TY - JOUR
T1 - Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option
T2 - a practical guide
AU - Santiago, Inês
AU - Rodrigues, Bernardete
AU - Barata, Maria
AU - Figueiredo, Nuno
AU - Fernandez, Laura
AU - Galzerano, Antonio
AU - Parés, Oriol
AU - Matos, Celso
N1 - Funding Information:
We are grateful to all staff composing the?Imaging Department, the Colorectal Cancer Unit, and The Pathology Department of the Champalimaud Foundation. We would also like to thank Nuno Lou??o from Philips Healthcare (R) for the outstanding technical support.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
KW - Magnetic resonance imaging
KW - Neoadjuvant therapy
KW - Re-staging
KW - Rectal cancer
KW - “Watch-and-Wait”
UR - http://www.scopus.com/inward/record.url?scp=85112090188&partnerID=8YFLogxK
U2 - 10.1186/s13244-021-01055-w
DO - 10.1186/s13244-021-01055-w
M3 - Review article
AN - SCOPUS:85112090188
SN - 1869-4101
VL - 12
JO - Insights into Imaging
JF - Insights into Imaging
IS - 1
M1 - 114
ER -