The split scar sign as an indicator of sustained complete response after neoadjuvant therapy in rectal cancer

Santiago, Inês; Barata, Maria João; Figueiredo, Nuno; Parés, Oriol; Henriques, Vanessa; Galzerano, António; Carvalho, Carlos; Matos, Celso; Heald, R. J.

doi:10.1007/s00330-019-06348-9

Cited by 38 publications

(26 citation statements)

References 33 publications

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“…There are some signs at re-staging MR imaging that, although not validated, may favour a sustained complete response: Normalisation of the rectal wall at re-staging MR imaging has a 100% specificity for a sustained complete response according to the pattern base approach by Lambregts et al [ 32 ]. A positive split scar sign at first re-staging MR imaging may indicate a sustained complete response for a minimum period of 1 year with a specificity of 97%, as per our data [ 49 ] (Figs. 5 , 6 ).…”

Section: Follow-up Of Patients Who Deferred Surgerysupporting

confidence: 77%

“…A positive split scar sign at first re-staging MR imaging may indicate a sustained complete response for a minimum period of 1 year with a specificity of 97%, as per our data [ 49 ] (Figs. 5 , 6 ).…”

Section: Follow-up Of Patients Who Deferred Surgerysupporting

confidence: 77%

“…The split scar sign has a very high specificity (97%) and positive predictive value (93/94%) for a sustained complete response [ 46 ], but it was not yet validated prospectively. It may be found on high resolution T2-WI and is characterised by an organised layered morphologic pattern of the tumour bed after neoadjuvant therapy, composed of an inner thin and regular hypointense band corresponding to the fibrosed submucosa; an intermediate signal intensity layer immediately underneath it, corresponding to a thickened and partially fibrosed muscularis propria ; and an outer, irregular, hypointense layer of mesorectal fibrosis, which may be absent and usually is in staged ≦ T2 tumours [ 49 ]. The split scar sign is explained in greater detail in Fig.…”

Section: Re-staging After Neoadjuvant Therapymentioning

confidence: 99%

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Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide

et al. 2021

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In the past nearly 20 years, organ-sparing when no apparent viable tumour is present after neoadjuvant therapy has taken an increasingly relevant role in the therapeutic management of locally-advanced rectal cancer patients. The decision to include a patient or not in a “Watch-and-Wait” program relies mainly on endoscopic assessment by skilled surgeons, and MR imaging by experienced radiologists. Strict surveillance using the same modalities is required, given the chance of a local regrowth is of approximately 25–30%, almost always surgically salvageable if caught early. Local regrowths occur at the endoluminal aspect of the primary tumour bed in almost 90% of patients, but the rest are deep within it or outside the rectal wall, in which case detection relies solely on MR Imaging. In this educational review, we provide a practical guide for radiologists who are, or intend to be, involved in the re-staging and follow-up of rectal cancer patients in institutions with an established “Watch-and-Wait” program. First, we discuss patient preparation and MR imaging acquisition technique. Second, we focus on the re-staging MR imaging examination and review the imaging findings that allow us to assess response. Third, we focus on follow-up assessments of patients who defer surgery and confer about the early signs that may indicate a sustained/non-sustained complete response, a rectal/extra-rectal regrowth, and the particular prognosis of the “near-complete” responders. Finally, we discuss our proposed report template.

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Section: Follow-up Of Patients Who Deferred Surgerysupporting

confidence: 77%

Section: Follow-up Of Patients Who Deferred Surgerysupporting

confidence: 77%

Section: Re-staging After Neoadjuvant Therapymentioning

confidence: 99%

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Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide

et al. 2021

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“…Alternatively, for 3 patients, a sustained complete clinical response with repeated negative MRI examinations and endoscopy with or without biopsy was considered surrogate for a major pathological response for patients enrolled in watch-and-wait protocols 49 . More in detail, a sustained complete response was defined as a long-term recurrence-free clinical follow-up (minimum follow-up period of 1 year) 50 .…”

Section: Machine Learning: Partial Least Square (Pls) Regressionmentioning

confidence: 99%

MRI-based clinical-radiomics model predicts tumor response before treatment in locally advanced rectal cancer

