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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2020

01-08-2020 | Magnetic Resonance Imaging | Colorectal Cancer

Selection of Patients for Organ Preservation After Chemoradiotherapy: MRI Identifies Poor Responders Who Can Go Straight to Surgery

Authors: Hester E. Haak, MD, Monique Maas, MD, PhD, Max J. Lahaye, MD, PhD, Thierry N. Boellaard, MD, PhD, Andrea Delli Pizzi, MD, Casper Mihl, MD, PhD, Dennis van der Zee, MD, Cristina Fabris, MD, Marit E. van der Sande, MD, Jarno Melenhorst, MD, PhD, Regina G. H. Beets-Tan, MD, PhD, Geerard L. Beets, MD, PhD, Doenja M. J. Lambregts, MD, PhD

Published in: Annals of Surgical Oncology | Issue 8/2020

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Abstract

Objective

The aim of this study was to evaluate whether magnetic resonance imaging (MRI) can accurately identify poor responders after chemoradiotherapy (CRT) who will need to go straight to surgery, and to evaluate whether results are reproducible among radiologists with different levels of expertise.

Methods

Seven independent readers with different levels of expertise retrospectively evaluated the restaging MRIs (T2-weighted + diffusion-weighted imaging [T2W + DWI]) of 62 patients and categorized them as (1) poor responders – highly suspicious of tumor; (2) intermediate responders – tumor most likely; and (3) good – potential (near) complete responders. The reference standard was histopathology after surgery (or long-term follow-up in the case of a watch-and-wait program).

Results

Fourteen patients were complete responders and 48 had residual tumor. The median percentage of patients categorized by the seven readers as ‘poor’, ‘intermediate’, and ‘good’ responders was 21% (range 11–37%), 50% (range 23–58%), and 29% (range 23–42%), respectively. The vast majority of poor responders had histopathologically confirmed residual tumor (73% ypT3-4), with a low rate (0–5%) of ‘missed complete responders’. Of the 14 confirmed complete responders, a median percentage of 71% were categorized in the MR-good response group and 29% were categorized in the MR-intermediate response group.

Conclusions

Radiologists of varying experience levels should be able to use MRI to identify the ± 20% subgroup of poor responders who will definitely require surgical resection after CRT. This may facilitate more selective use of endoscopy, particularly in general settings or in centers with limited access to endoscopy.
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Metadata
Title
Selection of Patients for Organ Preservation After Chemoradiotherapy: MRI Identifies Poor Responders Who Can Go Straight to Surgery
Authors
Hester E. Haak, MD
Monique Maas, MD, PhD
Max J. Lahaye, MD, PhD
Thierry N. Boellaard, MD, PhD
Andrea Delli Pizzi, MD
Casper Mihl, MD, PhD
Dennis van der Zee, MD
Cristina Fabris, MD
Marit E. van der Sande, MD
Jarno Melenhorst, MD, PhD
Regina G. H. Beets-Tan, MD, PhD
Geerard L. Beets, MD, PhD
Doenja M. J. Lambregts, MD, PhD
Publication date
01-08-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08334-8

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