Surgical Sciences, Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Giovanni Castagna
- Department of Medical and Surgical Sciences, Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Stefano Cardelli
- Department of Medical and Surgical Sciences, Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Cristina Larotonda
- Department of Medical and Surgical Sciences, Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Benedetta Petrello
- Department of Medical and Surgical Sciences, Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Gilberto Poggioli
- Department of Medical and Surgical Sciences, Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
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23
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Seo N, Lim JS. [Interpretation of Rectal MRI after Neoadjuvant Treatment in Patients with Rectal Cancer]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:550-564. [PMID: 37325000 PMCID: PMC10265231 DOI: 10.3348/jksr.2023.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/28/2023] [Accepted: 03/14/2023] [Indexed: 06/17/2023]
Abstract
MRI is currently the imaging modality of choice to evaluate rectal cancer after neoadjuvant treatment. The purposes of restaging MRI are to assess the resectability of rectal cancer and to decide whether organ preservation strategies can be applied in patients with a complete clinical response. This review article indicates the key MRI features needed to evaluate rectal cancer after neoadjuvant treatment using a systematic approach. Assessment of primary tumor response including MRI findings to predict a complete response is discussed. Additionally, MRI evaluation of the relationship between the primary tumor and adjacent structures, lymph node response, extramural venous invasion, and tumor deposits after neoadjuvant treatment is presented. Knowledge of these imaging features and their clinical relevance may help radiologists provide an accurate and clinically valuable interpretation of restaging rectal MRI.
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Peng J, Wang W, Jin H, Qin X, Hou J, Yang Z, Shu Z. Develop and validate a radiomics space-time model to predict the pathological complete response in patients undergoing neoadjuvant treatment of rectal cancer: an artificial intelligence model study based on machine learning. BMC Cancer 2023; 23:365. [PMID: 37085830 PMCID: PMC10120125 DOI: 10.1186/s12885-023-10855-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/17/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVE In this study, we aimed to investigate the predictive efficacy of magnetic resonance imaging (MRI) radiomics features at different time points of neoadjuvant therapy for rectal cancer in patients with pathological complete response (pCR). Furthermore, we aimed to develop and validate a radiomics space-time model (RSTM) using machine learning for artificial intelligence interventions in predicting pCR in patients. METHODS Clinical and imaging data of 83 rectal cancer patients were retrospectively analyzed, and the patients were classified as pCR and non-pCR patients according to their postoperative pathological results. All patients received one MRI examination before and after neoadjuvant therapy to extract radiomics features, including pre-treatment, post-treatment, and delta features. Delta features were defined by the ratio of the difference between the pre- and the post-treatment features to the pre-treatment feature. After feature dimensionality reduction based on the above three feature types, the RSTM was constructed using machine learning methods, and its performance was evaluated using the area under the curve (AUC). RESULTS The AUC values of the individual basic models constructed by pre-treatment, post-treatment, and delta features were 0.771, 0.681, and 0.871, respectively. Their sensitivity values were 0.727, 0.864, and 0.909, respectively, and their specificity values were 0.803, 0.492, and 0.656, respectively. The AUC, sensitivity, and specificity values of the combined basic model constructed by combining pre-treatment, post-treatment, and delta features were 0.901, 0.909, and 0.803, respectively. The AUC, sensitivity, and specificity values of the RSTM constructed using the K-Nearest Neighbor (KNN) classifier on the basis of the combined basic model were 0.944, 0.871, and 0.983, respectively. The Delong test showed that the performance of RSTM was significantly different from that of pre-treatment, post-treatment, and delta models (P < 0.05) but not significantly different from the combined basic model of the three (P > 0.05). CONCLUSIONS The RSTM constructed using the KNN classifier based on the combined features of before and after neoadjuvant therapy and delta features had the best predictive efficacy for pCR of neoadjuvant therapy. It may emerge as a new clinical tool to assist with individualized management of rectal cancer patients.
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Affiliation(s)
- Jiaxuan Peng
- Jinzhou medical university, Jinzhou, Liaoning Province, China
| | - Wei Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Hui Jin
- Bengbu medical college, Bengbu, China
| | - Xue Qin
- Bengbu medical college, Bengbu, China
| | - Jie Hou
- Jinzhou medical university, Jinzhou, Liaoning Province, China
| | - Zhang Yang
- Center for General Practice Medicine, Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhenyu Shu
- Center for General Practice Medicine, Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Chuong MD, Palm RF, Tjong MC, Hyer DE, Kishan AU. Advances in MRI-Guided Radiation Therapy. Surg Oncol Clin N Am 2023; 32:599-615. [PMID: 37182995 DOI: 10.1016/j.soc.2023.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Image guidance for radiation therapy (RT) has evolved over the last few decades and now is routinely performed using cone-beam computerized tomography (CBCT). Conventional linear accelerators (LINACs) that use CBCT have limited soft tissue contrast, are not able to image the patient's internal anatomy during treatment delivery, and most are not capable of online adaptive replanning. RT delivery systems that use MRI have become available within the last several years and address many of the imaging limitations of conventional LINACs. Herein, the authors review the technical characteristics and advantages of MRI-guided RT as well as emerging clinical outcomes.
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Affiliation(s)
- Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, 8900 North Kendall Drive, Miami, FL 33176, USA.
