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  • Review Article
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MRI for assessing and predicting response to neoadjuvant treatment in rectal cancer

Nature Reviews Gastroenterology & Hepatology volume 11, pages 480–488 (2014)Cite this article

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Key Points

  • The availability of tools that can accurately measure response is critical for the selection of patients with rectal cancer who can be offered organ-saving treatment

  • After preoperative chemoradiotherapy, endorectal ultrasonography and MRI are limited in the detection of small tumour remnants within the fibrotic tumour bed

  • Functional MRI combines detailed information on tumour morphology with that on the tumour biological microenvironment and provides comprehensive information on tumour heterogeneity

  • Diffusion-weighted imaging, as a qualitative measure of response is promising for the assessment of clinical complete response, but the evidence so far is mainly from single-centre expert studies

  • It is too early to conclude that perfusion magnetic resonance biomarkers could have a role as a measure of response, and many issues need to be resolved

  • The future of response evaluation with imaging lies in further exploitation of all information that is within medical images

Abstract

Guidelines recommend MRI as part of the staging work-up of patients with rectal cancer because it can identify high-risk groups requiring preoperative treatment. Phenomenal tumour responses have been observed with current chemoradiotherapy regimens—even complete regression in 25% of patients. For these patients, the options of organ-saving treatment as an alternative to surgery are now discussed, and critical for this approach is the availability of tools that can accurately measure response. The value of MRI in rectal cancer staging is established, but the role of MRI for the selection of patients for organ-saving treatment is debatable, because MRI is not able to accurately assess tumour response to preoperative chemoradiotherapy (owing to its reliance on morphological changes). Functional MRI is emerging in the field of oncology. It combines information on detailed anatomy with that of tumour biology, providing comprehensive information on tumour heterogeneity and its changes as a result of treatment. This Review provides knowledge on the strengths and weaknesses of MRI for response assessment after chemoradiotherapy in rectal cancer and on its ability to predict tumour response at the time of primary diagnosis. It elaborates on new functional magnetic resonance technology and discusses whether this and new postprocessing approaches have the potential to improve prediction and assessment of response.

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Figure 1: DCE-MRI of a patient with rectal cancer and near complete response after preoperative chemoradiotherapy.
Figure 2: DW-MRI of a patient with rectal cancer and residual tumour after preoperative chemoradiotherapy.
Figure 3: DW-MRI of a patient with rectal cancer and complete response after preoperative chemoradiotherapy.

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Authors and Affiliations

  1. Department of Radiology, Maastrict University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, Netherlands

    Regina G. H. Beets-Tan

  2. Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, Netherlands

    Geerard L. Beets

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R.G.H.B.-T. contributed to researching data, discussion of content, writing and reviewing/editing the manuscript. G.L.B. contributed to discussion of content, writing and reviewing/editing the manuscript.

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Correspondence to Regina G. H. Beets-Tan.

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Beets-Tan, R., Beets, G. MRI for assessing and predicting response to neoadjuvant treatment in rectal cancer. Nat Rev Gastroenterol Hepatol 11, 480–488 (2014). https://doi.org/10.1038/nrgastro.2014.41

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