MRI predicts residual disease and outcomes in watch-and-wait patients with rectal cancer Journal Article
| Authors: | Williams, H.; Omer, D. M.; Thomson, H. M.; Lin, S. T.; Verheij, F. S.; Miranda, J.; Yuval, J. B.; Buckley, J.; Marco, M. R.; Qin, L. X.; Dombroski, D. A.; Kedar, R.; Oto, A.; Korngold, E.; Veniero, J. C.; Gandhi, S.; Krishnaraj, A.; Jagtiani, M.; Ohanian, K.; Vu, D.; Hope, T. A.; Lee, S.; Wasnik, A. P.; Madhuripan, N.; Gollub, M. J.; Garcia-Aguilar, J.; on behalf of the OPRA Consortium |
| Article Title: | MRI predicts residual disease and outcomes in watch-and-wait patients with rectal cancer |
| 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 P < .001). Five-year disease-free survival for participants with cCR, nCR, and iCR was 81.8%, 67.6%, and 49.6%, respectively (log-rank P < .001). The MRI response category also predicted overall survival (log-rank P < .001), distant recurrence-free survival (log-rank P = .005), and local regrowth (log-rank P = .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. © RSNA, 2024. |
| Keywords: | adult; controlled study; treatment outcome; treatment response; aged; middle aged; major clinical study; overall survival; disease free survival; neoadjuvant therapy; cancer staging; nuclear magnetic resonance imaging; follow up; magnetic resonance imaging; neoplasm staging; prospective study; prospective studies; adenocarcinoma; randomized controlled trial; pathology; diagnostic imaging; prediction; minimal residual disease; neoplasm, residual; watchful waiting; predictive value of tests; organ preservation; rectal neoplasms; rectum cancer; rectum tumor; diffusion weighted imaging; therapy; predictive value; total mesorectal excision; secondary analysis; rectal adenocarcinoma; procedures; local recurrence free survival; clinical complete response; humans; human; male; female; article; distant recurrence free survival |
| Journal Title: | Radiology |
| Volume: | 312 |
| Issue: | 3 |
| ISSN: | 0033-8419 |
| Publisher: | Radiological Society of North America, Inc. |
| Date Published: | 2024-09-01 |
| Start Page: | e232748 |
| Language: | English |
| DOI: | 10.1148/radiol.232748 |
| PUBMED: | 39225603 |
| PROVIDER: | scopus |
| PMCID: | PMC11427875 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Julio Garcia-Aguilar -- Source: Scopus |
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