| | - Russell F Palm
- Department of Radiation Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Michael C Tjong
- Department of Radiation Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Daniel E Hyer
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, 1338 S Hope Street, Los Angeles, CA 90015, USA
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Awiwi MO, Kaur H, Ernst R, Rauch GM, Morani AC, Stanietzky N, Palmquist SM, Salem UI. Restaging MRI of Rectal Adenocarcinoma after Neoadjuvant Chemoradiotherapy: Imaging Findings and Potential Pitfalls. Radiographics 2023; 43:e220135. [PMID: 36927125 DOI: 10.1148/rg.220135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Rectal adenocarcinoma constitutes about one-third of all colorectal adenocarcinoma cases. Rectal MRI has become mandatory for evaluation of patients newly diagnosed with rectal cancer because it can help accurately stage the disease, impact the choice to give neoadjuvant therapy or proceed with up-front surgery, and even direct surgical dissection planes. Better understanding of neoadjuvant chemoradiotherapy effects on rectal tumors and recognition that up to 30% of patients can have a pathologic complete response have opened the door for the nonsurgical "watch-and-wait" management approach for rectal adenocarcinoma. Candidates for this organ-preserving approach should have no evidence of malignancy on all three components of response assessment after neoadjuvant therapy (ie, digital rectal examination, endoscopy, and rectal MRI). Hence, rectal MRI again has a major role in directing patient management and possibly sparing patients from unnecessary surgical morbidity. In this article, the authors discuss the indications for neoadjuvant therapy in management of patients with rectal adenocarcinoma, describe expected imaging appearances of rectal adenocarcinoma after completion of neoadjuvant therapy, and outline the MRI tumor regression grading system. Since pelvic sidewall lymph node dissection is associated with a high risk of permanent genitourinary dysfunction, it is performed for only selected patients who have radiologic evidence of sidewall lymph node involvement. Therefore, the authors review the relevant lymphatic compartments of the pelvis and describe lymph node criteria for determining locoregional nodal spread. Finally, the authors discuss limitations of rectal MRI, describe several potential interpretation pitfalls after neoadjuvant therapy, and emphasize how these pitfalls may be avoided. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Muhammad O Awiwi
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Harmeet Kaur
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Randy Ernst
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Gaiane M Rauch
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Ajaykumar C Morani
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Nir Stanietzky
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Sarah M Palmquist
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Usama I Salem
- From the Division of Diagnostic Imaging, Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
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Çelik H, Barlık F, Sökmen S, Terzi C, Canda AE, Sağol Ö, Sarıoğlu S, Ünlü M, Bilkay Görken İ, Arıcan Alıcıkuş Z, Öztop İ. Diagnostic performance of magnetic resonance imaging in preoperative local staging of rectal cancer after neoadjuvant chemoradiotherapy. Diagn Interv Radiol 2023; 29:219-227. [PMID: 36971272 PMCID: PMC10679710 DOI: 10.4274/dir.2022.221333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/13/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE This paper aims to investigate the diagnostic performance of magnetic resonance imaging (MRI) in predicting the pathologic stage of locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (CRT) and the role of MRI in selecting patients with a pathologic complete response (ypCR). METHODS Restaging MRI (yMRI) examinations of 136 patients with LARC treated with neoadjuvant CRT followed by surgery were retrospectively analyzed by two radiologists. All examinations were performed on a 1.5 Tesla MRI machine with a pelvic phased-array coil. T2-weighted turbo spin-echo images and diffusion-weighted imaging were obtained. Histopathologic reports of the surgical specimens were the reference standard. The accuracy, sensitivity, specificity, positive and negative predictive values (PPV and NPV) of yMRI in predicting the pathologic T-stage (ypT), N-stage, and ypCR were calculated. The inter-observer agreement was evaluated using kappa statistics. RESULTS The yMRI results showed 67% accuracy, 59% sensitivity, 80% specificity, 81% PPV, and 56% NPV in identifying ypT (ypT0-2 versus ypT3-4). In predicting the nodal status, the yMRI results revealed 63% accuracy, 60% sensitivity, 65% specificity, 47% PPV, and 75% NPV. In predicting ypCR, the yMRI results showed 84% accuracy, 20% sensitivity, 92% specificity, 23% PPV, and 90% NPV. The kappa statistics revealed substantial agreement between the two radiologists. CONCLUSION Utilization of yMRI showed high specificity and PPV in predicting the tumor stage and high NPV in predicting the nodal stage; in addition, yMRI revealed moderate accuracy in the T and N classifications, mainly due to underestimating the tumor stage and overestimating the nodal status. Finally, yMRI revealed high specificity and NPV but low sensitivity in predicting the complete response.
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Affiliation(s)
- Hakkı Çelik
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Funda Barlık
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Selman Sökmen
- Department of General Surgery, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Cem Terzi
- Department of General Surgery, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Aras Emre Canda
- Department of General Surgery, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Özgül Sağol
- Department of Pathology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Sülen Sarıoğlu
- Department of Pathology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Mehtat Ünlü
- Department of Pathology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - İlknur Bilkay Görken
- Department of Radiation Oncology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Zümre Arıcan Alıcıkuş
- Department of Radiation Oncology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - İlhan Öztop
- Department of Medical Oncology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Horvat N, El Homsi M, Miranda J, Mazaheri Y, Gollub MJ, Paroder V. Rectal MRI Interpretation After Neoadjuvant Therapy. J Magn Reson Imaging 2023; 57:353-369. [PMID: 36073323 PMCID: PMC9851947 DOI: 10.1002/jmri.28426] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 02/01/2023] Open
Abstract
In recent years, several key advances in the management of locally advanced rectal cancer have been made, including the implementation of total mesorectal excision as the standard surgical approach; use of neoadjuvant chemoradiotherapy in selected patients with a high risk of local recurrence, and finally, adoption of organ preservation strategies, through either local excision or nonoperative management in selected patients with clinical complete response following neoadjuvant chemoradiotherapy. This review aims to shed light on the role of rectal MRI in the assessment of treatment response after neoadjuvant therapy, which is especially important given the growing feasibility of nonoperative management. First, an overview of current neoadjuvant therapies and response assessment based on digital rectal examination, endoscopy, and MRI will be provided. Second, the use of a high-quality restaging rectal MRI protocol will be presented. Third, a step-by-step approach to assessing treatment response on restaging rectal MRI following neoadjuvant treatment will be outlined, acknowledging challenges faced by radiologists during MRI interpretation. Finally, research related to response assessment will be discussed. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joao Miranda
- Department of Radiology, University of Sao Paulo, Sao Paulo, Brazil
| | - Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J. Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bogveradze N, Snaebjornsson P, Grotenhuis BA, van Triest B, Lahaye MJ, Maas M, Beets GL, Beets-Tan RGH, Lambregts DMJ. MRI anatomy of the rectum: key concepts important for rectal cancer staging and treatment planning. Insights Imaging 2023; 14:13. [PMID: 36652149 PMCID: PMC9849549 DOI: 10.1186/s13244-022-01348-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/04/2022] [Indexed: 01/19/2023] Open
Abstract
A good understanding of the MRI anatomy of the rectum and its surroundings is pivotal to ensure high-quality diagnostic evaluation and reporting of rectal cancer. With this pictorial review, we aim to provide an image-based overview of key anatomical concepts essential for treatment planning, response evaluation and post-operative assessment. These concepts include the cross-sectional anatomy of the rectal wall in relation to T-staging; differences in staging and treatment between anal and rectal cancer; landmarks used to define the upper and lower boundaries of the rectum; the anatomy of the pelvic floor and anal canal, the mesorectal fascia, peritoneum and peritoneal reflection; and guides to help discern different pelvic lymph node stations on MRI to properly stage regional and non-regional rectal lymph node metastases. Finally, this review will highlight key aspects of post-treatment anatomy, including the assessment of radiation-induced changes and the evaluation of the post-operative pelvis after different surgical resection and reconstruction techniques.
