MRI Monitoring of Locally Advanced Rectal Cancer in Watch and Wait Patients

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2025-06-06 DOI:10.1016/j.clcc.2025.05.003

Jian Zhao , Kanghua Huang , Akao Zhu , Jinghan Zhu , Yimin Fang , Xiaofeng Zhou , Hao Jiang , Li Shen , Haiyan Chen

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引用次数: 0

Abstract

Background

Watch and wait (W&W) is an alternative strategy for locally advanced rectal cancer (LARC) (T3-4/N+) patients. MRI-based evaluation of clinical complete response (cCR) and post-cCR disease monitoring remain uncertain. This study aims to investigate the association between MRI feature changes and survival outcomes in these patients.

Methods

LARC Patients achieving cCR after neoadjuvant chemoradiotherapy and opting for W&W were included. MRI features were recorded from pretreatment to the follow-up period, including tumor bed scarring on post-treatment T2-weighted imaging (T2WI), magnetic resonance tumor regression grade (mrTRG), and high-signal areas on diffusion-weighted imaging (DWI). The relationship between follow-up data and MRI feature changes over time was analyzed.

Results

41 patients were included, and 5-year PFS and OS were 64.1% and 90.9%. For the 11 patients without cCR at the initial assessment, tumor signals decreased over time on both T2WI and DWI, with an increasing trend in scar formation on T2WI. Cumulative cCR rates at 7 weeks (± 1 week), 16 weeks (± 3 weeks), 24 weeks (± 4 weeks), and 32 weeks (± 3 weeks) were 72.5%, 80.5%, 95.1%, and 100.0%. Seven patients (17.1%) had a recurrence, with a disruption of the scar and the appearance of intermediate-intensity signals within the low-signal fibrotic area of the original tumor bed on T2WI. A newly developed high-signal area was observed on DWI.

Conclusions

The cCR rate increased over time. The scar sign on T2WI was more prevalent in patients with cCR, increased over time. MRI surveillance is essential for W&W patients but remains dynamic and challenging.

查看原文本刊更多论文

局部进展期直肠癌观察等待患者的MRI监测。

背景：观察和等待（W&W）是局部晚期直肠癌（LARC）（T3-4/N+）患者的替代策略。基于mri的临床完全缓解（cCR）评估和cCR后疾病监测仍不确定。本研究旨在探讨这些患者的MRI特征变化与生存结果之间的关系。方法：纳入经新辅助放化疗后达到cCR并选择W&W的LARC患者。记录从治疗前到随访期间的MRI特征，包括治疗后t2加权成像（T2WI）上的肿瘤床瘢痕、磁共振肿瘤消退分级（mrTRG）、弥散加权成像（DWI）上的高信号区。分析随访数据与MRI特征随时间变化的关系。结果：纳入41例患者，5年PFS和OS分别为64.1%和90.9%。在初步评估时无cCR的11例患者中，T2WI和DWI上的肿瘤信号随时间的推移而减弱，T2WI上的疤痕形成呈增加趋势。7周（±1周）、16周（±3周）、24周（±4周）和32周（±3周）的累积cCR率分别为72.5%、80.5%、95.1%和100.0%。7例（17.1%）复发，T2WI表现为瘢痕破坏，原肿瘤床低信号纤维化区出现中强度信号。在DWI上观察到一个新形成的高信号区。结论：cCR率随着时间的推移而增加。T2WI上疤痕征像在cCR患者中更为普遍，随着时间的推移而增加。MRI监测对W&W患者至关重要，但仍然是动态的和具有挑战性的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.