Restaging MRI of Rectal Adenocarcinoma after Neoadjuvant                     Chemoradiotherapy: Imaging Findings and Potential Pitfalls

Awiwi, Muhammad O.; Kaur, Harmeet; Ernst, Randy D.; Rauch, Gaiane M.; Morani, Ajaykumar C.; Stanietzky, Nir; Palmquist, Sarah; Salem, Usama

doi:10.1148/rg.220135

Cited by 7 publications

(6 citation statements)

References 73 publications

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“…Overall pCR rate has been previously reported to be 8%-30%. 3,14 One study revealed that, even when residual tumor is identified at staging MRI, DRE, and surgeon-led endoscopy, the pCR rate is 15%. 3 Restaging near-complete responders to NT instead of taking these patients directly to TME may allow a higher number of clinical complete responses and fewer pCR.…”

Section: Resultsmentioning

confidence: 99%

“…3,14 One study revealed that, even when residual tumor is identified at staging MRI, DRE, and surgeon-led endoscopy, the pCR rate is 15%. 3 Restaging near-complete responders to NT instead of taking these patients directly to TME may allow a higher number of clinical complete responses and fewer pCR. Taking into consideration the staging limitations differentiating complete and equivocal abnormalities that suggest possible clinical near-complete response, the more recently reported "optimum" pCR rate is about 10%-11%.…”

Section: Resultsmentioning

confidence: 99%

“…Overall pCR rate has been previously reported to be 8%–30% 3,14 . One study revealed that, even when residual tumor is identified at staging MRI, DRE, and surgeon‐led endoscopy, the pCR rate is 15% 3 .…”

Section: Discussionmentioning

confidence: 99%

“…Advances in magnetic resonance imaging (MRI) have allowed an increase in the adoption of organ preservation without rectal resection for those patients having a clinical complete response (cCR) after neoadjuvant therapy (NT). [1][2][3] cCR is characterized by no evidence of residual neoplasm by digital rectal exam, endoscopic examination, and MRI. Studies to date suggest a local recurrence (tumor regrowth) rate of 20%-30% after cCR, and acceptable outcomes with salvage rectal resection for regrowth.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Operative trends following the adoption of nonoperative management of rectal cancer

Brewer,

Kamara,

Huebner

et al. 2024

Journal of Surgical Oncology

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BackgroundDifferentiating clinical near‐complete and complete responses (cCR) after neoadjuvant therapy (NT) is challenging in rectal cancer patients. We hypothesized that magnetic resonance imaging staging limitations for low rectal cancers may increase the proportion of abdominoperineal resection (APR) with permanent colostomy for those without a cCR.MethodsSingle institution retrospective analysis of rectal cancer cases before and after adoption of nonoperative “watch and wait” (W&W) pathway. APR as a percentage of rectal resections was the primary outcome.ResultsThere were 76 total mesorectal excisions (TME) in the pre‐W&W group and 98 in the post‐W&W group. NT was significantly more common in the post‐W&W group. There was no significant difference in the APR primary outcome (pre‐W&W APR 33.3% vs. post‐W&W APR 26.5%, p = 0.482). APR patients had fewer complete TME grades (69.2% vs. 46.2%) and more pathologic complete responses (0% vs. 26.9%) in the post‐W&W period. The cCR rate for patients with nonoperative management was 51.4% (n = 37) and 13.5% (n = 5) had regrowths, all of whom underwent salvage surgery.ConclusionAPR for those without a cCR to NT has not increased in the nonoperative management era. Balancing the pathologic complete response rate may require restaging some patients with clinical near‐complete responses.

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Section: Resultsmentioning

confidence: 99%