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Affiliation(s)
- Nino Bogveradze
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands ,grid.5012.60000 0001 0481 6099GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands ,Department of Radiology, American Hospital Tbilisi, Tbilisi, Georgia
| | - Petur Snaebjornsson
- grid.430814.a0000 0001 0674 1393Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Brechtje A. Grotenhuis
- grid.430814.a0000 0001 0674 1393Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Baukelien van Triest
- grid.430814.a0000 0001 0674 1393Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Max J. Lahaye
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
| | - Monique Maas
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
| | - Geerard L. Beets
- grid.5012.60000 0001 0481 6099GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands ,grid.430814.a0000 0001 0674 1393Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G. H. Beets-Tan
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands ,grid.5012.60000 0001 0481 6099GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands ,grid.10825.3e0000 0001 0728 0170Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Doenja M. J. Lambregts
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
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Carbonara R, Surgo A, Ciliberti MP, Gregucci F, Bonaparte I, Nicosia L, Meldolesi E, Caliandro M, Ferraro V, Inchingolo R, Memeo R, Ludovico E, Calbi R, Lavalle M, Gambacorta MA, Alongi F, Fiorentino A. Impact of preoperative chemoradiation with higher dose intensity modulated radiotherapy on pathological complete response for locally advanced rectal cancer: a systematic review. Expert Rev Anticancer Ther 2022; 22:1249-1259. [PMID: 36174658 DOI: 10.1080/14737140.2022.2130895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/25/2022] [Accepted: 09/27/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Neoadjuvant chemoradiation (CRT) followed by total mesorectal excision is the current standard-of-care for locally advanced UICC II-III stage rectal cancer (LARC). A pathological complete response (pCR) correlates with survival. Improvements of pCR, including dose escalation, should be explored. The aim of this explorative analysis is to assess the impact on pCR of intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB). AREAS COVERED A literature search via PICO (Population, Intervention, Comparison, Outcome) in MEDLINE/PubMed and EMBASE and a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Metanalysis) methodology were performed. Studies that reported pCR rate in patients with LARC in clinical stage T2N+M0 or cT3/4 N0/+M0 treated with preoperative CRT with SIB-IMRT/VMAT (Volumetric Modulated Arc Therapy) were included. Sixty-two studies were identified, but only eight clinical trials with a total of 311 patients were included . Median follow-up was 16-61 months. pCR reached the value of 38%. Good survival outcomes were observed with a mild toxicity profile. EXPERT OPINION Radiotherapy dose intensification in LARC showed a slight increase of pCR compared to historical studies. Prospective evaluations are necessary to define which patients would benefit most.
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Affiliation(s)
- Roberta Carbonara
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Alessia Surgo
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Maria Paola Ciliberti
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Fabiana Gregucci
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Ilaria Bonaparte
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Luca Nicosia
- IRCCS, Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Elisa Meldolesi
- Radiation Oncology Department, Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy
| | - Morena Caliandro
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Valentina Ferraro
- Hepatobiliary and Pancreatic Surgery Unit, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Inchingolo
- Hepatobiliary and Pancreatic Surgery Unit, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Memeo
- Hepatobiliary and Pancreatic Surgery Unit, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Elena Ludovico
- Radiology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti (BA), Bari, Italy
| | - Roberto Calbi
- Radiology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti (BA), Bari, Italy
| | - Mariadea Lavalle
- Nuclear Medicine Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti (BA), Bari, Italy
| | | | - Filippo Alongi
- IRCCS, Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
- Medicine Faculty, University of Brescia, Brescia, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
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Pham TT, Lim S, Lin M. Predicting neoadjuvant chemoradiotherapy response with functional imaging and liquid biomarkers in locally advanced rectal cancer. Expert Rev Anticancer Ther 2022; 22:1081-1098. [PMID: 35993178 DOI: 10.1080/14737140.2022.2114457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Non-invasive predictive quantitative biomarkers are required to guide treatment individualization in patients with locally advanced rectal cancer (LARC) in order to maximise therapeutic outcomes and minimise treatment toxicity. Magnetic resonance imaging (MRI), positron emission tomography (PET) and blood biomarkers have the potential to predict chemoradiotherapy (CRT) response in LARC. AREAS COVERED This review examines the value of functional imaging (MRI and PET) and liquid biomarkers (circulating tumor cells (CTCs) and circulating tumor nucleic acid (ctNA)) in the prediction of CRT response in LARC. Selected imaging and liquid biomarker studies are presented and the current status of the most promising imaging (apparent diffusion co-efficient (ADC), Ktrans, SUVmax, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) and liquid biomarkers (circulating tumor cells (CTCs), circulating tumor nucleic acid (ctNA)) is discussed. The potential applications of imaging and liquid biomarkers for treatment stratification and a pathway to clinical translation are presented. EXPERT OPINION Functional imaging and liquid biomarkers provide novel ways of predicting CRT response. The clinical and technical validation of the most promising imaging and liquid biopsy biomarkers in multi-centre studies with harmonised acquisition techniques is required. This will enable clinical trials to investigate treatment escalation or de-escalation pathways in rectal cancer.
