Hester E Haak1,2, Monique Maas3, Max J Lahaye3, Thierry N Boellaard3, Andrea Delli Pizzi4, Casper Mihl5, Dennis van der Zee6, Cristina Fabris7, Marit E van der Sande1,2, Jarno Melenhorst8, Regina G H Beets-Tan2,3, Geerard L Beets1,2, Doenja M J Lambregts9. 1. Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands. 2. GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands. 3. Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands. 4. ITAB Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University, Chieti, Italy. 5. Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands. 6. Department of Radiology, Bernhoven, Uden, The Netherlands. 7. Department of Radiology, Policlinico G.B. Rossi, University of Verona, Verona, Italy. 8. Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. 9. Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands. d.lambregts@nki.nl.
Abstract
OBJECTIVE: The aim of this study was to evaluate whether magnetic resonance imaging (MRI) can accurately identify poor responders after chemoradiotherapy (CRT) who will need to go straight to surgery, and to evaluate whether results are reproducible among radiologists with different levels of expertise. METHODS: Seven independent readers with different levels of expertise retrospectively evaluated the restaging MRIs (T2-weighted + diffusion-weighted imaging [T2W + DWI]) of 62 patients and categorized them as (1) poor responders - highly suspicious of tumor; (2) intermediate responders - tumor most likely; and (3) good - potential (near) complete responders. The reference standard was histopathology after surgery (or long-term follow-up in the case of a watch-and-wait program). RESULTS: Fourteen patients were complete responders and 48 had residual tumor. The median percentage of patients categorized by the seven readers as 'poor', 'intermediate', and 'good' responders was 21% (range 11-37%), 50% (range 23-58%), and 29% (range 23-42%), respectively. The vast majority of poor responders had histopathologically confirmed residual tumor (73% ypT3-4), with a low rate (0-5%) of 'missed complete responders'. Of the 14 confirmed complete responders, a median percentage of 71% were categorized in the MR-good response group and 29% were categorized in the MR-intermediate response group. CONCLUSIONS: Radiologists of varying experience levels should be able to use MRI to identify the ± 20% subgroup of poor responders who will definitely require surgical resection after CRT. This may facilitate more selective use of endoscopy, particularly in general settings or in centers with limited access to endoscopy.
OBJECTIVE: The aim of this study was to evaluate whether magnetic resonance imaging (MRI) can accurately identify poor responders after chemoradiotherapy (CRT) who will need to go straight to surgery, and to evaluate whether results are reproducible among radiologists with different levels of expertise. METHODS: Seven independent readers with different levels of expertise retrospectively evaluated the restaging MRIs (T2-weighted + diffusion-weighted imaging [T2W + DWI]) of 62 patients and categorized them as (1) poor responders - highly suspicious of tumor; (2) intermediate responders - tumor most likely; and (3) good - potential (near) complete responders. The reference standard was histopathology after surgery (or long-term follow-up in the case of a watch-and-wait program). RESULTS: Fourteen patients were complete responders and 48 had residual tumor. The median percentage of patients categorized by the seven readers as 'poor', 'intermediate', and 'good' responders was 21% (range 11-37%), 50% (range 23-58%), and 29% (range 23-42%), respectively. The vast majority of poor responders had histopathologically confirmed residual tumor (73% ypT3-4), with a low rate (0-5%) of 'missed complete responders'. Of the 14 confirmed complete responders, a median percentage of 71% were categorized in the MR-good response group and 29% were categorized in the MR-intermediate response group. CONCLUSIONS: Radiologists of varying experience levels should be able to use MRI to identify the ± 20% subgroup of poor responders who will definitely require surgical resection after CRT. This may facilitate more selective use of endoscopy, particularly in general settings or in centers with limited access to endoscopy.
Authors: Doenja M J Lambregts; Andrea Delli Pizzi; Max J Lahaye; Joost J M van Griethuysen; Monique Maas; Geerard L Beets; Frans C H Bakers; Regina G H Beets-Tan Journal: Dis Colon Rectum Date: 2018-03 Impact factor: 4.585
Authors: Andrea Delli Pizzi; Antonio Maria Chiarelli; Piero Chiacchiaretta; Martina d'Annibale; Pierpaolo Croce; Consuelo Rosa; Domenico Mastrodicasa; Stefano Trebeschi; Doenja Marina Johanna Lambregts; Daniele Caposiena; Francesco Lorenzo Serafini; Raffaella Basilico; Giulio Cocco; Pierluigi Di Sebastiano; Sebastiano Cinalli; Antonio Ferretti; Richard Geoffrey Wise; Domenico Genovesi; Regina G H Beets-Tan; Massimo Caulo Journal: Sci Rep Date: 2021-03-08 Impact factor: 4.996
Authors: Jaromir Kargol; Wojciech Rudnicki; Jakub Kenig; Justyna Filipowska; Ewa Kaznowska; Tomasz Kluz; Wiesław Guz; Elżbieta Łuczyńska Journal: Med Sci Monit Date: 2021-12-06