Magnetic resonance imaging (MRI) may help patients with rectal cancer avoid invasive surgery and its potentially lifelong side effects, according to a recent study published by Williams et al in Radiology.
Background
“After undergoing chemotherapy and radiation for rectal cancer, patients are understandably concerned [about] whether their cancer is gone or whether there may be some leftover disease,” said co–study author Arun Krishnaraj, MD, MPH, a radiologist and imaging expert at the University of Virginia (UVA) Cancer Center and Director of the Division of Body Imaging at UVA Health.
Some patients may undergo a watch-and-wait approach, in which physicians continue to monitor patients for cancer recurrence or metastasis—thereby holding off on surgery but potentially leaving them uncertain and anxious about the future.
Although rectal cancer has been declining among older adults, the disease is increasing among adults under 50 years. Prior research has determined that rectal cancer could occur in approximately 1 in 23 men and 1 in 25 women, according to the American Cancer Society.
The disease is typically treated with radiation and chemotherapy; however, some patients require total mesorectal excision to remove a substantial portion of their bowel. This can be life-saving but also life-changing. For instance, the side effects of this type of treatment can include the need for a permanent colostomy bag and sexual dysfunction.
Study Methods and Results
In the recent study, researchers examined the outcomes of 277 patients with an average age of 58 years who underwent MRI to determine their rectal cancer stage and participated in the OPRA trial. They sought to better understand whether an MRI could be predictive of the effects of the watch-and-wait approach.
After an average follow-up of 4 years, the researchers discovered that an MRI was an effective tool for predicting patients’ overall survival, the risk of cancer recurrence, and their ability to keep their bowel intact.
The researchers indicated that an MRI could predict patient outcomes and the risk of the cancer recurrence or metastasis among those who have undergone chemotherapy and radiation. This information could be useful in determining the treatment options and in deciding whether a patient can avoid surgery in favor of a watch-and-wait approach. An MRI may also provide comfort for patients.
Conclusions
“Using newer MRI techniques, we are now able to predict much better than in the past whether any cancer remains and, if so, whether it will come back and spread. No one wants to get surgery if they can avoid it. Now, we have a powerful tool to help patients and their [physicians] predict who would benefit from surgery after initial chemotherapy and radiation and who can likely avoid surgery,” said Dr. Krishnaraj.
The researchers suggested that an MRI could be more effective when combined with data from posttreatment endoscopies. Nonetheless, further studies may be needed to determine the potential benefit of the combination.
“I am optimistic that continued advancement in MRI and other tools like endoscopy will provide better information about future outcomes,” Dr. Krishnaraj underscored. “Ultimately, I would love to get close to 99% predictive probability in better informing our patients about their potential risk for recurrence or [metastasis] of their cancers following treatment. We may not be there quite yet, but that is our goal,” he concluded.
Disclosure: For full disclosures of the study authors, visit pubs.rsna.org.
