DWI for Assessment of Rectal Cancer Nodes After Chemoradiotherapy: Is the Absence of Nodes at DWI Proof of a Negative Nodal Status?

Heeswijk, Miriam M. van; Lambregts, Doenja M. J.; Palm, Walter M.; Hendriks, Babs M. F.; Maas, Monique; Beets, Geerard L.; Beets‐Tan, Regina G. H.

doi:10.2214/ajr.16.17117

Cited by 59 publications

(39 citation statements)

References 37 publications

(59 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…After CRT, evaluating nodal size in the short axis is more reliable than evaluating borders and shape to assess for residual malignancy (33). The absence of lymph nodes at DWI, the decrease in size in at least 70% of lymph nodes, and a nodal size less than 2.5 mm in the short axis have been shown to be reliable predictors of negative node status after surgery (Fig 16) (71).…”

Section: Assessing Other Posttreatment Featuresmentioning

confidence: 99%

MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management

et al. 2019

View full text Add to dashboard Cite

Rectal cancer is prone to local recurrence and systemic metastasis. However, owing to improvements in TNM staging and treatment, including a more widespread use of rectal MRI and increased radiologist awareness of the key rectal cancer TNM staging features, the mortality rate of rectal cancer has been declining over the past few decades in adults over 50 years of age. Currently, rectal MRI plays a key role in the pre-and posttreatment evaluation of rectal cancer, assisting the multidisciplinary team in tailoring the most appropriate treatment option. The benefits achieved with rectal MRI are strictly dependent on obtaining good-quality images, which is important for the characterization of the main anatomic structures and their relationship with the tumor. In primary staging, rectal MRI helps the radiologist (a) describe the tumor location and morphology, (b) provide its T and N categories, (c) detect the presence of extramural vascular invasion, and (d) identify its relationship with surrounding structures, including the sphincter complex and involvement of the mesorectal fascia. These features help diagnose locally advanced rectal tumors (categories T3c-d, T4, N1, and N2), for which neoadjuvant chemoradiotherapy (CRT) is indicated. In restaging after neoadjuvant CRT, in addition to reassessing the features noted during primary staging, rectal MRI can help in the assessment of treatment response, especially with the emergence of nonsurgical approaches such as "watch and wait." © RSNA, 2019 • radiographics.rsna.org

show abstract

Section: Assessing Other Posttreatment Featuresmentioning

confidence: 99%

MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Accordingly, a recent consensus statement recommended using nodal size for follow-up assessment after neoadjuvant therapy (with nodes whose short axis diameter is < 5 mm considered benign), given the absence of other reliable criteria[ 16 ]. However, several studies have reported the presence of small groups of residual cancerous cells in a significant number of small nodes (up to 3 mm), a finding that limits the sensitivity of this criterion[ 67 , 69 , 70 ]. Some authors have suggested that these foci could show a late response to treatment, but this hypothesis is unconfirmed and controversial[ 10 , 71 , 72 ].…”

Section: Diagnosis and Reassessmentmentioning

confidence: 99%

Watch and wait approach in rectal cancer: Current controversies and future directions

López-Campos¹,

Martín²,

Pérez³

et al. 2020

WJG

View full text Add to dashboard Cite

According to the main international clinical guidelines, the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. However, doubts have been raised about the appropriate definition of clinical complete response (cCR) after neoadjuvant therapy and the role of surgery in patients who achieve a cCR. Surgical resection is associated with significant morbidity and decreased quality of life (QoL), which is especially relevant given the favourable prognosis in this patient subset. Accordingly, there has been a growing interest in alternative approaches with less morbidity, including the organ-preserving watch and wait strategy, in which surgery is omitted in patients who have achieved a cCR. These patients are managed with a specific follow-up protocol to ensure adequate cancer control, including the early identification of recurrent disease. However, there are several open questions about this strategy, including patient selection, the clinical and radiological criteria to accurately determine cCR, the duration of neoadjuvant treatment, the role of dose intensification (chemotherapy and/or radiotherapy), optimal follow-up protocols, and the future perspectives of this approach. In the present review, we summarize the available evidence on the watch and wait strategy in this clinical scenario, including ongoing clinical trials, QoL in these patients, and the controversies surrounding this treatment approach.

show abstract

“…Both the accuracy for assessing response and interreader agreement improved significantly compared to the more well-known 5-point mrTRG score which uses T 2 W-MRI only. 46 A single report by Park and colleagues evaluated the use of DWI in addition to T 2 W-MRI to predict tumour clearance of the MRF after neoadjuvant CRT. 38 The authors reported a significantly improved performance after the addition of DWI (AUC 0.92-0.96) compared to use of only T 2 W MRI (AUC 0.77-0.85).…”

Section: Tumour Restagingmentioning

confidence: 99%

Diffusion-weighted imaging in rectal cancer: current applications and future perspectives

Schurink

Lambregts

Beets‐Tan

2019

The British Journal of Radiology

113

View full text Add to dashboard Cite

This paper aims to give an overview of the various clinical applications of DWI and discuss their potential role for rectal cancer imaging. PRiMARy RectAl cANceR stAgiNg Rectal tumour detection The main goal of MRI for rectal cancer is staging rather than tumour detection, since typically the presence of tumour has already been established by endoscopy or CT-colonography. 2 It is probably therefore that only a few studies have focused on DWI for the primary detection of rectal cancer. 3-10 Nevertheless, published reports have shown consistently good results for DWI to detect rectal tumours. In a recent meta-analysis, albeit focusing on colorectal tumours in general and not specifically on rectal cancer, pooled sensitivity, specificity and area under the curve (AUC) were 95%, 93% and 0.98, respectively. 11

show abstract

DWI for Assessment of Rectal Cancer Nodes After Chemoradiotherapy: Is the Absence of Nodes at DWI Proof of a Negative Nodal Status?

Abstract: Although the absence of nodes at DWI is not a frequent finding, it appears to be a reliable predictor of yN0 status after CRT in patients with rectal cancer. DWI may thus be a helpful adjunct in assessing response after CRT and may help select patients for organ-saving treatment.

Cited by 59 publications

References 37 publications

MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management

MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management

Watch and wait approach in rectal cancer: Current controversies and future directions

Diffusion-weighted imaging in rectal cancer: current applications and future perspectives

Contact Info

Product

Resources

About