Modern multidisciplinary treatment of rectal cancer based on staging with magnetic resonance imaging leads to excellent local control, but distant control remains a challenge

Abstract

With a differentiated multimodality treatment based on dedicated preoperative MR imaging, local recurrence is no longer the main problem in rectal cancer treatment. The new challenges are early diagnosis and treatment, reducing morbidity of treatment and preferably prevention of metastatic disease.

Circumferential resection margin as a prognostic factor after rectal cancer surgery: A large population‐based retrospective study

“…While several studies showed that CRM should not be used as a prognostic factor in rectal cancer,4, 5 other studies demonstrated the importance of CRM as an independent prognostic factor of local recurrence and long‐term survival,6, 7, 8, 9 including the first report by Quirke et al10 suggesting that CRM might be a strong predictor of long‐term oncologic outcomes. According to the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for rectal cancer, CRM is defined as involved if it is ≤1 mm from the tumor‐free margin, leading to an increased risk of local recurrence, distant metastases, and poorer survival 11…”

MRI volumetry for prediction of tumour response to neoadjuvant chemotherapy followed by chemoradiotherapy in locally advanced rectal cancer

“…2,5,6 At present, the challenge is to reduce treatment morbidity and prevent metastatic disease. 5 It has recently been advocated that customized and individualized treatment strategies may result in a more optimal balance between over-and undertreatment.…”

“…2,5,6 At present, the challenge is to reduce treatment morbidity and prevent metastatic disease. 5 It has recently been advocated that customized and individualized treatment strategies may result in a more optimal balance between over-and undertreatment. 9,25 The promising results of our study and the studies of Nougaret et al 16 and Aiba et al 17 support that MRI volumetry after NACT can be used to stratify good responders into studies exploring individualized, less extensive treatment regimens, such as omission of RT and less extensive surgery, or even deferral of surgery.…”

“…In addition, a studyspecific MRI was performed after NACT and the first three RT fractions, MRI NACT . The median time from MRI PRE to the start of NACT was 5 days (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], and the median time from MRI CRT to surgery was 20 days (range, 7-98). 41 of the study patients were imaged using a 1.5-T GE Signa® LS scanner (GE Healthcare, Milwaukee, WI) with a phased-array torso coil.…”

“…[2][3][4] On the other hand, modern multimodal treatment based on MRI leads to excellent local control, but distant control remains a challenge. 5,6 Reliable identification of good and poor responders at an early stage could allow for more individualized, effective and less toxic treatment of these patients.…”