Pizzi

Chiarelli

Chiacchiaretta

et al. 2021

Sci Rep

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Neoadjuvant chemo-radiotherapy (CRT) followed by total mesorectal excision (TME) represents the standard treatment for patients with locally advanced (≥ T3 or N+) rectal cancer (LARC). Approximately 15% of patients with LARC shows a complete response after CRT. The use of pre-treatment MRI as predictive biomarker could help to increase the chance of organ preservation by tailoring the neoadjuvant treatment. We present a novel machine learning model combining pre-treatment MRI-based clinical and radiomic features for the early prediction of treatment response in LARC patients. MRI scans (3.0 T, T2-weighted) of 72 patients with LARC were included. Two readers independently segmented each tumor. Radiomic features were extracted from both the “tumor core” (TC) and the “tumor border” (TB). Partial least square (PLS) regression was used as the multivariate, machine learning, algorithm of choice and leave-one-out nested cross-validation was used to optimize hyperparameters of the PLS. The MRI-Based “clinical-radiomic” machine learning model properly predicted the treatment response (AUC = 0.793, p = 5.6 × 10–5). Importantly, the prediction improved when combining MRI-based clinical features and radiomic features, the latter extracted from both TC and TB. Prospective validation studies in randomized clinical trials are warranted to better define the role of radiomics in the development of rectal cancer precision medicine.

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“…However, morphological MRI is unable to discriminate between sterilized fibrosis and small viable tumors during restaging [4]. The performance of MRI in identifying complete responders is limited, which is an increasingly important clinical issue given the recent paradigm shift in rectal cancer treatment towards organ-preserving treatments [6,7]. Conventional morphological assessments are also limited in the early prediction of treatment response to nCRT.…”

Section: Introductionmentioning

confidence: 99%

MRI features and texture analysis for the early prediction of therapeutic response to neoadjuvant chemoradiotherapy and tumor recurrence of locally advanced rectal cancer

et al. 2020

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Objectives This study aimed to evaluate the efficiency of imaging features and texture analysis (TA) based on baseline rectal MRI for the early prediction of therapeutic response to neoadjuvant chemoradiotherapy (nCRT) and tumor recurrence in patients with locally advanced rectal cancer (LARC). Methods Consecutive patients with LARC who underwent rectal MRI between January 2014 and December 2015 and surgical resection after completing nCRT were retrospectively enrolled. Imaging features were analyzed, and TA parameters were extracted from the tumor volume of interest (VOI) from baseline rectal MRI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the optimal TA parameter cutoff values to stratify the patients. Logistic and Cox regression analyses were performed to assess the efficacy of each imaging feature and texture parameter in predicting tumor response and disease-free survival. Results In total, 78 consecutive patients were enrolled. In the logistic regression, good treatment response was associated with lower tumor location (OR = 13.284, p = 0.012), low Conv_Min (OR = 0.300, p = 0.013) and high Conv_Std (OR = 3.174, p = 0.016), Shape_Sphericity (OR = 3.170, p = 0.015), and Shape_Compacity (OR = 2.779, p = 0.032). In the Cox regression, a greater risk of tumor recurrence was related to higher cT stage (HR = 5.374, p = 0.044), pelvic side wall lymph node positivity (HR = 2.721, p = 0.013), and gray-level run length matrix_long-run low gray-level emphasis (HR = 2.268, p = 0.046). Conclusions Imaging features and TA based on baseline rectal MRI could be valuable for predicting the treatment response to nCRT for rectal cancer and tumor recurrence. Key Points• Imaging features and texture parameters of T2-weighted MR images of rectal cancer can help to predict treatment response and the risk for tumor recurrence. • Tumor location as well as conventional and shape indices of texture features can help to predict treatment response for rectal cancer. • Clinical T stage, positive pelvic side wall lymph nodes, and the high-order texture parameter, GLRLM_LRLGE, can help to predict tumor recurrence for rectal cancer.

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The split scar sign as an indicator of sustained complete response after neoadjuvant therapy in rectal cancer

Cited by 38 publications

References 33 publications

Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide

Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide

MRI-based clinical-radiomics model predicts tumor response before treatment in locally advanced rectal cancer

MRI features and texture analysis for the early prediction of therapeutic response to neoadjuvant chemoradiotherapy and tumor recurrence of locally advanced rectal cancer

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