Findings can save some lower-risk patients surgery after chemo, radiation
By Lori Solomon HealthDay Reporter
TUESDAY, Oct. 29, 2024 (HealthDay News) — Restaging magnetic resonance imaging (MRI) can predict organ preservation and survival with rectal cancer, according to a study published online Sept. 3 in Radiology.
Hannah Williams, M.D., from the Memorial Sloan Kettering Cancer Center in New York City, and colleagues evaluated the ability of restaging MRI to predict oncologic outcomes and identify imaging features associated with residual disease after total neoadjuvant therapy (TNT). The analysis included data from 277 participants in the Organ Preservation in Rectal Adenocarcinoma trial, which randomly assigned participants (April 2014 to March 2020) with stages II or III rectal adenocarcinoma to undergo either induction or consolidation TNT.
The researchers found that during a median follow-up of 4.1 years, participants with clinical complete response (cCR) had higher rates of organ preservation versus those with near-complete clinical response (nCR; 65.3 versus 41.6 percent1). Five-year disease-free survival was 81.8, 67.6, and 49.6 percent, respectively, for participants with cCR, nCR, and incomplete clinical response. Overall survival was also predicted by the MRI response category, distant recurrence-free survival, and local regrowth. Among the 266 participants with at least two years of follow-up, 48.5 percent had residual disease. The presence of restricted diffusion (odds ratio, 2.50) and presence of abnormal nodal morphologic features (odds ratio, 5.04) were independently associated with residual disease.
“Now we have a powerful tool to help patients and their doctors predict who would benefit from surgery after initial chemotherapy and radiation and who can likely avoid surgery,” coauthor Arun Krishnaraj, M.D., from the University of Virginia in Charlottesville, said in a statement.
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