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MRIs were able to predict organ preservation and survival with the “watch-and-wait” approach in patients with rectal cancer.
Among patients with locally advanced rectal cancer who were treated with total neoadjuvant therapy and whose doctors continue to monitor for signs of cancer recurrence or spread, the MRI response category was able to predict organ preservation and survival.
According to study findings published in Radiology, “Restaging MRI can stratify patients treated with total neoadjuvant therapy into clinical response categories predictive of organ preservation, local regrowth and survival,” the study authors wrote.
Restricted diffusion, which often indicates areas of inflammation or damage, and abnormal nodal morphologic features, indicating signs of the disease, on restaging MRI scans were associated with an increased likelihood of any remaining cancer cells after treatment.
Neoadjuvant: treatment given before surgery.
Restaging MRI: MRI scans after treatment to assess tumor response.
Complete clinical response (cCR): no evidence of tumor on MRI.
non-complete clinical response (nCR): some residual tumor but no viable tumor cells.
incomplete clinical response (iCR): tumor still present and likely viable.
After a median follow-up of 4.1 years, patients with complete clinical response (cCR) had higher rates of organ preservation compared with those with non-complete clinical response (nCR), at 65.3% versus 41.6%, respectively. Five-year disease-free survival was 81.8% for cCR, 67.6% for nCR and 49.6% for incomplete clinical response (iCR). The MRI response category also predicted overall survival, distant recurrence-free survival and local regrowth. Among the 266 participants with at least two years of follow-up, 129 had restricted diffusion. An analysis showed that the presence of restricted diffusion and abnormal nodal morphologic features remained independently associated with restricted diffusion.
“After undergoing chemotherapy and radiation for rectal cancer, patients are understandably concerned whether their cancer is gone or whether there may be some leftover disease. Using newer MRI techniques, we are now able to predict much better than in the past whether any cancer remains and, if so, whether it will come back and spread,” Dr. Arun Krishnaraj, radiologist, imaging expert and director of UVA Health’s Division of Body Imaging, said in a news release issued by UVA Health. “No one wants to get surgery if they can avoid it. Now we have a powerful tool to help patients and their doctors predict who would benefit from surgery after initial chemotherapy and radiation and who can likely avoid surgery.”
According to a news release issued by UVA Health, MRIs can help many patients with rectal cancer avoid invasive surgery, which often comes with lifelong side effects, according to new research. The study shows that MRIs can predict patient outcomes and assess the risk of tumor recurrence or spread in individuals who have received chemotherapy and radiation.
The release also stated that this information could be invaluable in determining the most appropriate treatment and deciding whether a patient can opt for a “watch and wait” approach instead of surgery. In the watch-and-wait approach, doctors monitor patients for signs of cancer recurrence or spread, postponing surgery while potentially leaving patients feeling uncertain about their future. The insights provided by MRIs would be beneficial for both doctors and patients, as the findings suggest.
A total of 277 patients, with a median age of 58 years old, who participated in the OPRA trial had restaging MRI forms completed.
“I am optimistic that continued advancement in MRI and other tools like endoscopy will provide better information about future outcomes,” Krishnaraj said. “Ultimately, I would love to get close to 99% predictive probability in better informing our patients about their potential risk for recurrence or spread of their cancers following treatment. We may not be there quite yet, but that is our goal.”
The primary focus of the trial was to assess the association between cCR, nCR and iCR with oncological outcomes.
Reference
“MRI Predicts Residual Disease and Outcomes in Watch-and-Wait Patients with Rectal Cancer” by Dr. Hannah Williams, et al., Radiology.
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