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Affiliation(s)
- Trang Thanh Pham
- South West Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Liverpool NSW Australia 2170.,Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool NSW Australia 2170.,Ingham Institute for Applied Medical Research, Liverpool NSW Australia 2170
| | - Stephanie Lim
- Ingham Institute for Applied Medical Research, Liverpool NSW Australia 2170.,Department of Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown Australia 2560.,School of Medicine, Western Sydney University, Campbelltown, Sydney 2560
| | - Michael Lin
- South West Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Liverpool NSW Australia 2170.,School of Medicine, Western Sydney University, Campbelltown, Sydney 2560.,Department of Nuclear Medicine, Liverpool Hospital, Liverpool NSW Australia 2170
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Lu QY, Guan Z, Zhang XY, Li XT, Sun RJ, Li QY, Sun YS. Contrast-enhanced MRI for T Restaging of Locally Advanced Rectal Cancer Following Neoadjuvant Chemotherapy and Radiation Therapy. Radiology 2022; 305:364-372. [DOI: 10.1148/radiol.212905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Qiao-Yuan Lu
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Zhen Guan
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Xiao-Yan Zhang
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Xiao-Ting Li
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Rui-Jia Sun
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Qing-Yang Li
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
| | - Ying-Shi Sun
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing 100142, China
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Zins M, Santiago IAGP. MRI for T Restaging of Locally Advanced Rectal Cancer Following Neoadjuvant Chemotherapy and Radiation Therapy. Radiology 2022; 305:373-374. [DOI: 10.1148/radiol.221397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marc Zins
- From the Department of Radiology, Hôpital Paris Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France (M.Z.); and Department of Radiology, Champalimaud Foundation, Lisbon, Portugal (I.A.G.P.S)
| | - Inês A. G. P. Santiago
- From the Department of Radiology, Hôpital Paris Saint-Joseph, 185 Rue Raymond Losserand, 75014 Paris, France (M.Z.); and Department of Radiology, Champalimaud Foundation, Lisbon, Portugal (I.A.G.P.S)
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Bulens PP, Smets L, Debucquoy A, Joye I, D'Hoore A, Wolthuis A, Debrun L, Dekervel J, Van Cutsem E, Dresen R, Vandecaveye V, Deroose CM, Sagaert X, Haustermans K. Nonoperative versus Operative Approach According to the Response to Neoadjuvant Chemoradiotherapy for Rectal Cancer: A Prospective Cohort Study. Clin Transl Radiat Oncol 2022; 36:113-120. [PMID: 35993092 PMCID: PMC9382364 DOI: 10.1016/j.ctro.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Watch-and-wait patients after chemoradiotherapy for rectal cancer have good functional outcome. No survival differences were seen between patients undergoing surgery versus patients in a watch-and-wait protocol. There is a subset of patients that has initial favorable response but will recur with distant metastases afterwards. A previously published model predicting (near)-complete response could not be validated. Purpose To report on organ preservation following chemoradiotherapy (CRT) in a prospective cohort of locally advanced rectal cancer patients. Methods and materials Fifty-two patients received CRT. MRI and 18F-FDG-PET/CT were performed prior to CRT. Response assessment was done 6 and 12 weeks after CRT using digital rectal examination, MRI, 18F-FDG-PET/CT and endoscopy. For clinical complete response or minimal residual disease, a watch-and-wait (W&W) protocol was started. Regrowth-free survival (ReFS), Total Mesorectal Excision-free disease-free survival, distant metastasis-free survival (DMFS) and overall survival (OS) were evaluated using Kaplan-Meier method. Functional outcome was compared with the Wilcoxon signed-rank test using EORTC QLQ-C30, MSKCC BFI, LARS and IIEF-5/FSFI-5 questionnaires. A previously developed prediction model performance was tested using receiver operating characteristic analysis. Results 29/52 patients entered a W&W protocol. There was no difference in two-year DMFS (81.1 % vs 78.8 %, p = 0.82), two-year OS (96.4 % vs 100 %, p = 0.38) and two-year DFS (77.5 % vs 78.8 %, p = 0.87) between W&W patients and those who underwent surgery at 12 weeks after CRT. Two-year DMFS differed between W&W with local regrowth, W&W with sustained response and patients who had surgery (66.7 % vs 88.0 % vs 78.8 %; p = 0.04). At 6 and 12 months, W&W patients reported good QoL and bowel function. The model validation reached an AUC of 0.627. Conclusion Good functional outcome in patients with rectal cancer allocated to surveillance after CRT needs to be balanced against potentially worse DMFS in a subset of patients without sustained clinical complete response. Reliable prediction of patients eligible for surveillance programs needs further investigation.
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Jiménez de los Santos ME, Reyes-Pérez JA, Domínguez Osorio V, Villaseñor-Navarro Y, Moreno-Astudillo L, Vela-Sarmiento I, Sollozo-Dupont I. Whole lesion histogram analysis of apparent diffusion coefficient predicts therapy response in locally advanced rectal cancer. World J Gastroenterol 2022; 28:2609-2624. [PMID: 35949349 PMCID: PMC9254137 DOI: 10.3748/wjg.v28.i23.2609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/25/2021] [Accepted: 04/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Whole-tumor apparent diffusion coefficient (ADC) histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy (nCRT) response in patients with locally advanced rectal cancer (LARC).
AIM To evaluate the performance of ADC histogram-derived parameters for predicting the outcomes of patients with LARC.
METHODS This is a single-center, retrospective study, which included 48 patients with LARC. All patients underwent a pre-treatment magnetic resonance imaging (MRI) scan for primary tumor staging and a second restaging MRI for response evaluation. The sample was distributed as follows: 18 responder patients (R) and 30 non-responders (non-R). Eight parameters derived from the whole-lesion histogram analysis (ADCmean, skewness, kurtosis, and ADC10th, 25th, 50th, 75th, 90th percentiles), as well as the ADCmean from the hot spot region of interest (ROI), were calculated for each patient before and after treatment. Then all data were compared between R and non-R using the Mann-Whitney U test. Two measures of diagnostic accuracy were applied: the receiver operating characteristic curve and the diagnostic odds ratio (DOR). We also reported intra- and interobserver variability by calculating the intraclass correlation coefficient (ICC).
RESULTS Post-nCRT kurtosis, as well as post-nCRT skewness, were significantly lower in R than in non-R (both P < 0.001, respectively). We also found that, after treatment, R had a larger loss of both kurtosis and skewness than non-R (∆%kurtosis and ∆skewness, P < 0.001). Other parameters that demonstrated changes between groups were post-nCRT ADC10th, ∆%ADC10th, ∆%ADCmean, and ROI ∆%ADCmean. However, the best diagnostic performance was achieved by ∆%kurtosis at a threshold of 11.85% (Area under the receiver operating characteristic curve [AUC] = 0.991, DOR = 376), followed by post-nCRT kurtosis = 0.78 × 10-3 mm2/s (AUC = 0.985, DOR = 375.3), ∆skewness = 0.16 (AUC = 0.885, DOR = 192.2) and post-nCRT skewness = 1.59 × 10-3 mm2/s (AUC = 0.815, DOR = 168.6). Finally, intraclass correlation coefficient analysis showed excellent intraobserver and interobserver agreement, ensuring the implementation of histogram analysis into routine clinical practice.
CONCLUSION Whole-tumor ADC histogram parameters, particularly kurtosis and skewness, are relevant biomarkers for predicting the nCRT response in LARC. Both parameters appear to be more reliable than ADCmean from one-slice ROI.
