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Do treated rectal tumors appear differently on MRI after chemotherapy versus chemoradiotherapy?

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Abstract

Purpose

Increasing studies have focused on neoadjuvant chemotherapy (NCT) in rectal cancer. However, few studies explored the differences in radiographic variation between patients treated with NCT and neoadjuvant chemoradiotherapy (NCRT).

Methods

Stage II/III rectal cancer patients from March 2016 to December 2019 meeting the criteria treated with NCRT or NCT were included. MRI features, including tumor location, longitudinal length, DWI signal, MRI tumor regression grade (mrTRG), and radiomic texture features, before and after neoadjuvant treatments were reviewed.

Results

116 patients with NCRT and 61 with NCT were analyzed. Among these patients, 46 patients in the NCRT group and 18 in the NCT group were responders with pathological TRG0-1. Within these responders, the mean tumor longitudinal length regression rate (TLRR) of the NCT group was 60.08 ± 11.17%, which was significantly higher than the 50.73 ± 15.28% of the NCRT group (p = 0.010). The proportion of high signal in the DWI image after NCT was higher than that of the NCRT group (88.89% vs 50.00%, p = 0.004). NCT responders had significantly higher median change rates than those of NCRT responders in 11 radiomic features, especially those shape features.

Conclusion

MRI images change differently between responders treated with NCRT and those with NCT in rectal cancer. The tumor volumetry and some radiomic features change more obviously in NCT responders, and the tumor signal changes more obviously in NCRT responders. During the evaluation of the response of the tumor to the neoadjuvant treatments, images of patients should be treated differently.

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Funding

This work was supported by the National Natural Science Foundation of China (82103541, 82203474 and 82203394), Department of Science and Technology of Sichuan Province (Nos. 2022YFS0162 and 2021YFS0025), 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (No. 20HXJS003), 1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, and West China Hospital, Sichuan University (Nos. 22HXFH001 and 2019HXFH031).

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Author notes

  1. Yu Shen, Yanqiong Wen, and Liang Bi have contributed equally to this work.

Authors and Affiliations

  1. Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Street, Chengdu, 610041, Sichuan, China

    Yu Shen, Liang Bi, Xuyang Yang, Xiangbing Deng, Wenjian Meng & Ziqiang Wang

  2. Operating Room, Department of Anesthesiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China

    Yanqiong Wen

  3. Department of Colorectal Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China

    Liang Bi

  4. Department of Radiology, West China Hospital, Sichuan University, Chengdu, China

    Xiaoling Gong

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  1. Yu Shen
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Correspondence to Xiangbing Deng, Wenjian Meng or Ziqiang Wang.

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Shen, Y., Wen, Y., Bi, L. et al. Do treated rectal tumors appear differently on MRI after chemotherapy versus chemoradiotherapy?. Abdom Radiol 49, 774–782 (2024). https://doi.org/10.1007/s00261-023-04115-5

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