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Good Responders to Rectal Cancer Neoadjuvant Chemotherapy, based on the MRI Findings Can Help to Avoid Radiotherapy:
Daisuke Kuwata1, Takuya Miura2, Hiromasa Fujita3
1Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8216, Aomori, Japan.
Surgery Today
|June 4, 2026
Summary
Posttreatment mesorectal fascia (MRF) positivity is a key prognostic factor in rectal cancer. Patients with MRF-negative status after neoadjuvant chemotherapy (NAC) show survival outcomes comparable to those treated with radiation therapy (RT).
Area of Science:
- Oncology
- Surgical Oncology
- Gastrointestinal Oncology
Background:
- Preoperative treatment for rectal cancer aims to improve outcomes.
- Identifying prognostic factors is crucial for treatment selection.
- Neoadjuvant chemotherapy (NAC) and radiation therapy (RT) are standard preoperative treatments.
Purpose of the Study:
- To identify prognostic factors in preoperatively treated rectal cancer.
- To determine patient selection criteria for neoadjuvant chemotherapy (NAC) alone.
- To evaluate the role of mesorectal fascia (MRF) status in predicting outcomes.
Main Methods:
- Retrospective analysis of 78 rectal cancer patients treated from 2016-2022.
- Comparison of outcomes between NAC (n=58) and RT (n=20) groups.
- Multivariate analysis to identify independent prognostic factors.
Main Results:
- Posttreatment MRF-positive status significantly correlated with poor disease-free survival and increased local recurrence.
- In MRF-negative cases, 3-year disease-free survival was 85.7% in both NAC and RT groups.
- The 3-year local recurrence rate was 0% in the NAC group versus 14.3% in the RT group for MRF-negative patients.
Conclusions:
- Posttreatment MRF positivity is an independent risk factor for adverse outcomes in rectal cancer.
- MRF-negative patients responding to NAC demonstrate survival outcomes similar to those receiving RT.
- This suggests NAC alone may be a viable option for selected MRF-negative rectal cancer patients.
