MRI Evaluation of Complete and Near-Complete Response after Neoadjuvant Therapy in Patients with Locally Advanced Rectal Cancer

Popița, Anca-Raluca; Lisencu, Cosmin; Rusu, Adriana; Popiţa, Cristian; Căinap, Călin; Irimie, Alexandra Iulia; Resiga, Liliana; Fekete, Zsolt; Badea, Radu

doi:10.3390/diagnostics12040921

Cited by 5 publications

(7 citation statements)

References 39 publications

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“…The initial search yielded 3015 articles (Fig. 2 ), from which 71 articles were reviewed, and 4 articles were considered eligible [ 3 , 9 – 11 ]. Three of the studies were retrospective; of these, two were single-center and one was multi-center.…”

Section: Resultsmentioning

confidence: 99%

“…Three of the studies employed rectal microenema, while the other study did not provide this information. Two authors justified the use of microenema to reduce DWI susceptibility artifacts [ 9 , 11 ]. Although it is not a consensus, this approach is aligned with evidence provided by a small sample single-center study that reported better quality in DWI with reduced geometric distortion from rectal gas [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…A disruption of the hypointense scar by intermediate T2WI signal would indicate a residual or recurrent tumor. While the initial study reporting the SSS showed a specificity of 97% in identifying complete responders, subsequent studies have demonstrated variable diagnostic performance [ 3 , 9 – 11 ].

Fig.…”

Section: Introductionmentioning

confidence: 99%

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Split scar sign to predict complete response in rectal cancer after neoadjuvant chemoradiotherapy: systematic review and meta-analysis

Torri,

Wiethan,

Langer

et al. 2023

Eur Radiol

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Objectives Magnetic resonance imaging (MRI) is the modality of choice for rectal cancer initial staging and restaging after neoadjuvant chemoradiation. Our objective was to perform a meta-analysis of the diagnostic performance of the split scar sign (SSS) on rectal MRI in predicting complete response after neoadjuvant therapy. Methods MEDLINE, EMBASE, and Cochrane databases were searched for relevant published studies through June 2023. Primary studies met eligibility criteria if they evaluated the diagnostic performance of the SSS to predict complete response on pathology or clinical follow-up in patients undergoing neoadjuvant chemoradiation. A meta-analysis with a random-effects model was used to estimate pooled sensitivity and specificity, area under the curve (AUC), and diagnostic odds ratio (DOR) of the SSS. Results A total of 4 studies comprising 377 patients met the inclusion criteria. The prevalence of complete response in the studies was 21.7–52.5%. The pooled sensitivity and specificity of the SSS to predict complete response were 62.0% (95% CI, 43.5–78.5%) and 91.9% (95% CI, 78.9–97.2%), respectively. The estimated AUC for SSS was 0.83 (95% CI, 0.56–0.94) with a DOR of 18.8 (95% CI, 3.65–96.5). Conclusion The presence of SSS on rectal MRI demonstrated high specificity for complete response in patients with rectal cancer after neoadjuvant chemoradiation. This imaging pattern can be a valuable tool to identify potential candidates for organ-sparing treatment and surveillance. Clinical relevance statement SSS presents high specificity for complete response post-neoadjuvant. This MRI finding enhances rectal cancer treatment assessment and aids clinicians and patients in choosing watch-and-wait over immediate surgery, which can potentially reduce costs and associated morbidity. Key Points •Fifteen to 50% of rectal cancer patients achieve complete response after neoadjuvant chemoradiation and may be eligible for a watch-and-wait strategy. •The split scar sign has high specificity for a complete response. •This imaging finding is valuable to select candidates for organ-sparing management.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Split scar sign to predict complete response in rectal cancer after neoadjuvant chemoradiotherapy: systematic review and meta-analysis

Torri,

Wiethan,

Langer

et al. 2023

Eur Radiol

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“…RT and/or CT are often used to treat LARC, followed by total excision of the mesorectum (4)(5)(6)(7). This treatment approach has been shown to reduce tumour size and stage, and can result in a pathological complete response in 10% to 25% of patients (6,8,9). Patients who have achieved a complete response after NAT can benefit from less invasive treatment options, such as local resection with anal sphincter sparing and the nonsurgical approach after NAT known as Watch and Wait (6,8,(10)(11)(12).…”

Section: Introduction Introductionmentioning

confidence: 99%

Assessment of Response to Neoadjuvant Therapy using Magnetic Rresonance Imaging in Rectal Cancer: Comparison with Anatomopathological Study

