Annals of Surgical Oncology

, Volume 19, Issue 9, pp 2842–2852 | Cite as

Comparison of Magnetic Resonance Imaging and Histopathological Response to Chemoradiotherapy in Locally Advanced Rectal Cancer

  • Uday Bharat Patel
  • Gina BrownEmail author
  • Harm Rutten
  • Nicholas West
  • David Sebag-Montefiore
  • Robert Glynne-Jones
  • Eric Rullier
  • Marc Peeters
  • Eric Van Cutsem
  • Sergio Ricci
  • Cornelius Van de Velde
  • Pennert Kjell
  • Philip Quirke
Colorectal Cancer



Magnetic resonance imaging (MRI) methods for chemoradiotherapy (CRT) response assessment of rectal cancer include posttreatment T staging (ymrT), tumor regression grading (mrTRG), volume reduction posttreatment, and modified RECIST measurement. We compared these methods in identifying good versus poor responders with the histopathological standards of T stage (ypT) and tumor regression grading (TRG).


A total of 86 patients underwent CRT in a prospective phase II trial for MRI-defined locally advanced rectal cancer. Two readers independently assessed MRIs for ymrT, mrTRG, volume change, and RECIST. Parameters for each case were categorized as good or poor response and analyzed against ypT and TRG by univariate logistic regression.


A total of 83 patients had evaluable imaging, and 78 had final pathology (five did not undergo surgery). Of these, 34 patients had good response (ypT0-3a) and 44 had poor response (>ypT3a). Also, 27 patients had favorable pathologic TRG (predominant fibrosis) and 51 had unfavorable TRG (predominant tumor). Good mrTRG and ymr <T3b stage were both significantly (P = 0.001) associated with favorable pathology odds ratio [OR] = 16.11 (95 % confidence interval [95 % CI]: 3.36–77.29) and 17.50 (95 % CI: 5.38–56.89), respectively. RECIST measurements and volume reduction of >80 % showed an OR of 3.23 (95 % CI: 1.14–9.17), 4.25 (95 % CI: 0.92–15.45), respectively, for a good ypT score (P = 0.028), but there was no association for histopathological TRG.


Favorable and unfavorable histopathology are predicted by both ymrT and mrTRG, and we recommend these parameters for post-treatment assessment of rectal cancers treated with CRT.


Rectal Cancer Circumferential Resection Margin Advanced Rectal Cancer Tumor Regression Grade Tumor Length 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



GB., H. R., D. S. M., R. G. J., E. R., M. P., S. R., C. V. V., and P. Q. were paid honoraria by Sanofi-Aventis for the design of study protocol. E.V.C. received research funding at the University Hospital Leuven paid by Sanofi-Aventis.


