MRI scans may help spare some rectal cancer patients from surgery and the need for a colostomy, according to a new study published in Radiology. The research indicates that MRI can accurately predict which patients are at higher risk for cancer recurrence and require surgery plus chemotherapy, versus those who can safely opt for a "watch-and-wait" strategy.
Dr. Arun Krishnaraj, who directs the body imaging division at the University of Virginia's UVA Health system, explained that newer MRI techniques allow for better prediction of residual cancer and its likelihood of recurrence after chemotherapy and radiation. The study followed 277 rectal cancer patients with an average age of 58 years over four years, finding that MRI scans were a good indicator of overall survival, cancer recurrence, and the odds of preserving bowel function.
The Need for Alternatives to Surgery
Rectal cancer is a common malignancy, with approximately 46,220 new cases diagnosed annually in the United States. While doctors aim to treat rectal cancers with radiation and chemotherapy alone to preserve bowel function, some patients require surgery, specifically total mesorectal excision, which involves removing a section of the bowel. This procedure can result in a lifelong need for a colostomy bag and other complications like sexual dysfunction. Therefore, identifying patients who can avoid surgery is crucial.
MRI's Predictive Capabilities
The study assessed the predictive value of MRI scans in determining patient outcomes. Researchers found that MRI scans accurately predicted overall survival, cancer recurrence, and the likelihood of successful bowel preservation. Adding endoscopic views of the bowel to MRI results may further improve the accuracy of these predictions.
Future Directions
Dr. Krishnaraj expressed optimism about continued advancements in MRI and other tools like endoscopy, aiming for a 99% predictive probability in informing patients about their risk of cancer recurrence or spread following treatment. He emphasized that this tool can help patients and doctors predict who would benefit from surgery after initial chemotherapy and radiation and who can likely avoid it.
This research builds on previous findings, including a Swedish study published in eClinical Medicine in September, which found that administering chemotherapy and radiation therapies before surgery for rectal cancer can eliminate the need for rectal removal in more patients.
