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How Can We Identify Pathologic Complete Responders After Chemoradiotherapy?

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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.

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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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Author information

Authors and Affiliations

  1. Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1066 CX, Amsterdam, The Netherlands

    Doenja M. J. Lambregts MD, PhD & Regina G. H. Beets-Tan MD, PhD

Authors
  1. Doenja M. J. Lambregts MD, PhD
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  2. Regina G. H. Beets-Tan MD, PhD
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Corresponding author

Correspondence to Doenja M. J. Lambregts MD, PhD .

Editor information

Editors and Affiliations

  1. Dept. of Radiation Oncology, Università Cattolica S Cuore, Rome, Italy

    Vincenzo Valentini

  2. Head, Div. Clinical Oncology Research, University Clinic Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany

    Hans-Joachim Schmoll

  3. Department of Surgery, Leiden Univ Med Ctr, Leiden, The Netherlands

    Cornelis J. H. van de Velde

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Lambregts, D.M.J., Beets-Tan, R.G.H. (2018). How Can We Identify Pathologic Complete Responders After Chemoradiotherapy?. In: Valentini, V., Schmoll, HJ., van de Velde, C. (eds) Multidisciplinary Management of Rectal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-43217-5_14

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  • DOI: https://doi.org/10.1007/978-3-319-43217-5_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43215-1

  • Online ISBN: 978-3-319-43217-5

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