TY - JOUR
T1 - Response assessment after (chemo)radiotherapy for rectal cancer
T2 - Why are we missing complete responses with MRI and endoscopy?
AU - van der Sande, Marit E.
AU - Beets, Geerard L.
AU - Hupkens, Britt J. P.
AU - Breukink, Stephanie O.
AU - Melenhorst, Jarno
AU - Bakers, Frans C. H.
AU - Lambregts, Doenja M. J.
AU - Grabsch, Heike I.
AU - Beets-Tan, Regina G. H.
AU - Maas, Monique
N1 - Publisher Copyright:
© 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
PY - 2019/6
Y1 - 2019/6
N2 - Purpose: To evaluate what features on restaging MRI and endoscopy led to a false clinical diagnosis of residual tumour in patients with a pathological complete response after rectal cancer surgery.Methods: Patients with an unrecognized complete response after (chemo)radiotherapy were selected in a tertiary referral centre for rectal cancer treatment. An unrecognized complete response was defined as a clinical incomplete response at MRI and/or endoscopy with a pathological complete response of the primary tumour after surgery. The morphology of the tumour bed and the lymph nodes were evaluated on post-CRT T2-weighted MRI (T2-MRI) and diffusion weighted imaging (DWI). Post-CRT endoscopy images were evaluated for residual mucosal abnormalities. MRI and endoscopy features were correlated with histopathology.Results: Thirty-six patients with an unrecognized complete response were included. Mucosal abnormalities were present at restaging endoscopy in 84%, mixed signal intensity on T2-MRI in 53%, an irregular aspect of the former tumour location on T2-MRI in 69%, diffusion restriction on DWI in 51% and suspicious lymph nodes in 25%.Conclusions: Overstaging of residual tumour after (chemo)radiotherapy in rectal cancer is mainly due to residual mucosal abnormalities at endoscopy, mixed signal intensity or irregular fibrosis at T2-MRI, diffusion restriction at DWI and residual suspicious lymph nodes. Presence of these features is not definitely associated with residual tumour and in selected cases an extended waiting interval can be considered. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
AB - Purpose: To evaluate what features on restaging MRI and endoscopy led to a false clinical diagnosis of residual tumour in patients with a pathological complete response after rectal cancer surgery.Methods: Patients with an unrecognized complete response after (chemo)radiotherapy were selected in a tertiary referral centre for rectal cancer treatment. An unrecognized complete response was defined as a clinical incomplete response at MRI and/or endoscopy with a pathological complete response of the primary tumour after surgery. The morphology of the tumour bed and the lymph nodes were evaluated on post-CRT T2-weighted MRI (T2-MRI) and diffusion weighted imaging (DWI). Post-CRT endoscopy images were evaluated for residual mucosal abnormalities. MRI and endoscopy features were correlated with histopathology.Results: Thirty-six patients with an unrecognized complete response were included. Mucosal abnormalities were present at restaging endoscopy in 84%, mixed signal intensity on T2-MRI in 53%, an irregular aspect of the former tumour location on T2-MRI in 69%, diffusion restriction on DWI in 51% and suspicious lymph nodes in 25%.Conclusions: Overstaging of residual tumour after (chemo)radiotherapy in rectal cancer is mainly due to residual mucosal abnormalities at endoscopy, mixed signal intensity or irregular fibrosis at T2-MRI, diffusion restriction at DWI and residual suspicious lymph nodes. Presence of these features is not definitely associated with residual tumour and in selected cases an extended waiting interval can be considered. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
KW - Rectal cancer
KW - Organ preservation
KW - Complete response
KW - Magnetic resonance imaging
KW - Endoscopy
KW - COMPLETE CLINICAL-RESPONSE
KW - DIFFUSION-WEIGHTED MRI
KW - TERM-FOLLOW-UP
KW - NEOADJUVANT CHEMORADIATION
KW - ORGAN PRESERVATION
KW - CHEMORADIOTHERAPY
KW - THERAPY
KW - CRITERIA
U2 - 10.1016/j.ejso.2018.11.019
DO - 10.1016/j.ejso.2018.11.019
M3 - Article
C2 - 30528891
SN - 0748-7983
VL - 45
SP - 1011
EP - 1017
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 6
ER -