Current Colorectal Cancer Reports

, Volume 9, Issue 2, pp 136–145 | Cite as

MRI-Based Assessment of Tumor Regression in Rectal Cancer

  • Uday B. Patel
  • Gina BrownEmail author
Localized Rectal Cancer (R Glynne-Jones, Section Editor)


Until recently, there has been uncertainty regarding the exact role, importance, and validity of MRI in restaging rectal cancers after preoperative treatment. MRI tumor reassessment has wide-ranging implications, for example, altering surgical planning, timing of surgery, and potential deferral of surgery for MRI-identified good responders. Several approaches for restaging rectal cancer after treatment have been proposed, for example, T staging, volume reduction of tumor, MRI tumor regression grading, and diffusion-weighted-imaging assessment. Likewise several approaches to restaging the potential resection margin and nodal disease have also been investigated. This article seeks to review the evidence for each of the proposed approaches to restage rectal cancer after chemoradiotherapy and concludes with recommendations for current clinical practice.


Rectal cancer MRI Chemoradiotherapy Volume Diffusion Tumor regression grade 



This authors are supported by a grant from the National Institute for Health Research (UK).

Conflict of Interest

Uday B. Patel declares he has no conflict of interest.

Gina Brown declares she has no conflict of interest.


  1. 1.
    Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Hartley A, Ho KF, McConkey C, Geh JI. Pathological complete response following pre-operative chemoradiotherapy in rectal cancer: analysis of phase II/III trials. Br J Radiol. 2005;78(934):934–8.PubMedCrossRefGoogle Scholar
  3. 3.
    O'Neill BD, Brown G, Heald RJ, Cunningham D, Tait DM. Non-operative treatment after neoadjuvant chemoradiotherapy for rectal cancer. Lancet Oncol. 2007;8(7):625–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Taylor FG, Swift RI, Blomqvist L, Brown G. A systematic approach to the interpretation of preoperative staging MRI for rectal cancer. AJR Am J Roentgenol. 2008;191(6):1827–35.PubMedCrossRefGoogle Scholar
  5. 5.
    Willett CG, Badizadegan K, Ancukiewicz M, Shellito PC. Prognostic factors in stage T3N0 rectal cancer: do all patients require postoperative pelvic irradiation and chemotherapy? Dis Colon Rectum. 1999;42(2):167–73.PubMedCrossRefGoogle Scholar
  6. 6.
    Hermanek P, Henson D, Hutter R, Sobin L. TNM supplement. New York: Springer; 1993.Google Scholar
  7. 7.
    Chen CC, Lee RC, Lin JK, Wang LW, Yang SH. How accurate is magnetic resonance imaging in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy? Dis Colon Rectum. 2005;48(4):722–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Patel UB, Brown G, Rutten H, et al. Comparison of magnetic resonance imaging and histopathological response to chemoradiotherapy in locally advanced rectal cancer. Ann Surg Oncol. 2012;19(9):2842–52.PubMedCrossRefGoogle Scholar
  9. 9.
    Barbaro B, Fiorucci C, Tebala C, et al. Locally advanced rectal cancer: MR imaging in prediction of response after preoperative chemotherapy and radiation therapy. Radiology. 2009;250(3):730–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Dresen RC, Beets GL, Rutten HJ, et al. Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy. Part I. Are we able to predict tumor confined to the rectal wall? Radiology. 2009;252(1):71–80.PubMedCrossRefGoogle Scholar
  11. 11.
    Kuo LJ, Chern MC, Tsou MH, et al. Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy. Dis Colon Rectum. 2005;48(1):23–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Nougaret S, Rouanet P, Molinari N, et al. MR volumetric measurement of low rectal cancer helps predict tumor response and outcome after combined chemotherapy and radiation therapy. Radiology. 2012;263(2):409–18.PubMedCrossRefGoogle Scholar
  13. 13.
    Yeo SG, Kim DY, Park JW, et al. Tumor volume reduction rate after preoperative chemoradiotherapy as a prognostic factor in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys. 2012;82(2):e193–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Patel UB, Blomqvist LK, Taylor F, et al. MRI after treatment of locally advanced rectal cancer: how to report tumor response–the MERCURY experience. AJR Am J Roentgenol. 2012;199(4):W486–95.PubMedCrossRefGoogle Scholar
  15. 15.
    Patel UB, Taylor F, Blomqvist L, et al. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol. 2011;29(28):3753–60.PubMedCrossRefGoogle Scholar
  16. 16.
    Brown G, Richards CJ, Bourne MW, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology. 2003;227(2):371–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart A. Revised tumor and node categorization for rectal cancer based on surveillance, epidemiology, and end results and rectal pooled analysis outcomes. J Clin Oncol. 2010;28(2):256–63.PubMedCrossRefGoogle Scholar