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Affiliation(s)
| | | | | | | | | | - Itzel Vela-Sarmiento
- Department of Gastrointestinal Surgery, National Cancer Institute, Mexico 14080, Mexico
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36
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Fontana G, Barcellini A, Boccuzzi D, Pecorilla M, Loap P, Cobianchi L, Vitolo V, Fiore MR, Vai A, Baroni G, Preda L, Imparato S, Orlandi E. Role of diffusion-weighted MRI in recurrent rectal cancer treated with carbon ion radiotherapy. Future Oncol 2022; 18:2403-2412. [PMID: 35712914 DOI: 10.2217/fon-2021-1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the association between pretreatment diffusion-weighted MRI (DW-MRI) and 12-month radiological response in locally recurrent rectal cancer treated with carbon ion radiotherapy. Methods: Histogram analysis was performed on pretreatment DW-MRI for patients re-irradiated with carbon ion radiotherapy for local recurrence of rectal cancer. Results: A total of 17 patients were enrolled in the study. Pretreatment DW-MRI b-value of 1000 s/mm2 (b1000) and apparent diffusion coefficient (ADC) lesion median values for 1-year nonresponders (six patients) and responders (11 patients) demonstrated a median (interquartile of median values) of 62.5 (23.9) and 34.0 (13.0) and 953.0 (277.0) and 942.5 (339.0) μm2/s, respectively. All b1000 histogram features (h-features) and ADC h-kurtosis showed statistically significant differences, whereas only b1000 h-median, b1000 h-interquartile range and ADC h-kurtosis demonstrated remarkable diagnostic accuracy. Conclusion: DW-MRI showed promising results in predicting carbon ion radiotherapy outcome in local recurrence of rectal cancer, particularly with regard to b1000 h-median, b1000 h-interquartile range and ADC h-kurtosis.
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Affiliation(s)
- Giulia Fontana
- Clinical Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Dario Boccuzzi
- Department of Radiology, Diagnostic Radiology Residency School, University of Pavia, Pavia, 27100, Italy.,Department of Radiology, Valduce Hospital, Como, 22100, Italy
| | - Mattia Pecorilla
- Radiology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Pierre Loap
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy.,Department of Radiation Oncology, Institut Curie, Paris, 75005, France
| | - Lorenzo Cobianchi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, 27100, Italy.,Department of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Viviana Vitolo
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Maria Rosaria Fiore
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Alessandro Vai
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Guido Baroni
- Clinical Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, 20133, Italy
| | - Lorenzo Preda
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, 27100, Italy.,Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Sara Imparato
- Radiology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
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Wetzel A, Viswanath S, Gorgun E, Ozgur I, Allende D, Liska D, Purysko AS. Staging and Restaging of Rectal Cancer With MRI: A Pictorial Review. Semin Ultrasound CT MR 2022; 43:441-454. [DOI: 10.1053/j.sult.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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38
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Voogt EL, Nordkamp S, van Zoggel DM, Daniëls-Gooszen AW, Nieuwenhuijzen GA, Bloemen JG, Creemers GJ, Cnossen JS, van Lijnschoten G, Burger JW, Rutten HJ, Nederend J. MRI tumour regression grade in locally recurrent rectal cancer. BJS Open 2022; 6:zrac033. [PMID: 35552373 PMCID: PMC9097816 DOI: 10.1093/bjsopen/zrac033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/03/2022] [Accepted: 02/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study aimed to investigate the agreement between magnetic resonance tumour regression grade (mrTRG) and pathological regression grade (pTRG) in patients with locally recurrent rectal cancer (LRRC). Also, the reproducibility of mrTRG was investigated. METHODS All patients with LRRC who underwent a resection between 2010 and 2018 after treatment with induction chemotherapy and neoadjuvant chemo(re)irradiation in whom a restaging MRI was available were retrospectively selected. All MRI scans were reassessed by two independent radiologists using the mrTRG, and the pTRG was reassessed by an independent pathologist. The interobserver agreement between the radiologists as well as between the radiologists and the pathologist was assessed with the weighted kappa test. A subanalysis was performed to evaluate the influence of the interval between imaging and surgery. RESULTS Out of 313 patients with LRRC treated during the study interval, 124 patients were selected. Interobserver agreement between the radiologists was fair (k = 0.28) using a two-tier grading system (mrTRG 1-2 versus mrTRG 3-5). For the lead radiologist, agreement with pTRG was moderate (k = 0.52; 95 per cent c.i. 0.36 to 0.68) when comparing good (mrTRG 1-2 and Mandard 1-2) and intermediate/poor responders (mrTRG 3-5 and Mandard 3-5), and the agreement was fair between the other abdominal radiologist and pTRG (k = 0.39; 95 per cent c.i. 0.22 to 0.56). A shorter interval (less than 7 weeks) between MRI and surgery resulted in an improved agreement (k = 0.69), compared with an interval more than 7 weeks (k = 0.340). For the lead radiologist, the positive predictive value for predicting good responders was 95 per cent (95 per cent c.i. 71 per cent to 99 per cent), whereas this was 56 per cent (95 per cent c.i. 44 per cent to 66 per cent) for the other radiologist. CONCLUSION This study showed that, in LRRC, the reproducibility of mrTRG among radiologists is limited and the agreement of mrTRG with pTRG is low. However, a shorter interval between MRI and surgery seems to improve this agreement and, if assessed by a dedicated radiologist, mrTRG could predict good responders.
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Affiliation(s)
- Eva L.K. Voogt
- Department of Surgery, Catherina Hospital, Eindhoven, the Netherlands
| | - Stefi Nordkamp
- Department of Surgery, Catherina Hospital, Eindhoven, the Netherlands
| | | | | | | | | | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Jeltsje S. Cnossen
- Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands
| | - Gesina van Lijnschoten
- Department of Pathology, PAMM Laboratory for Pathology and Medical Microbiology, Eindhoven, the Netherlands
| | | | - Harm J.T. Rutten
- Department of Surgery, Catherina Hospital, Eindhoven, the Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
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Popita AR, Lisencu C, Rusu A, Popita C, Cainap C, Irimie A, Resiga L, Munteanu A, Fekete Z, Badea R. MRI Evaluation of Complete and Near-Complete Response after Neoadjuvant Therapy in Patients with Locally Advanced Rectal Cancer. Diagnostics (Basel) 2022; 12:diagnostics12040921. [PMID: 35453969 PMCID: PMC9027294 DOI: 10.3390/diagnostics12040921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose To evaluate MRI performance in restaging locally advanced rectal cancers (LARC) after neoadjuvant chemoradiotherapy (nCRT) and interobserver agreement in identifying complete response (CR) and near-complete response (nCR). Methods 40 patients with CR and nCR on restaging MRI, surgery and/or endoscopy were enrolled. Two radiologists independently scored the restaging MRI and reported the presence of split scar sign (SSS) and MRI tumor regression grade (mrTRG). Diagnostic accuracy and ROC curves were calculated for single and combined sequences, with inter-reader agreement. Results Diagnostic performance was good for detecting CR and weaker for nCR. T2WI had the highest AUCs among individual sequences. There was a significant positive correlation between SSS and CR, with high Sp (89.5%/73.7%) and PPV (90%/79.2%) for both Readers. Similar accuracy rates were observed for the combination of sequences, with AUCs of 0.828–0.847 for CR and 0.690–0.762 for nCR. Interobserver agreement was strong for SSS, moderate for T2WI, weak for the combination of sequences. Conclusions Restaging MRI had good diagnostic performance in identifying CR and nCR. SSS had high Sp and PPV in diagnosing CR, with a strong level of interobserver agreement. T2WI with DWI was the optimal combination of sequences for selecting good responders.
