Locally advanced rectal cancer: is diffusion weighted MRI helpful for the identification of complete responders (ypT0N0) after neoadjuvant chemoradiation therapy?

Sassen, Sander; Booij, M. de; Sosef, Meindert N.; Berendsen, Ralph C M; Lammering, Guido; Clarijs, Ruud; Bakker, Marlies; Beets‐Tan, Regina G. H.; Warmerdam, Fabienne; Vliegen, Roy F. A.

doi:10.1007/s00330-013-2956-1

Cited by 80 publications

(60 citation statements)

References 25 publications

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“…Four studies have compared the accuracy of DWI and standard MRI in predicting the response to nCRT. Three of the four studies found that DWI improved the interobserver reliability of different radiologists in assessing pCR but this was not statistically significant for all the radiologists . In all studies, the accuracy of DWI was insufficient to change clinical practice .…”

Section: Resultsmentioning

confidence: 85%

“…Three of the four studies found that DWI improved the interobserver reliability of different radiologists in assessing pCR but this was not statistically significant for all the radiologists [81,82,93,94]. In all studies, the accuracy of DWI was insufficient to change clinical practice [81,82,94,95]. One study noted that the high negative predictive value might be of value in excluding pCR, but the positive predictive value was poor [94].…”

Section: Magnetic Resonance Imagingmentioning

confidence: 96%

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Assessing pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a systematic review

et al. 2015

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Section: Resultsmentioning

confidence: 85%

Section: Magnetic Resonance Imagingmentioning

confidence: 96%

Assessing pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a systematic review

et al. 2015

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“…Four articles demonstrate that late qualitative DWI assessment can predict pCR with a pooled specificity of 94% and an overall accuracy of 87%, thereby outperforming quantitative DWI measurements [30,[36][37][38].…”

Section: Resultsmentioning

confidence: 97%

The role of diffusion-weighted MRI and 18F-FDG PET/CT in the prediction of pathologic complete response after radiochemotherapy for rectal cancer: A systematic review

Joye¹,

Deroose²,

Vandecaveye³

et al. 2014

Radiotherapy and Oncology

167

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After neoadjuvant radiochemotherapy (RCT) for locally advanced rectal cancer, 15-27% of the patients experience a pathological complete response (pCR). This observation raises the question as to whether invasive surgery could be avoided in a selected cohort of patients who obtain a clinical complete response after preoperative RCT. In this respect, there has been growing interest in functional imaging techniques to improve clinical response assessment. This systematic review focuses on the role of diffusion-weighted imaging (DWI) and (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in the prediction of pCR after RCT for rectal cancer. A total of 14 publications on DWI and 25 on (18)F-FDG PET/CT were retrieved. Pooled analysis of individual patient data shows both imaging modalities have a low positive predictive value in the prediction of pCR (mean PPV of 54% and 39% for DWI- and (18)F-FDG PET/CT-based parameters respectively). Especially pre-RCT imaging is unable to predict pCR with overall accuracies of 68-72% for DWI and 44% for (18)F-FDG PET/CT. Qualitative DWI assessment 5-10weeks after the end of RCT may outperform apparent diffusion coefficient (ADC)-based DWI-parameters (overall accuracy of 87% vs. 74-78%). Although few data are available, early changes in FDG-uptake seem promising in the prediction of pCR and the role of (18)F-FDG PET/CT during RCT should be further investigated. Quantitative and qualitative (18)F-FDG PET/CT measurements are equally effective in the assessment of pCR after RCT. The major strength of DWI and (18)F-FDG PET/CT lies in the identification of non-responders who are not candidates for organ preservation. Up to now, DWI and (18)F-FDG PET/CT are not accurate enough to safely select patients for organ-sparing strategies. Future research must focus on the integration of functional imaging with clinical data and molecular biomarkers.

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“…38 MRI achieved a much higher level of agreement between pre-operative staging and histologic assessment compared to digital rectal examination and EUS, 39 although a low positive predictive value for absence of pCR after a MRI T2 weighted was reported. 40 Unfortunately, the excellent anatomical data provided by MRI cannot rule out small clusters of cancer after CRT. In our series, five patients presented isolated LR, and we proposed resection to all of them.…”

Section: Discussionmentioning

confidence: 99%

Nonoperative management of rectal cancer after chemoradiation opposed to resection after complete clinical response. A comparative study

Araujo

Valadão

Borges

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Locally advanced rectal cancer: is diffusion weighted MRI helpful for the identification of complete responders (ypT0N0) after neoadjuvant chemoradiation therapy?

Cited by 80 publications

References 25 publications

Assessing pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a systematic review

Assessing pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a systematic review

The role of diffusion-weighted MRI and 18F-FDG PET/CT in the prediction of pathologic complete response after radiochemotherapy for rectal cancer: A systematic review

Nonoperative management of rectal cancer after chemoradiation opposed to resection after complete clinical response. A comparative study

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