  18. 18.
    Shihab OC, Moran BJ, Heald RJ, Quirke P, Brown G. MRI staging of low rectal cancer. Eur Radiol. 2009;19(3):643–50.PubMedCrossRefGoogle Scholar
  19. 19.
    MERCURY. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ. 2006;333(7572):779.CrossRefGoogle Scholar
  20. 20.
    Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. 2002;20(7):1729–34.PubMedCrossRefGoogle Scholar
  21. 21.
    Vliegen RF, Beets GL, Lammering G, et al. Mesorectal fascia invasion after neoadjuvant chemotherapy and radiation therapy for locally advanced rectal cancer: accuracy of MR imaging for prediction. Radiology. 2008;246(2):454–62.PubMedCrossRefGoogle Scholar
  22. 22.
    Park MJ, Kim SH, Lee SJ, Jang KM, Rhim H. Locally advanced rectal cancer: added value of diffusion-weighted MR imaging for predicting tumor clearance of the mesorectal fascia after neoadjuvant chemotherapy and radiation therapy. Radiology. 2011;260(3):771–80.PubMedCrossRefGoogle Scholar
  23. 23.
    Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis. 1997;12(1):19–23.PubMedCrossRefGoogle Scholar
  24. 24.
    Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer. 1994;73(11):2680–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Rodel C, Martus P, Papadoupolos T, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol. 2005;23(34):8688–96.PubMedCrossRefGoogle Scholar
  26. 26.
    Suarez J, Vera R, Balen E, et al. Pathologic response assessed by Mandard grade is a better prognostic factor than down staging for disease-free survival after preoperative radiochemotherapy for advanced rectal cancer. Colorectal Dis. 2008;10(6):563–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Mehta S, Johnson RJ, Schofield PF. Staging of colorectal cancer. Clin Radiol. 1994;49(8):515–23.PubMedCrossRefGoogle Scholar
  28. 28.
    Wheeler JM, Warren BF, Mortensen NJ, et al. Quantification of histologic regression of rectal cancer after irradiation: a proposal for a modified staging system. Dis Colon Rectum. 2002;45(8):1051–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Torkzad MR, Lindholm J, Martling A, Cedermark B, Glimelius B, Blomqvist L. MRI after preoperative radiotherapy for rectal cancer; correlation with histopathology and the role of volumetry. Eur Radiol. 2007;17(6):1566–73.PubMedCrossRefGoogle Scholar
  30. 30.
    Kang JH, Kim YC, Kim H, et al. Tumor volume changes assessed by three-dimensional magnetic resonance volumetry in rectal cancer patients after preoperative chemoradiation: the impact of the volume reduction ratio on the prediction of pathologic complete response. Int J Radiat Oncol Biol Phys. 2010;76(4):1018–25.PubMedCrossRefGoogle Scholar
  31. 31.
    Sun YS, Zhang XP, Tang L, et al. Locally advanced rectal carcinoma treated with preoperative chemotherapy and radiation therapy: preliminary analysis of diffusion-weighted MR imaging for early detection of tumor histopathologic downstaging. Radiology. 2010;254(1):170–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Yeo SG, Kim DY, Kim TH, et al. Tumor volume reduction rate measured by magnetic resonance volumetry correlated with pathologic tumor response of preoperative chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2009.Google Scholar
  33. 33.
    Koh DM, Padhani AR. Diffusion-weighted MRI: a new functional clinical technique for tumour imaging. Br J Radiol. 2006;79(944):633–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Lambregts DM, Vandecaveye V, Barbaro B, et al. Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol. 2011;18(8):2224–31.PubMedCrossRefGoogle Scholar
  35. 35.
    Kim SH, Lee JM, Hong SH, et al. Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy. Radiology. 2009;253(1):116–25.PubMedCrossRefGoogle Scholar
  36. 36.
    Curvo-Semedo L, Lambregts DM, Maas M, et al. Rectal cancer: assessment of complete response to preoperative combined radiation therapy with chemotherapy–conventional MR volumetry versus diffusion-weighted MR imaging. Radiology. 2011;260(3):734–43.PubMedCrossRefGoogle Scholar
  37. 37.
    Barbaro B, Vitale R, Valentini V, et al. Diffusion-weighted magnetic resonance imaging in monitoring rectal cancer response to neoadjuvant chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(2):594–9.PubMedGoogle Scholar
  38. 38.
    Kim SH, Lee JY, Lee JM, Han JK, Choi BI. Apparent diffusion coefficient for evaluating tumour response to neoadjuvant chemoradiation therapy for locally advanced rectal cancer. Eur Radiol. 2011;21(5):987–95.PubMedCrossRefGoogle Scholar
  39. 39.
    Kim YC, Lim JS, Keum KC, et al. Comparison of diffusion-weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer. J Magn Reson Imaging. 2011;34(3):570–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of RadiologyThe Royal Marsden Hospital NHS TrustSuttonUK

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