How Can We Identify Pathologic Complete Responders After Chemoradiotherapy?

  • Doenja M. J. Lambregts
  • Regina G. H. Beets-Tan
Chapter

Abstract

With the introduction of organ-preserving treatment strategies, response evaluation after chemoradiotherapy is becoming an increasingly relevant issue. When accurately selected, patients with a complete tumour response may be offered a ‘watch-and-wait’ approach instead of surgical resection. Imaging plays an important role in assessing response after chemoradiotherapy. However, for the identification of complete responders, MRI as well as endorectal ultrasound and CT show limited accuracy, mainly due to difficulties in discriminating viable tumour remnants within post-radiation fibrosis. Addition of diffusion-weighted imaging can significantly improve the performance of MRI in identifying complete responders. Best results are obtained when combining MRI (including diffusion MRI) with digital rectal examination and endoscopy.

Abbreviations

ADC

Apparent diffusion coefficient

CRT

Chemoradiotherapy

CT

Computed tomography

DCE

Dynamic contrast enhanced

DRE

Digital rectal examination

DWI

Diffusion-weighted (magnetic resonance) imaging

EUS

Endorectal (or endoscopic) ultrasound

MRI

Magnetic resonance imaging

PET/FDG-PET

Positron emission tomography/18F-fluorodeoxygenase positron emission tomography

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Copyright information

© Springer-Verlag Berlin Heidelberg 2018

Authors and Affiliations

  • Doenja M. J. Lambregts
    • 1
  • Regina G. H. Beets-Tan
    • 1
  1. 1.Department of RadiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands

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