ECR 2013 Rec: MRI-based selection of clinical complete and good responders after chemoradiation for rectal cancer allows for successful minimal invasive treatment #SS1801a #B0940

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B-0949 MRI-based selection of clinical complete and good responders after chemoradiation for rectal cancer allows for successful minimal invasive treatment

L. Heijnen, M. Maas, M.H. Martens, D.M.J. Lambregts, J.W.A. Leijtens, R.G.H. Beets-Tan, G.L. Beets | Monday, March 11, 14:00 – 15:30 / Room E2

Purpose: Patients with good or complete response after neoadjuvant chemoradiation have excellent long-term outcome. Minimal invasive treatment (i.e. transanal endoscopic microsurgery (TEM) and wait-and-see policy) are increasingly considered as an alternative to major surgery. With this prospective cohort study we aimed to evaluate long-term outcome of strictly MR-based selected patients who have been treated with minimal invasive treatment.
Methods and Materials: Eight weeks after chemoradiation, endoscopy and restaging MRI were performed (including diffusion-weighted MRI for yT-staging and gadofosveset-enhanced MRI for yN-staging). Complete responders were selected for wait-and-see policy and good responders with small tumour remnant for TEM. Both treatment groups underwent intensive 3-to-6 monthly follow-up, using MR imaging (DWI+gadofosveset), CEA, CT of thorax and abdomen and endoscopy was performed. Long-term outcome was estimated with Kaplan-Meier curves.
Results: Forty-one patients were included, thirty-three in the wait-and-see group and eight in the TEM-group. Mean follow-up was 26 months (range 6-91). For the TEM-group, 4 patients had ypT0 and 4 had ypT2. Two patients, both in the wait-and-see group, developed a local recurrence within two years and underwent surgery, leading to a 2-year local recurrence rate of 9 %. Both recurrences were detected on (DWI-)MRI in an early stage. The cumulative probabilities of 2-year disease-free survival and overall survival were 93 % and 100 %, respectively. No recurrences occurred in the TEM-group.
Conclusion: Both selection and follow-up of good and complete responders after chemoradiation for rectal cancer with MRI is feasible. Long-term outcome so far is excellent. (DWI-)MRI seems to be a reliable tool for early recurrence detection.

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