Ramos,

Simoes,

Amorim

et al. 2024

SGO

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Introduction: MRI is one of the main tools for staging and assessing response to neoadjuvant therapy in locally advanced rectal cancer. However, there is no consensus on its role in restaging. The aim of this retrospective study was to assess the imaging response with MRI and to compare restaging MRI with histopathological findings in patients with locally advanced rectal cancer who underwent neoadjuvant therapy. Material and Method: A significant difference was found between staging and restaging MRI in clinical stage T (Z=-5.03, p<0.001) and N (Z=-5.15, p<0.001), tumour length (t(56)=10.35, p<0.001), mesorectal fascia status (p=0.004), and number of suspicious mesorectal lymph nodes (Z=-5.24, p<0.001). Results: The agreement between restaging MRI and pathology was moderate for stage T and the status of the circumferential resection margin (K=0.58 and K=0.46, respectively, p=0.001), and low for stage N (K=0.34, p=0.005). Over-staging with MRI occurred in 34.4% of cases for stage T and 22.2% for stage N. Conclusion: Restaging MRI is essential for evaluating the response to neoadjuvant therapy in locally advanced rectal carcinoma. However, it should not be the sole basis for therapeutic decisions as its concordance with anatomopathological study is limited.

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“…However, no consensus exists for any reliable and reproducible methods for accurate prediction before operation. The mrTRG, proposed by the MERCURY research team ( 11 ), was demonstrated in several studies ( 10 , 12 , 13 ) to have a significant association with pCR, while a recent meta-analysis reported that mrTRG exhibited superior specificity (93.5%) for pCR, but inferior sensitivity (32.3%) ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

A multiple-time-scale comparative study for the added value of magnetic resonance imaging-based radiomics in predicting pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Peng,

Wan,

Wang

et al. 2023

Front. Oncol.

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ObjectiveRadiomics based on magnetic resonance imaging (MRI) shows potential for prediction of therapeutic effect to neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC); however, thorough comparison between radiomics and traditional models is deficient. We aimed to construct multiple-time-scale (pretreatment, posttreatment, and combined) radiomic models to predict pathological complete response (pCR) and compare their utility to those of traditional clinical models.MethodsIn this research, 165 LARC patients undergoing nCRT followed by surgery were enrolled retrospectively, which were divided into training and testing sets in the ratio of 7:3. Morphological features on pre- and posttreatment MRI, coupled with clinical data, were evaluated by univariable and multivariable logistic regression analysis for constructing clinical models. Radiomic parameters were derived from pre- and posttreatment T2- and diffusion-weighted images to develop the radiomic signatures. The clinical-radiomics models were then generated. All the models were developed in the training set and then tested in the testing set, the performance of which was assessed using the area under the receiver operating characteristic curve (AUC). Radiomic models were compared with the clinical models with the DeLong test.ResultsOne hundred and sixty-five patients (median age, 55 years; age interquartile range, 47–62 years; 116 males) were enrolled in the study. The pretreatment maximum tumor length, posttreatment maximum tumor length, and magnetic resonance tumor regression grade were selected as independent predictors for pCR in the clinical models. In the testing set, the pre- and posttreatment and combined clinical models generated AUCs of 0.625, 0.842, and 0.842 for predicting pCR, respectively. The MRI-based radiomic models performed reasonably well in predicting pCR, but neither the pure radiomic signatures (AUCs, 0.734, 0.817, and 0.801 for the pre- and posttreatment and combined radiomic signatures, respectively) nor the clinical-radiomics models (AUCs, 0.734, 0.860, and 0.801 for the pre- and posttreatment and combined clinical-radiomics models, respectively) showed significant added value compared with the clinical models (all P > 0.05).ConclusionThe MRI-based radiomic models exhibited no definite added value compared with the clinical models for predicting pCR in LARC. Radiomic models can serve as ancillary tools for tailoring adequate treatment strategies.

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MRI Evaluation of Complete and Near-Complete Response after Neoadjuvant Therapy in Patients with Locally Advanced Rectal Cancer

Cited by 5 publications

References 39 publications

Split scar sign to predict complete response in rectal cancer after neoadjuvant chemoradiotherapy: systematic review and meta-analysis

Split scar sign to predict complete response in rectal cancer after neoadjuvant chemoradiotherapy: systematic review and meta-analysis

Assessment of Response to Neoadjuvant Therapy using Magnetic Rresonance Imaging in Rectal Cancer: Comparison with Anatomopathological Study

A multiple-time-scale comparative study for the added value of magnetic resonance imaging-based radiomics in predicting pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

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