Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide
Abstract In the past nearly 20 years, organ-sparing when no apparent viable tumour is present after neoadjuvant therapy has taken an increasingly relevant role in the therapeutic management of locally-advanced rectal cancer patients. The decision to include a patient or not in a “Watch-and-Wait” pro...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2021-08-01
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| Series: | Insights into Imaging |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13244-021-01055-w |
| _version_ | 1831749131445469184 |
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| author | Inês Santiago Bernardete Rodrigues Maria Barata Nuno Figueiredo Laura Fernandez Antonio Galzerano Oriol Parés Celso Matos |
| author_facet | Inês Santiago Bernardete Rodrigues Maria Barata Nuno Figueiredo Laura Fernandez Antonio Galzerano Oriol Parés Celso Matos |
| author_sort | Inês Santiago |
| collection | DOAJ |
| description | Abstract In the past nearly 20 years, organ-sparing when no apparent viable tumour is present after neoadjuvant therapy has taken an increasingly relevant role in the therapeutic management of locally-advanced rectal cancer patients. The decision to include a patient or not in a “Watch-and-Wait” program relies mainly on endoscopic assessment by skilled surgeons, and MR imaging by experienced radiologists. Strict surveillance using the same modalities is required, given the chance of a local regrowth is of approximately 25–30%, almost always surgically salvageable if caught early. Local regrowths occur at the endoluminal aspect of the primary tumour bed in almost 90% of patients, but the rest are deep within it or outside the rectal wall, in which case detection relies solely on MR Imaging. In this educational review, we provide a practical guide for radiologists who are, or intend to be, involved in the re-staging and follow-up of rectal cancer patients in institutions with an established “Watch-and-Wait” program. First, we discuss patient preparation and MR imaging acquisition technique. Second, we focus on the re-staging MR imaging examination and review the imaging findings that allow us to assess response. Third, we focus on follow-up assessments of patients who defer surgery and confer about the early signs that may indicate a sustained/non-sustained complete response, a rectal/extra-rectal regrowth, and the particular prognosis of the “near-complete” responders. Finally, we discuss our proposed report template. |
| first_indexed | 2024-12-21T22:04:23Z |
| format | Article |
| id | doaj.art-f574a12f2d8b449b97979a35d0811aef |
| institution | Directory Open Access Journal |
| issn | 1869-4101 |
| language | English |
| last_indexed | 2024-12-21T22:04:23Z |
| publishDate | 2021-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Insights into Imaging |
| spelling | doaj.art-f574a12f2d8b449b97979a35d0811aef2022-12-21T18:48:45ZengSpringerOpenInsights into Imaging1869-41012021-08-0112111710.1186/s13244-021-01055-wRe-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guideInês Santiago0Bernardete Rodrigues1Maria Barata2Nuno Figueiredo3Laura Fernandez4Antonio Galzerano5Oriol Parés6Celso Matos7Radiology Department, Champalimaud FoundationCentro Hospitalar de Tondela-Viseu, EPERadiology Department, Champalimaud FoundationColorectal Surgery, Digestive Unit, Champalimaud FoundationColorectal Surgery, Digestive Unit, Champalimaud FoundationPathology Department, Champalimaud FoundationRadiation Oncology Department, Champalimaud FoundationRadiology Department, Champalimaud FoundationAbstract In the past nearly 20 years, organ-sparing when no apparent viable tumour is present after neoadjuvant therapy has taken an increasingly relevant role in the therapeutic management of locally-advanced rectal cancer patients. The decision to include a patient or not in a “Watch-and-Wait” program relies mainly on endoscopic assessment by skilled surgeons, and MR imaging by experienced radiologists. Strict surveillance using the same modalities is required, given the chance of a local regrowth is of approximately 25–30%, almost always surgically salvageable if caught early. Local regrowths occur at the endoluminal aspect of the primary tumour bed in almost 90% of patients, but the rest are deep within it or outside the rectal wall, in which case detection relies solely on MR Imaging. In this educational review, we provide a practical guide for radiologists who are, or intend to be, involved in the re-staging and follow-up of rectal cancer patients in institutions with an established “Watch-and-Wait” program. First, we discuss patient preparation and MR imaging acquisition technique. Second, we focus on the re-staging MR imaging examination and review the imaging findings that allow us to assess response. Third, we focus on follow-up assessments of patients who defer surgery and confer about the early signs that may indicate a sustained/non-sustained complete response, a rectal/extra-rectal regrowth, and the particular prognosis of the “near-complete” responders. Finally, we discuss our proposed report template.https://doi.org/10.1186/s13244-021-01055-wRectal cancerMagnetic resonance imagingNeoadjuvant therapyRe-staging“Watch-and-Wait” |
| spellingShingle | Inês Santiago Bernardete Rodrigues Maria Barata Nuno Figueiredo Laura Fernandez Antonio Galzerano Oriol Parés Celso Matos Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide Insights into Imaging Rectal cancer Magnetic resonance imaging Neoadjuvant therapy Re-staging “Watch-and-Wait” |
| title | Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide |
| title_full | Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide |
| title_fullStr | Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide |
| title_full_unstemmed | Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide |
| title_short | Re-staging and follow-up of rectal cancer patients with MR imaging when “Watch-and-Wait” is an option: a practical guide |
| title_sort | re staging and follow up of rectal cancer patients with mr imaging when watch and wait is an option a practical guide |
| topic | Rectal cancer Magnetic resonance imaging Neoadjuvant therapy Re-staging “Watch-and-Wait” |
| url | https://doi.org/10.1186/s13244-021-01055-w |
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