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Affiliation(s)
- Anca-Raluca Popita
- “Ion Chiricuţă” Oncology Institute, 400015 Cluj-Napoca, Romania; (A.-R.P.); (C.L.); (C.P.); (A.I.); (L.R.); (A.M.); (Z.F.)
- Medical Imaging Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania;
| | - Cosmin Lisencu
- “Ion Chiricuţă” Oncology Institute, 400015 Cluj-Napoca, Romania; (A.-R.P.); (C.L.); (C.P.); (A.I.); (L.R.); (A.M.); (Z.F.)
- Oncology Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
| | - Adriana Rusu
- Diabetes and Nutrition Diseases Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Cristian Popita
- “Ion Chiricuţă” Oncology Institute, 400015 Cluj-Napoca, Romania; (A.-R.P.); (C.L.); (C.P.); (A.I.); (L.R.); (A.M.); (Z.F.)
| | - Calin Cainap
- “Ion Chiricuţă” Oncology Institute, 400015 Cluj-Napoca, Romania; (A.-R.P.); (C.L.); (C.P.); (A.I.); (L.R.); (A.M.); (Z.F.)
- Oncology Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-026-459-8363
| | - Alexandru Irimie
- “Ion Chiricuţă” Oncology Institute, 400015 Cluj-Napoca, Romania; (A.-R.P.); (C.L.); (C.P.); (A.I.); (L.R.); (A.M.); (Z.F.)
- Oncology Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
| | - Liliana Resiga
- “Ion Chiricuţă” Oncology Institute, 400015 Cluj-Napoca, Romania; (A.-R.P.); (C.L.); (C.P.); (A.I.); (L.R.); (A.M.); (Z.F.)
| | - Alina Munteanu
- “Ion Chiricuţă” Oncology Institute, 400015 Cluj-Napoca, Romania; (A.-R.P.); (C.L.); (C.P.); (A.I.); (L.R.); (A.M.); (Z.F.)
| | - Zsolt Fekete
- “Ion Chiricuţă” Oncology Institute, 400015 Cluj-Napoca, Romania; (A.-R.P.); (C.L.); (C.P.); (A.I.); (L.R.); (A.M.); (Z.F.)
- Oncology Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
| | - Radu Badea
- Medical Imaging Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania;
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Fernandes MC, Gollub MJ, Brown G. The importance of MRI for rectal cancer evaluation. Surg Oncol 2022; 43:101739. [PMID: 35339339 PMCID: PMC9464708 DOI: 10.1016/j.suronc.2022.101739] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 12/19/2022]
Abstract
Magnetic resonance imaging (MRI) has gained increasing importance in the management of rectal cancer over the last two decades. The role of MRI in patients with rectal cancer has expanded beyond the tumor-node-metastasis (TNM) system in both staging and restaging scenarios and has contributed to identifying "high" and "low" risk features that can be used to tailor and personalize patient treatment; for instance, selecting the patients for neoadjuvant chemoradiation (NCRT) before the total mesorectal excision (TME) surgery based on risk of recurrence. Among those features, the status of the circumferential resection margin (CRM), extramural vascular invasion (EMVI), and tumor deposits (TD) have stood out. Moreover, MRI also has played a role in surgical planning, especially when the tumor is located in the low rectum, when the relationship between tumor and the anal canal is important to choose the best surgical approach, and in cases of locally advanced or recurrent tumors invading adjacent pelvic organs that may require more complex surgeries such as pelvic exenteration. As approaches using organ preservation emerge, including transanal local excision and "watch-and-wait", MRI may help in the patient selection for those treatments, follow up, and detection of tumor regrowth. Additionally, potential MRI-based prognostic and predictive biomarkers, such as quantitative and semi-quantitative metrics derived from functional sequences like diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE), and radiomics, are under investigation. This review provides an overview of the current role of MRI in rectal cancer in staging and restaging and highlights the main areas under investigation and future perspectives.
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Suzuki C, Halperin SK, Nilsson PJ, Martling A, Holm T. Initial magnetic resonance imaging tumour regression grade (mrTRG) as response evaluation after neoadjuvant treatment predicts sustained complete response in patients with rectal cancer. Eur J Surg Oncol 2022; 48:1643-1649. [DOI: 10.1016/j.ejso.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/02/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
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Value of intravoxel incoherent motion for assessment of lymph node status and tumor response after chemoradiation therapy in locally advanced rectal cancer. Eur J Radiol 2022; 146:110106. [DOI: 10.1016/j.ejrad.2021.110106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/12/2021] [Accepted: 12/08/2021] [Indexed: 12/23/2022]
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43
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Park IJ. Watch and wait strategies for rectal cancer A systematic review. PRECISION AND FUTURE MEDICINE 2021. [DOI: 10.23838/pfm.2021.00177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Munk NE, Bondeven P, Pedersen BG. Diagnostic performance of MRI and endoscopy for assessing complete response in rectal cancer after neoadjuvant chemoradiotherapy: a systematic review of the literature. Acta Radiol 2021; 64:20-31. [PMID: 34928715 DOI: 10.1177/02841851211065925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The diagnostic performance of magnetic resonance imaging (MRI) modalities and/or endoscopy for assessing complete response in rectal cancer after neoadjuvant chemoradiotherapy (nCRT) is unclear. PURPOSE To summarize existing evidence on the diagnostic performance of diffusion-weighted MRI, perfusion-weighted MRI, T2-weighted MR tumor regression grade, and/or endoscopy for assessing complete tumor response after nCRT. MATERIAL AND METHODS MEDLINE and Embase databases were searched. The PRISMA guidelines were followed. Sensitivity, specificity, negative predictive, and positive predictive values were retrieved from included studies. RESULTS In total, 81 studies were eligible for inclusion. Evidence suggests that combined use of MRI and endoscopy tends to improve the diagnostic performance compared to single imaging modality. The positive predictive value of a complete response varies substantially between studies. There is considerable heterogeneity between studies. CONCLUSION Combined re-staging tends to improve diagnostic performance compared to single imaging modality, but the vast majority of studies fail to offer true clinical value due to the study heterogeneity.
