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MRI Monitoring of Locally Advanced Rectal Cancer in Watch and Wait Patients
Jian Zhao1, Kanghua Huang2, Akao Zhu3
1Department of Radiation Oncology, The first affiliated hospital of Bengbu Medical University, Bengbu, Anhui, China; Joint Research Center for Regional Diseases of IHM, Bengbu Medical University, Bengbu, Anhui, China; Joint Research Center for Regional Diseases of IHM, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China; Anhui Provincial Key Laboratory of Tumor Evolution and Intelligent Diagnosis and Treatment, Bengbu Medical University, Bengbu, Anhui, China; Department of Radiation Oncology (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Zhejiang Provincial Clinical Research Center for CANCER; Cancer Center of Zhejiang University, China.
Watch and wait (W&W) for rectal cancer shows increasing clinical complete response (cCR) rates over time. MRI monitoring of scar formation on T2WI and diffusion-weighted imaging (DWI) is crucial for assessing response and detecting recurrence in W&W patients.
Area of Science:
- Oncology
- Radiology
- Gastroenterology
Background:
- Watch and wait (W&W) is an alternative for locally advanced rectal cancer (LARC) patients.
- MRI evaluation of clinical complete response (cCR) and disease monitoring in W&W is uncertain.
Purpose of the Study:
- Investigate MRI feature changes and their association with survival outcomes in LARC patients undergoing W&W.
Main Methods:
- Included LARC patients achieving cCR after neoadjuvant chemoradiotherapy and opting for W&W.
- Recorded MRI features: tumor bed scarring (T2WI), mrTRG, and DWI high-signal areas.
- Analyzed follow-up data and MRI feature changes over time.
Main Results:
- 5-year PFS and OS were 64.1% and 90.9%.
- Cumulative cCR rates increased over time, reaching 100% by 32 weeks.
- Recurrence (17.1%) showed scar disruption and new DWI high-signal areas.
Conclusions:
- cCR rates increase over time in W&W patients.
- Scar sign on T2WI is prevalent in cCR patients and increases over time.
- Dynamic MRI surveillance is essential but challenging for W&W patients.
