MRI Predicts Residual Disease and Outcomes in Watch-and-Wait Patients with Rectal Cancer

Background MRI plays a crucial role in restaging locally advanced rectal cancer treated with total neoadjuvant therapy (TNT); however, prospective studies have not evaluated its ability to accurately select patients for nonoperative management. Purpose To evaluate the ability of restaging MRI to predict oncologic outcomes and identify imaging features associated with residual disease (RD) after TNT. Materials and Methods This was a secondary analysis of the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial, which randomized participants from April 2014 to March 2020 with stages II or III rectal adenocarcinoma to undergo either induction or consolidation TNT. Participants enrolled in the OPRA trial who underwent restaging MRI were eligible for inclusion in the present study. Radiologists classified participants as having clinical complete response (cCR), near-complete clinical response (nCR), or incomplete clinical response (iCR) based on restaging MRI at a mean of 8 weeks ± 4 (SD) after treatment. Oncologic outcomes according to MRI response category were assessed using Kaplan-Meier curves. Logistic regression analysis was performed to identify imaging characteristics associated with RD. Results A total of 277 participants (median age, 58 years [IQR, 17 years]; 179 male) who were randomized in the OPRA trial had restaging MRI forms completed. The median follow-up duration was 4.1 years. Participants with cCR had higher rates of organ preservation compared with those with nCR (65.3% vs 41.6%, log-rank <i>P</i> < .001). Five-year disease-free survival for participants with cCR, nCR, and iCR was 81.8%, 67.6%, and 49.6%, respectively (log-rank <i>P</i> < .001). The MRI response category also predicted overall survival (log-rank <i>P</i> < .001), distant recurrence-free survival (log-rank <i>P</i> = .005), and local regrowth (log-rank <i>P</i> = .02). Among the 266 participants with at least 2 years of follow-up, 129 (48.5%) had RD. At multivariable analysis, the presence of restricted diffusion (odds ratio, 2.50; 95% CI: 1.22, 5.24) and abnormal nodal morphologic features (odds ratio, 5.04; 95% CI: 1.43, 23.9) remained independently associated with RD. Conclusion The MRI response category was predictive of organ preservation and survival. Restricted diffusion and abnormal nodal morphologic features on restaging MRI scans were associated with increased likelihood of residual tumor. ClinicalTrials.gov identifier: NCT02008656 © RSNA, 2024 <i>Supplemental material is available for this article.</i> See also the editorial by Milot in this issue.

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Journal
Radiology
Published
2024-09-01
DOI
https://doi.org/10.1148/radiol.232748
Citations
14
Primary Topic
Colorectal Cancer Surgical Treatments
Type
article
Field-Weighted Citation Impact
3.96

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article

MRI Predicts Residual Disease and Outcomes in Watch-and-Wait Patients with Rectal Cancer

Jin K. Kim, Garrett M. Nash, Madhulika G. Varma, James Buckley et al.
14 citations
Radiology
Colorectal Cancer Surgical Treatments
3.96
article

MRI Predicts Residual Disease and Outcomes in Watch-and-Wait Patients with Rectal Cancer

Jin K. Kim, Garrett M. Nash, Madhulika G. Varma, James Buckley, Aytekin Oto, Li‐Xuan Qin, Minal Jagtiani Sangwaiya, Julio García‐Aguilar, Ashish P. Wasnik, Floris S. Verheij, Martin R. Weiser, Peter A. Cataldo, Richard F. Dunne, Ana Gleisner, David Dombroski, Elena Korngold, Abraham J. Wu, José G. Guillem, Joseph C. Carmichael, Maria Widmar, Andrea Cercek, Leonard B. Saltz, Rona Yaeger, Dan Vu, Arun Krishnaraj, Dana M. Omer, Sunil Gandhi, Karyn A. Goodman, H Thompson, Meghan Lee, Anita Gregory, Daniel O. Herzig, J. Joshua Smith, Andrew L. Coveler, Neil H. Segal, Blasé N. Polite, Marc J. Gollub, Iris H. Wei, Emmanouil P. Pappou, Thomas A. Hope, Jorge Marcet, Sabrina T. Lin, Charles A. Ternent, Jonathan Benjamin Yuval, David Liska, Philip B. Paty, Charles M. Friel, Michael R. Marco, Joseph C. Veniero, Brian L. Bello, R P Kedar, John C. Krauss, Hannah Williams, Sujata Patil, Sonia Lee, Kirk Ohanian, Nikhil Madhuripan, Steven R. Hunt, Larissa K. Temple, João Miranda, Samuel Oommen
article en
14 citations

Abstract

Background MRI plays a crucial role in restaging locally advanced rectal cancer treated with total neoadjuvant therapy (TNT); however, prospective studies have not evaluated its ability to accurately select patients for nonoperative management. Purpose To evaluate the ability of restaging MRI to predict oncologic outcomes and identify imaging features associated with residual disease (RD) after TNT. Materials and Methods This was a secondary analysis of the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial, which randomized participants from April 2014 to March 2020 with stages II or III rectal adenocarcinoma to undergo either induction or consolidation TNT. Participants enrolled in the OPRA trial who underwent restaging MRI were eligible for inclusion in the present study. Radiologists classified participants as having clinical complete response (cCR), near-complete clinical response (nCR), or incomplete clinical response (iCR) based on restaging MRI at a mean of 8 weeks ± 4 (SD) after treatment. Oncologic outcomes according to MRI response category were assessed using Kaplan-Meier curves. Logistic regression analysis was performed to identify imaging characteristics associated with RD. Results A total of 277 participants (median age, 58 years [IQR, 17 years]; 179 male) who were randomized in the OPRA trial had restaging MRI forms completed. The median follow-up duration was 4.1 years. Participants with cCR had higher rates of organ preservation compared with those with nCR (65.3% vs 41.6%, log-rank <i>P</i> < .001). Five-year disease-free survival for participants with cCR, nCR, and iCR was 81.8%, 67.6%, and 49.6%, respectively (log-rank <i>P</i> < .001). The MRI response category also predicted overall survival (log-rank <i>P</i> < .001), distant recurrence-free survival (log-rank <i>P</i> = .005), and local regrowth (log-rank <i>P</i> = .02). Among the 266 participants with at least 2 years of follow-up, 129 (48.5%) had RD. At multivariable analysis, the presence of restricted diffusion (odds ratio, 2.50; 95% CI: 1.22, 5.24) and abnormal nodal morphologic features (odds ratio, 5.04; 95% CI: 1.43, 23.9) remained independently associated with RD. Conclusion The MRI response category was predictive of organ preservation and survival. Restricted diffusion and abnormal nodal morphologic features on restaging MRI scans were associated with increased likelihood of residual tumor. ClinicalTrials.gov identifier: NCT02008656 © RSNA, 2024 <i>Supplemental material is available for this article.</i> See also the editorial by Milot in this issue.

RadiologyVol. 312(3)
Orange (Poland) (PL), Cleveland Clinic (US), Memorial Sloan Kettering Cancer Center (US), John Muir Health (US), Oregon Health & Science University (US), University of California, San Francisco (US), University of Washington (US), University of California, Irvine (US), University of South Florida (US), University of Michigan (US), University of Rochester Medical Center (US), University of Chicago (US), University of Virginia (US), University of Colorado Anschutz Medical Campus (US)
National Institutes of Health, National Cancer Institute
Zero hunger
Openalex Percentile: Top 5%
Colorectal Cancer Surgical Treatments
3.96
DOIOpen Access PDFOpenAlex
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