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Affiliation(s)
| | - Peter Bondeven
- Department of Surgery, Regional Hospital Randers, Randers, Denmark
| | - Bodil Ginnerup Pedersen
- Department of Radiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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Kastner C, Petritsch B, Reibetanz J, Germer CT, Wiegering A. [Complete response after neoadjuvant therapy of rectal cancer: implications for surgery]. Chirurg 2021; 93:144-151. [PMID: 34878582 DOI: 10.1007/s00104-021-01540-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 12/17/2022]
Abstract
For (locally advanced) rectal cancer, a multimodal therapy concept comprising neoadjuvant radiotherapy/chemoradiotherapy, radical surgical resection with partial/complete mesorectal excision and subsequent adjuvant chemotherapy represents the current international standard of care. Further developments in neoadjuvant therapy concepts, such as the principle of total neoadjuvant therapy, lead to an increasing number of patients who show a complete clinical response in restaging after neoadjuvant therapy without clinically detectable residual tumor. In view of the risk associated with radical surgical resection in terms of perioperative morbidity and a potentially non-continence-preserving procedure, the question of the oncological justifiability of an organ-preserving procedure in the case of a complete clinical response under neoadjuvant therapy is increasingly being raised. The therapeutic principle of watch and wait, defined by refraining from immediate radical surgical resection and inclusion in a close-meshed, structured follow-up program, currently appears to be oncologically justifiable based on the current study situation; however, for the initial evaluation of the extent of the clinical response and for the structuring of the close-meshed follow-up program, further optimization and standardization based on broadly designed studies appear necessary in order to be able to provide this concept to a clearly defined patient collective as an oncologically equivalent therapy principle also outside specialized centers.
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Affiliation(s)
- Carolin Kastner
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum für operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
- Institut für Biochemie und molekulare Biologie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Bernhard Petritsch
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Joachim Reibetanz
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum für operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - Christoph-Thomas Germer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum für operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
- Comprehensive Cancer Center Mainfranken, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Armin Wiegering
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum für operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
- Institut für Biochemie und molekulare Biologie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland.
- Comprehensive Cancer Center Mainfranken, Universitätsklinikum Würzburg, Würzburg, Deutschland.
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Sabry MS, Rady AEE, Niazi GEM, Ali SA. Role of diffusion-weighted MRI in diagnosis and post therapeutic follow-up of colorectal cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00561-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
The colorectal cancer (CRC) is one of the deadliest cancers in the world. Local tumor stage, vascular or lymphatic invasion, and tumor grade are essential for accurate management. The main imaging modality for initial assessment and therapeutic response evaluation of CRC is magnetic resonance imaging (MRI). The purpose of this prospective study was to illustrate the role of diffusion-weighted MRI (DWI) and apparent diffusion coefficient (ADC) value in initial assessment and grading of colorectal carcinoma as well as evaluation of its response to chemotherapy or combined chemoradiation.
Results
Restricted diffusion in DWI was found in 37 out of 40 patients with sensitivity of about 92.5%. In the studied group, the median ADC value was 1.21 (min 0.80, max 1.31) and the average ADC value was 1.14 ± 0.161. The mean ADC value in poorly differentiated tumors was 0.979 × 10−3mm2/s. The mean ADC value in moderately differentiated tumors was 1.112 × 10−3mm2/s. The mean ADC value in well-differentiated tumors was 1.273 × 10−3mm2/s. The sensitivity, specificity, PPV, NPV, and accuracy were higher with addition of DWI and ADC value to conventional MRI reaching 100%, 80%, 83.3%, 100%, and 90%, respectively.
Conclusion
Adding DW imaging with ADC value to conventional MRI yields better diagnostic accuracy than using conventional MR imaging alone in detection, correlation with tumor histologic grade, initial staging, and response evaluation to neoadjuvant chemoradiotherapy in patients with locally advanced colorectal cancer.
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Vendrely V, Rullier E. [Rectal Cancer: Organ preservation and neoadjuvant treatment escalation]. Bull Cancer 2021; 108:1126-1131. [PMID: 34802716 DOI: 10.1016/j.bulcan.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/17/2021] [Indexed: 11/15/2022]
Abstract
Standard treatment consisting of chemoradiotherapy followed by radical surgery with total mesorectal excision, results in good oncologic local control but high morbidity and poor functional results. Since chemoradiotherapy results in 15% pathological complete response, even reaching up to 30% in case of association with neoadjuvant chemotherapy, radical surgery has been recently debated for good responders. Therefore, a de-escalation strategy, by omitting radical surgery in good responders, has recently been developed with two different options: a watch and wait strategy, requiring an accurate clinical and radiological definition of complete response and a local excision strategy including patients with sub-complete response. Ongoing trials focus on response optimization by chemotherapy intensification or radiotherapy dose escalation. However, many questions are still to be answered regarding definition of complete response, follow-up strategy, morbidity of salvage surgery in case of recurrence as well as long-term oncological and functionnal results.
