MRI after treatment of locally advanced rectal cancer: How to report tumor response - The MERCURY experience

Department of Radiology, Royal Marsden Hospital, Downs Rd, Sutton SM2 5PT, United Kingdom.
American Journal of Roentgenology (Impact Factor: 2.73). 10/2012; 199(4):W486-95. DOI: 10.2214/AJR.11.8210
Source: PubMed


The Magnetic Resonance Imaging and Rectal Cancer European Equivalence (MERCURY) Study validated the use of MRI for posttreatment staging and its correlation with survival outcomes. As a consequence, reassessment of MRI scans after preoperative therapy has implications for surgical planning, the timing of surgery, sphincter preservation, deferral of surgery for good responders, and development of further preoperative treatments for radiologically identified poor responders.

In this article we report a validated systematic approach to the interpretation of MR images of patients with rectal cancer after chemoradiation.

38 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Until recently, there has been uncertainty regarding the exact role, importance, and validity of MRI in restaging rectal cancers after preoperative treatment. MRI tumor reassessment has wide-ranging implications, for example, altering surgical planning, timing of surgery, and potential deferral of surgery for MRI-identified good responders. Several approaches for restaging rectal cancer after treatment have been proposed, for example, T staging, volume reduction of tumor, MRI tumor regression grading, and diffusion-weighted-imaging assessment. Likewise several approaches to restaging the potential resection margin and nodal disease have also been investigated. This article seeks to review the evidence for each of the proposed approaches to restage rectal cancer after chemoradiotherapy and concludes with recommendations for current clinical practice.
    Current Colorectal Cancer Reports 06/2013; 9(2). DOI:10.1007/s11888-013-0169-2
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: High-resolution (HR) magnetic resonance imaging (MRI) has become an indispensable tool for multidisciplinary teams (MDTs) addressing rectal cancer. It provides anatomic information for surgical planning and allows patients to be stratified into different groups according to the risk of local and distant recurrence. One of the objectives of the MDT is the preoperative identification of high-risk patients who will benefit from neoadjuvant treatment. For this reason, the correct evaluation of the circumferential resection margin (CRM), the depth of tumor spread beyond the muscularis propria, extramural vascular invasion and nodal status is of the utmost importance. Low rectal tumors represent a special challenge for the MDT, because decisions seek a balance between oncologic safety, in the pursuit of free resection margins, and the patient's quality of life, in order to preserve sphincter function. At present, the exchange of information between the different specialties involved in dealing with patients with rectal cancer can rank the contribution of colleagues, auditing their work and incorporating knowledge that will lead to a better understanding of the pathology. Thus, beyond the anatomic description of the images, the radiologist's role in the MDT makes it necessary to know the prognostic value of the findings that we describe, in terms of recurrence and survival, because these findings affect decision making and, therefore, the patients' life. In this review, the usefulness of HR MRI in the initial staging of rectal cancer and in the evaluation of neoadjuvant treatment, with a focus on the prognostic value of the findings, is described as well as the contribution of HR MRI in assessing patients with suspected or confirmed recurrence of rectal cancer.
    Cancer Imaging 07/2013; 13(2):277-97. DOI:10.1102/1470-7330.2013.0028 · 2.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Optimal treatment decisions for patients with rectal cancer are based on knowledge of tumor characteristics and prognostic features and any initial treatment must aim to reduce the risk of both local and distant recurrence. The radiologist has become an increasingly important part of multidisciplinary team managing rectal cancer. The primary goal of MRI staging of rectal tumors is to identify prognostic factors in order to offer patients a tailored treatment based on individual risks. Restaging of rectal tumors using MRI after chemoradiation therapy is becoming more relevant issue, since further tailoring of treatment is increasingly being considered after the treatment.
    Magnetic resonance imaging clinics of North America 05/2013; 21(2):385-408. DOI:10.1016/j.mric.2013.01.006 · 0.99 Impact Factor
Show more