Long-term follow-up features on rectal mri during a wait-and-see approach after a clinical complete response in patients with rectal cancer treated with chemoradiotherapy

D.M. Lambregts, M. Maas, F.C. Bakers, V.C. Cappendijk, G. Lammering, G.L. Beets, R.G. Beets Tan

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Abstract

BACKGROUND: : The "wait-and-see" policy instead of standard surgery for patients with rectal cancer who undergo a complete tumor regression after chemoradiation treatment is highly controversial. It is not clear yet how patients should be monitored once they are managed nonoperatively and whether follow-up by MRI has any potential role. OBJECTIVE: : This study aimed to describe the rectal wall MRI morphology during short-term and long-term follow-up in patients with a clinical complete tumor response undergoing a wait-and-see policy without surgical treatment. DESIGN, SETTING, AND PATIENTS: : As part of an observational study in our center, a cohort of 19 carefully selected patients with a clinical complete response after chemoradiation was managed with a wait-and-see policy and followed regularly (every 3-6 mo) by clinical examination, endoscopy with biopsies, and a rectal MRI. The MR morphology of the tumor bed was studied on the consecutive MRI examinations. MAIN OUTCOME MEASURES: : The primary outcome measured was the morphology of the tumor bed on the consecutive MRI examinations performed during short-term (</=6 mo) and long-term (>6 mo) follow-up. RESULTS: : Patients with a complete tumor response after chemoradiation presented with either a normalized rectal wall (26%) or fibrosis (74%). In the latter group, 3 patterns of fibrosis were observed (full-thickness, minimal, or spicular fibrosis). The morphology patterns of a normalized rectal wall or fibrosis remained consistent during long-term follow-up in 18 of 19 patients. One patient developed a small, endoluminal recurrence, which was salvaged with transanal endoscopic microsurgery. In 26% of patients, an edematous wall thickening was observed in the first months after chemoradiation, which gradually decreased during long-term follow-up. Median follow-up was 22 months (range, 12-60). LIMITATIONS: : This was a small observational study, and had no histological validation. CONCLUSIONS: : Four MR patterns of a persistent complete response of rectal cancer after chemoradiation were identified. These MR features can serve as a reference for the follow-up in a wait-and-see policy.
Original languageEnglish
Pages (from-to)1521-1528
Number of pages8
JournalDiseases of the Colon & Rectum
Volume54
Issue number12
DOIs
Publication statusPublished - Dec 2011

Keywords

  • Locally advanced rectal cancer
  • Complete tumor response
  • Wait-and-see policy
  • Follow-up
  • MRI
  • DWI
  • NEOADJUVANT CHEMORADIATION THERAPY
  • RADIATION-THERAPY
  • NONOPERATIVE TREATMENT
  • TUMOR RESPONSE
  • CHEMOTHERAPY
  • DIAGNOSIS
  • EXCISION

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