  1. 1.
    MERCURY. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology. 2007;243:132–9.Google Scholar
  2. 2.
    Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.PubMedCrossRefGoogle Scholar
  3. 3.
    Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.PubMedCrossRefGoogle Scholar
  4. 4.
    O’Neill BD, Brown G, Heald RJ, Cunningham D, Tait DM. Non-operative treatment after neoadjuvant chemoradiotherapy for rectal cancer. Lancet Oncol. 2007;8:625–33.PubMedCrossRefGoogle Scholar
  5. 5.
    Guillem JG, Diaz-Gonzalez JA, Minsky BD, Valentini V, Jeong SY, Rodriguez-Bigas MA, et al. cT3N0 rectal cancer: potential overtreatment with preoperative chemoradiotherapy is warranted. J Clin Oncol. 2008;26:368–73.PubMedCrossRefGoogle Scholar
  6. 6.
    Suarez J, Vera R, Balen E, Gomez M, Arias F, Lera JM, 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;10:563–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Theodoropoulos G, Wise WE, Padmanabhan A, Kerner BA, Taylor CW, Aguilar PS, et al. T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum. 2002;4:895–903.CrossRefGoogle Scholar
  8. 8.
    Kuo LJ, Liu MC, Jian JJ, Horng CF, Cheng TI, Chen CM, et al. Is final TNM staging a predictor for survival in locally advanced rectal cancer after preoperative chemoradiation therapy? Ann Surg Oncol. 2007;14:2766–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Valentini V, Coco C, Picciocchi A, Morganti AG, Trodella L, Ciabattoni A, et al. Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients. Int J Radiat Oncol Biol Phys. 2002;53:664–74.PubMedCrossRefGoogle Scholar
  10. 10.
    Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro U, Jr., Silva e Sousa AH, Jr., et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg. 2004;240:711–7; discussion 717–8.PubMedGoogle Scholar
  11. 11.
    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;48:722–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Yeo SG, Kim DY, Kim TH, Jung KH, Hong YS, Chang HJ, 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. 2010;78:164–71.PubMedCrossRefGoogle Scholar
  13. 13.
    Patel UB, Taylor F, Blomqvist L, George CD, Evans H, Tekkis P, et al. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol. 2011;29:3753–60.PubMedCrossRefGoogle Scholar
  14. 14.
    Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis. 1997;12:19–23.PubMedCrossRefGoogle Scholar
  15. 15.
    Brown G, Daniels IR, Richardson C, Revell P, Peppercorn D, Bourne M. Techniques and trouble-shooting in high spatial resolution thin slice MRI for rectal cancer. Br J Radiol. 2005;78:245–51.PubMedCrossRefGoogle Scholar
  16. 16.
    Moran B, Brown G, Cunningham D, Daniels I, Heald R, Quirke P, et al. Clarifying the TNM staging of rectal cancer in the context of modern imaging and neo-adjuvant treatment: ‘y’‘u’ and ‘p’ need ‘mr’ and ‘ct’. Colorectal Dis. 2008;10:242–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Sobin LH, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumours (UICC International Union Against Cancer). Wiley, Oxford; 2009.Google Scholar
  18. 18.
    Hermanek P, Henson D, Hutter RVP, Sobin LH. TNM Supplement. New York: Springer-Verlag; 1993.CrossRefGoogle Scholar
  19. 19.
    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;42:167–73.PubMedCrossRefGoogle Scholar
  20. 20.
    Salerno G, Chandler I, Wotherspoon A, Thomas K, Moran B, Brown G. Sites of surgical wasting in the abdominoperineal specimen. Br J Surg. 2008;95:1147–54.PubMedCrossRefGoogle Scholar
  21. 21.
    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;191:1827–35.CrossRefGoogle Scholar
  22. 22.
    Barbaro B, Fiorucci C, Tebala C, Valentini V, Gambacorta MA, Vecchio FM, et al. Locally advanced rectal cancer: MR imaging in prediction of response after preoperative chemotherapy and radiation therapy. Radiology. 2009;250:730–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Machida N, Boku N, Yoshino S, Hironaka Y, Onozawa A, Fukutomi K, et al. editors. Impact of baseline sum longest diameter of target lesions by RECIST on survival of patients with metastatic colorectal cancer (MCRC). Abstract No. 266, 2007 Gastrointestinal Cancers Symposium. American Society of Clinical Oncology: Orlando; 2007.Google Scholar
  24. 24.
    Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.PubMedCrossRefGoogle Scholar
  25. 25.
    Francois Y, Nemoz CJ, Baulieux J, Vignal J, Grandjean JP, Partensky C, et al. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial. J Clin Oncol. 1999;17:2396.PubMedGoogle Scholar
  26. 26.
    Dresen RC, Beets GL, Rutten HJ, Engelen SM, Lahaye MJ, Vliegen RF, 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;252:71–80.PubMedCrossRefGoogle Scholar
  27. 27.
    Kang JH, Kim YC, Kim H, Kim YW, Hur H, Kim JS, 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;76:1018–25.PubMedCrossRefGoogle Scholar
  28. 28.
    Mayr NA, Yuh WT, Taoka T, Wang JZ, Wu DH, Montebello JF, et al. Serial therapy-induced changes in tumor shape in cervical cancer and their impact on assessing tumor volume and treatment response. AJR Am J Roentgenol. 2006;187:65–72.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Uday Bharat Patel
    • 1
  • Gina Brown
    • 1
    Email author
  • Harm Rutten
    • 2
  • Nicholas West
    • 3
  • David Sebag-Montefiore
    • 4
  • Robert Glynne-Jones
    • 5
  • Eric Rullier
    • 6
  • Marc Peeters
    • 7
  • Eric Van Cutsem
    • 8
  • Sergio Ricci
    • 9
  • Cornelius Van de Velde
    • 10
  • Pennert Kjell
    • 1
  • Philip Quirke
    • 3
  1. 1.Department of RadiologyThe Royal Marsden HospitalSuttonUK
  2. 2.Department of SurgeryCatharina HospitalEindhovenThe Netherlands
  3. 3.Section of Pathology and Tumor BiologyLeeds Institute of Molecular Medicine, University of LeedsLeedsUK
  4. 4.St James’s Institute of OncologyLeedsUK
  5. 5.Department of Clinical OncologyMount Vernon Cancer CenterNorthwoodUK
  6. 6.Department of SurgerySaint-Andre HospitalBordeauxFrance
  7. 7.Digestive Oncology UnitUniversity Hospital GhentGhentBelgium
  8. 8.Digestive OncologyUniversity Hospital Gasthuisberg/LeuvenLeuvenBelgium
  9. 9.Department of Medical OncologySanta Chiara HospitalPisaItaly
  10. 10.Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands

Personalised recommendations