Can MRI Predict Patient Outcomes and the Risk of Tumor Recurrence in Rectal Cancer Cases? Study Sheds Light

Magnetic resonance imaging (MRI) can spare many patients with rectal cancer from invasive surgery that can carry lifelong side effects, new research indicates.

The findings, from UVA Cancer Center’s Arun Krishnaraj, MD, MPH, and collaborators, indicate that MRI can predict patient outcomes and the risk of the tumor reccurring or spreading for patients who have undergone chemotherapy and radiation.

That information could be extremely useful in determining the best course of treatment and deciding whether a patient can avoid surgery in favor of a “watch and wait” approach, the researchers say. In watch-and-wait, doctors continue to monitor patients for cancer reccurrence or spread, holding off on surgery but potentially leaving them uncertain and anxious about the future.

The information MRI can provide would be both useful for doctors and comforting for patients, the new findings suggest.

Rectal cancer is typically treated at first with radiation and chemotherapy, but some patients require what is known as “total mesorectal excision” – the removal of a substantial portion of their bowel. This can be lifesaving but it can also be life-changing: Side effects can include the need for a permanent colostomy bag and sexual dysfunction.

To help patients make the best choices and get the best outcomes, Krishnaraj a radiologist and imaging expert who is director of UVA Health’s Division of Body Imaging, and his collaborators wanted to see if MRI could serve as a crystal ball for the effects of watch-and-wait. To do this, they analyzed the results of the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial to see how MRI results aligned with patient outcomes. In total, they reviewed outcomes from 277 patients, with an average age of 58, who had the stage of their rectal cancer determined by MRI. The average length of the follow-up period was slightly more than 4 years.

After crunching the numbers, the researchers determined MRI was an effective tool for predicting the patients’ overall survival, the risk of their cancer returning and their chances for keeping their bowel intact.

The promising MRI crystal ball can likely be made even more effective by combining it with data from endoscopies (visual inspections) after treatment, the OPRA Consortium researchers say. They are urging additional research on the potential of the combination, which they believe could offer doctors and patients a powerful new tool.

Reference: Williams, H., Omer, D. M., Thompson, H. M., Lin, S. T., Verheij, F. S., Miranda, J., ... & OPRA Consortium. (2024). MRI Predicts Residual Disease and Outcomes in Watch-and-Wait Patients with Rectal Cancer. Radiology, 312(3), e232748.