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Affiliation(s)
- Véronique Vendrely
- Hôpital Haut Lévêque, université de Bordeaux, service d'oncologie radiothérapie, avenue de Magellan, 33604 Pessac cédex, France.
| | - Eric Rullier
- Hôpital Haut Lévêque, université de Bordeaux, service de chirurgie centre Magellan, avenue de Magellan, 33604 Pessac cédex, France
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Chiloiro G, Cusumano D, de Franco P, Lenkowicz J, Boldrini L, Carano D, Barbaro B, Corvari B, Dinapoli N, Giraffa M, Meldolesi E, Manfredi R, Valentini V, Gambacorta MA. Does restaging MRI radiomics analysis improve pathological complete response prediction in rectal cancer patients? A prognostic model development. Radiol Med 2021; 127:11-20. [PMID: 34725772 DOI: 10.1007/s11547-021-01421-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/14/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Our study investigated the contribution that the application of radiomics analysis on post-treatment magnetic resonance imaging can add to the assessments performed by an experienced disease-specific multidisciplinary tumor board (MTB) for the prediction of pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC). MATERIALS AND METHODS This analysis included consecutively retrospective LARC patients who obtained a complete or near-complete response after nCRT and/or a pCR after surgery between January 2010 and September 2019. A three-step radiomics features selection was performed and three models were generated: a radiomics model (rRM), a multidisciplinary tumor board model (yMTB) and a combined model (CM). The predictive performance of models was quantified using the receiver operating characteristic (ROC) curve, evaluating the area under curve (AUC). RESULTS The analysis involved 144 LARC patients; a total of 232 radiomics features were extracted from the MR images acquired post-nCRT. The yMTB, rRM and CM predicted pCR with an AUC of 0.82, 0.73 and 0.84, respectively. ROC comparison was not significant (p = 0.6) between yMTB and CM. CONCLUSION Radiomics analysis showed good performance in identifying complete responders, which increased when combined with standard clinical evaluation; this increase was not statistically significant but did improve the prediction of clinical response.
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Affiliation(s)
- Giuditta Chiloiro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Paola de Franco
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy.
| | - Jacopo Lenkowicz
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Davide Carano
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Brunella Barbaro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Barbara Corvari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Nicola Dinapoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Martina Giraffa
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Elisa Meldolesi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
| | - Riccardo Manfredi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Roma, Italy
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Kokaine L, Gardovskis A, Gardovskis J. Evaluation and Predictive Factors of Complete Response in Rectal Cancer after Neoadjuvant Chemoradiation Therapy. ACTA ACUST UNITED AC 2021; 57:medicina57101044. [PMID: 34684080 PMCID: PMC8537499 DOI: 10.3390/medicina57101044] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 12/18/2022]
Abstract
The response to neoadjuvant chemoradiation therapy is an important prognostic factor for locally advanced rectal cancer. Although the majority of the patients after neoadjuvant therapy are referred to following surgery, the clinical data show that complete clinical or pathological response is found in a significant proportion of the patients. Diagnostic accuracy of confirming the complete response has a crucial role in further management of a rectal cancer patient. As the rate of clinical complete response, unfortunately, is not always consistent with pathological complete response, accurate diagnostic parameters and predictive markers of tumor response may help to guide more personalized treatment strategies and identify potential candidates for nonoperative management more safely. The management of complete response demands interdisciplinary collaboration including oncologists, radiotherapists, radiologists, pathologists, endoscopists and surgeons, because the absence of a multidisciplinary approach may compromise the oncological outcome. Prediction and improvement of rectal cancer response to neoadjuvant therapy is still an active and challenging field of further research. This literature review is summarizing the main, currently known clinical information about the complete response that could be useful in case if encountering such condition in rectal cancer patients after neoadjuvant chemoradiation therapy, using as a source PubMed publications from 2010–2021 matching the search terms “rectal cancer”, “neoadjuvant therapy” and “response”.
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Affiliation(s)
- Linda Kokaine
- Department of Surgery, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; or
- Pauls Stradins Clinical University Hospital, Pilsoņu Street 13, LV-1002 Riga, Latvia
- Correspondence: (L.K.); (J.G.); Tel.: +371-2635-9472 (L.K.)
| | - Andris Gardovskis
- Department of Surgery, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; or
- Pauls Stradins Clinical University Hospital, Pilsoņu Street 13, LV-1002 Riga, Latvia
| | - Jānis Gardovskis
- Department of Surgery, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; or
- Pauls Stradins Clinical University Hospital, Pilsoņu Street 13, LV-1002 Riga, Latvia
- Correspondence: (L.K.); (J.G.); Tel.: +371-2635-9472 (L.K.)
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50
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Li D, Cui Y, Hou L, Bian Z, Yang Z, Xu R, Jia Y, Wu Z, Yang X. Diffusion kurtosis imaging-derived histogram metrics for prediction of resistance to neoadjuvant chemoradiotherapy in rectal adenocarcinoma: Preliminary findings. Eur J Radiol 2021; 144:109963. [PMID: 34562744 DOI: 10.1016/j.ejrad.2021.109963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE This study aimed to evaluate the potential role of diffusion kurtosis imaging (DKI)-derived parameters for assessing resistance to CRT in patients with Locally advanced rectal cancer (LARC) by using histogram analysis derived from whole-tumor volumes. METHOD 136 consecutive patients with histologically confirmed rectal adenocarcinoma who underwent MRI examination before and after chemoradiotherapy were enrolled in our retrospective study. The parameters D, K, and conventional apparent diffusion coefficient (ADC) were measured using whole-tumor volume histogram analysis. The AJCC tumor regression grading (TRG) system was the standard reference (resistance: TRG 3; non-resistance: TRG 0-2). Receiver operating characteristic (ROC) curves were used for evaluating the diagnostic performance. RESULTS Aside from the skew and kurtosis values, we found all the histogram metrics of D and ADC values significantly increased after CRT (all p < 0.001). In contrast, the histogram metrics of K values significantly decreased after CRT. The majority of percentiles metrics of D, K, and ADC values were correlated with tumor resistance before and after CRT (P < 0.05), except for the skew and kurtosis values. Regarding the comparison of the diagnostic performance of all the histogram metrics, the percentage Dmean change (ΔDmean) showed the highest AUC value of 0.939, and the corresponding sensitivity, specificity, PPV, and NPV were 84.1% and 94.6%, 88.1% and 92.6%, respectively. CONCLUSIONS These preliminary results demonstrated that DKI-derived histogram metrics, especially the pre-treatment metrics and ΔDmean, were useful to assess tumoral resistance to CRT and individual clinical management for patients with LARC.
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Affiliation(s)
- Dandan Li
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Medical University, Taiyuan 030013, China
| | - Yanfen Cui
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Medical University, Taiyuan 030013, China
| | - Lina Hou
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Medical University, Taiyuan 030013, China
| | - Zeyu Bian
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Medical University, Taiyuan 030013, China
| | - Zhao Yang
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Medical University, Taiyuan 030013, China
| | - Ruxin Xu
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Medical University, Taiyuan 030013, China
| | - Yaju Jia
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Medical University, Taiyuan 030013, China
| | - Zhifang Wu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China; Shanxi Medical University, Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan 030001, Shanxi, China.
| | - Xiaotang Yang
- Department of Radiology, Shanxi Province Cancer Hospital, Shanxi Medical University, Taiyuan 030013, China.
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