Diffusion-weighted imaging for evaluating lymph node eradication after neoadjuvant chemoradiation therapy in locally advanced rectal cancer

Ryu, Kyu-Hyung; Kim, Seung Ho; Yoon, Jung Hee; Lee, Yedaun; Paik, Jin Ho; Lim, Yun Jung; Lee, Kwang Hwi

doi:10.1177/0284185114568908

Cited by 17 publications

(17 citation statements)

References 29 publications

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“…yN0 stage) after CRT on a patient basis. 47,48 Van Heeswijk et al reported that the visual absence of nodes on DWI after CRT was a highly reliable predictor of a negative nodal status (sensitivity 100%), but the presence of nodes on post-CRT DWI was an unspecific finding, which could indicate either the presence of benign or malignant nodes, resulting in a low specificity of only 14%, again illustrating the limited capacity of DWI to visually characterize lymph nodes. 47 Ryu et al used a confidence level score to predict lymph node eradication after CRT with and without DWI and found no improvement in diagnostic performance for DWI compared to T 2 W-MRI with AUCs in the same range of 0.77-0.80.…”

Section: Nodal Restagingmentioning

confidence: 99%

Diffusion-weighted imaging in rectal cancer: current applications and future perspectives

Schurink

Lambregts

Beets‐Tan

2019

The British Journal of Radiology

117

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This paper aims to give an overview of the various clinical applications of DWI and discuss their potential role for rectal cancer imaging. PRiMARy RectAl cANceR stAgiNg Rectal tumour detection The main goal of MRI for rectal cancer is staging rather than tumour detection, since typically the presence of tumour has already been established by endoscopy or CT-colonography. 2 It is probably therefore that only a few studies have focused on DWI for the primary detection of rectal cancer. 3-10 Nevertheless, published reports have shown consistently good results for DWI to detect rectal tumours. In a recent meta-analysis, albeit focusing on colorectal tumours in general and not specifically on rectal cancer, pooled sensitivity, specificity and area under the curve (AUC) were 95%, 93% and 0.98, respectively. 11

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Section: Nodal Restagingmentioning

confidence: 99%

Diffusion-weighted imaging in rectal cancer: current applications and future perspectives

Schurink

Lambregts

Beets‐Tan

2019

The British Journal of Radiology

117

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“…Lymph node size, morphology, or both, typically based on MRI, appear to correlate with residual metastases . The reported accuracy of MRI in assessing complete response in initially involved lymph nodes ranges from 80% to 90%, with additional techniques such as contrast enhancement potentially improving these rates . Because of the potential predictive value of MRI, it has been incorporated by some groups into the assessment of cCR.…”

Section: Introductionmentioning

confidence: 99%

Nonoperative management of rectal cancer

Torok

Palta

Willett

et al. 2015

Cancer

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Surgery has long been the primary curative modality for localized rectal cancer. Neoadjuvant chemoradiation has significantly improved local control rates and, in a significant minority, eradicated all disease. Patients who achieve a pathologic complete response to neoadjuvant therapy have an excellent prognosis, although the combination treatment is associated with long-term morbidity. Because of this, a nonoperative management (NOM) strategy has been pursued to preserve sphincter function in select patients. Clinical and radiographic findings are used to identify patients achieving a clinical complete response to chemoradiation, and they are then followed with intensive surveillance. Incomplete, nonresponding and those demonstrating local progression are referred for salvage with standard surgery. Habr-Gama and colleagues have published extensively on this treatment strategy and have laid the groundwork for this approach. This watch-and-wait strategy has evolved over time, and several groups have now reported their results, including recent prospective experiences. Although initial results appear promising, several significant challenges remain for NOM of rectal cancer. Further study is warranted before routine implementation in the clinic. Cancer 2016;122:34-41. V C 2015 American Cancer Society.KEYWORDS: neoadjuvant therapy, nonoperative, radiation therapy, rectal cancer, watchful waiting. INTRODUCTIONIn 2015, an estimated 40,000 cases of rectal cancer will be diagnosed in the United States.1 Surgical therapy, by either low anterior resection (LAR) or abdominoperineal resection (APR), has long been considered the primary curative modality for localized disease. In recent decades, a paradigm shift for locally advanced disease has occurred: postoperative chemoradiation therapy (CRT) has largely been supplanted by a neoadjuvant approach, either through short-course radiation therapy (RT) alone or long-course CRT. This shift has been paralleled by improvements in preoperative imaging and staging, including endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI), as well as advancements in surgical techniques. Although the initial rationale for neoadjuvant treatment was to decrease local recurrence rates, improve treatment tolerability, and increase sphincter-preserving surgery rates, a small but significant percentage of patients were found to be complete pathologic responders upon examination of the surgical specimen. Investigators have since explored definitive CRT and careful follow up, also called nonoperative management (NOM), as a curative approach for select patients, with surgery reserved as salvage therapy. This review aims to critically evaluate NOM of rectal cancer in the modern era. BACKGROUNDThe preferred surgical approach for rectal cancer depends on the location of the cancer in relation to the anal sphincter complex: a sphincter-preserving LAR is reserved for proximal and midrectal lesions, and an APR requiring a permanent stoma is reserved for distal lesions. Both types of resections now...

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“…22 Our study included DWI but there was not increased concordance between pathologie and post treatment MRI staging lymph nodes (LN) evaluation is not clear. Ryu et al 23 evaluated the added value of DWI in the evaluation of LN eradication after CRT in patients with LARC. Pathological reports served as the reference standards for LN eradication.…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that adding DWI to T2W imaging provided no additional diagnostic benefit for the evaluation of LN eradication following CRT in patients with LARC. 23 Results of a meta-analysis showed that none of the three commonly used imaging modalities used in rectal cancer can provide reliable evaluation on regional LN metastasis. Perhaps we should conduct further research on specific contrast agents or functional imaging to try and improve the accuracy.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging Value to Predict Pathologic Staging in Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiation

Pinta¹,

Martín²,

Sempere³

et al. 2019

tjcd

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Amaç: Bu çalışma, neoadjuvan kemoradyoterapi (CRT) sonrası lokal ileri rektum kanserinin preoperatif olarak yeniden düzenlenmesinde, cerrahi tedavinin bireyselleştirilmesini kolaylaştırmak için manyetik rezonans görüntülemenin (MRG) rolünü değerlendirmek için tasarlanmıştır. Yöntem: MRG öncesi ve sonrasında neoadjuvan CRT alan 117 hastayı inceledik. Tüm hastalara yeniden evreleme için MRG ve takiben CRT bittikten sonra operasyon yapıldı. Bu çalışmanın birincil bitiş noktası, CRT sonrası MRG evrelemesinin patolojik evrelemeye göre doğruluğunu tahmin etmekti.

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Diffusion-weighted imaging for evaluating lymph node eradication after neoadjuvant chemoradiation therapy in locally advanced rectal cancer

Abstract: Adding DWI to T2W imaging provided no additional diagnostic benefit for the evaluation of LN eradication following CRT in patients with LARC.

Cited by 17 publications

References 29 publications

Diffusion-weighted imaging in rectal cancer: current applications and future perspectives

Diffusion-weighted imaging in rectal cancer: current applications and future perspectives

Nonoperative management of rectal cancer

Magnetic Resonance Imaging Value to Predict Pathologic Staging in Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiation

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