Long-term follow-up features on rectal mri during a wait-and-see approach after a clinical complete response in patients with rectal cancer treated with chemoradiotherapy
| Autor: | Geerard L. Beets, Guido Lammering, Vincent C. Cappendijk, Frans C. H. Bakers, Regina G. H. Beets-Tan, Monique Maas, Doenja M. J. Lambregts |
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| Přispěvatelé: | Beeldvorming, Radiotherapie, Surgery, RS: NUTRIM - R2 - Gut-liver homeostasis, RS: GROW - School for Oncology and Reproduction |
| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
medicine.medical_specialty
Colorectal cancer Long term follow up Complete tumor response medicine.medical_treatment DWI DIAGNOSIS EXCISION Clinical complete response Text mining RADIATION-THERAPY Medicine Humans In patient Watchful Waiting Locally advanced rectal cancer NEOADJUVANT CHEMORADIATION THERAPY Chemotherapy business.industry Rectal Neoplasms Follow-up NONOPERATIVE TREATMENT Gastroenterology Rectum General Medicine Chemoradiotherapy CHEMOTHERAPY medicine.disease Fibrosis Magnetic Resonance Imaging Radiation therapy Treatment Outcome TUMOR RESPONSE Radiology Neoplasm Recurrence Local business Follow-Up Studies Wait-and-see policy MRI |
| Zdroj: | Diseases of the Colon & Rectum, 54(12), 1521-1528. LIPPINCOTT WILLIAMS & WILKINS |
| ISSN: | 1530-0358 0012-3706 |
| Popis: | BACKGROUND: : The "wait-and-see" policy instead of standard surgery for patients with rectal cancer who undergo a complete tumor regression after chemoradiation treatment is highly controversial. It is not clear yet how patients should be monitored once they are managed nonoperatively and whether follow-up by MRI has any potential role. OBJECTIVE: : This study aimed to describe the rectal wall MRI morphology during short-term and long-term follow-up in patients with a clinical complete tumor response undergoing a wait-and-see policy without surgical treatment. DESIGN, SETTING, AND PATIENTS: : As part of an observational study in our center, a cohort of 19 carefully selected patients with a clinical complete response after chemoradiation was managed with a wait-and-see policy and followed regularly (every 3-6 mo) by clinical examination, endoscopy with biopsies, and a rectal MRI. The MR morphology of the tumor bed was studied on the consecutive MRI examinations. MAIN OUTCOME MEASURES: : The primary outcome measured was the morphology of the tumor bed on the consecutive MRI examinations performed during short-term (6 mo) follow-up. RESULTS: : Patients with a complete tumor response after chemoradiation presented with either a normalized rectal wall (26%) or fibrosis (74%). In the latter group, 3 patterns of fibrosis were observed (full-thickness, minimal, or spicular fibrosis). The morphology patterns of a normalized rectal wall or fibrosis remained consistent during long-term follow-up in 18 of 19 patients. One patient developed a small, endoluminal recurrence, which was salvaged with transanal endoscopic microsurgery. In 26% of patients, an edematous wall thickening was observed in the first months after chemoradiation, which gradually decreased during long-term follow-up. Median follow-up was 22 months (range, 12-60). LIMITATIONS: : This was a small observational study, and had no histological validation. CONCLUSIONS: : Four MR patterns of a persistent complete response of rectal cancer after chemoradiation were identified. These MR features can serve as a reference for the follow-up in a wait-and-see policy. |
| Databáze: | OpenAIRE |
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