Posted on 10/28/2024 9:19:40 PM PDT by ConservativeMind
Magnetic resonance imaging (MRI) can spare many patients with rectal cancer from invasive surgery that can carry lifelong side effects, research indicates.
The findings indicate that MRI can predict patient outcomes and the risk of the tumor recurring 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.
"Now we have a powerful tool to help patients and their doctors predict who would benefit from surgery after initial chemotherapy and radiation and who can likely avoid surgery."
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 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 Renal 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.
The researchers determined MRI was an effective tool for predicting the patients' overall survival, the risk of their cancer returning.
The promising MRI crystal ball can likely be made even more effective by combining it with data from endoscopies (visual inspections).
(Excerpt) Read more at medicalxpress.com ...
“Radiologists classified participants as having clinical complete response (cCR), near-complete clinical response (nCR), or incomplete clinical response (iCR) based on restaging MRI at a mean of 8 weeks ± 4 (SD) after treatment.”
“Five-year disease-free survival for participants with cCR, nCR, and iCR was 81.8%, 67.6%, and 49.6%, respectively (log-rank P < .001). The MRI response category also predicted overall survival (log-rank P < .001), distant recurrence-free survival (log-rank P = .005), and local regrowth (log-rank P = .02). Among the 266 participants with at least 2 years of follow-up, 129 (48.5%) had Rectal Disease.
So a slight majority did not have rectal disease, which likely meant they did not need to automatically get more tissue removed, as may be the practice.
The study is locked, so I could not get the specific MRI settings used, but it’s safe to say a follow up MRI with a scope could suffice to determine if another operations was needed.
Easiest way to avoid rectal cancer is to avoid deviant sex.
The MRI saved my life.
I had colon cancer surgery over twelve years ago and they removed 22 inches of my colon. No chemo or radiation required.
Last October I had an abdominal MRI to locate several hernias, one which had pinched my small intestine. Knowing the exact location of the hernia allowed me to push the intestine back through the hole and delay the surgery.
The abdominal MRI overlapped the bottom of my lung and showed a two inch cancer mass in the bottom of my left lung. I had no symptoms and it was pure luck to find it.
Again, surgery, this time to remove the bottom half of my left lung, but no chemo or radiation required.
Now I get a full body MRI every three months and they all have been clean.
Duke University did extensive research on proteins in the blood as markers for cancer. They took my two tumors that had been removed and identified a protein in my blood that was associated with my specific cancer.
I have a Signatera Oncotype genomic blood test every three months searching for that protein as a marker. This 12-gene test—with 7 cancer-related genes and 5 reference genes—looks at the underlying biology of my individual tumors,
So far, all blood tests have been negative. Same with the Cancer Antigen test and the CEA test.
That may cut down on it, but it ain’t the only causative factor...
I guess the rule of thumb is that it it’s operable, do that before cooking the tissue with radiation - you can always get radiation post-op but getting radiation first can complicate the surgery/recovery process due to the cooked scar tissue.
Makes it super important to get all info possible before choosing a route.
How did Duke sample your 12-year old tumor tissue and your new tumor tissue? Did you have it cryogenically frozen or did they do the protein analysis 12 years ago, with a new one, now?
You have a fascinating story.
Duke did both surgeries. They had the old tumor archived in pathology.
I’m participating in several oncology studies and my wife is an MD at Duke. They give me the royal treatment. (As they do everyone.)
My brother-in-law is a radiologist board certified in nuclear medicine and sits on several hospital cancer boards. He owns several Pet Scan and MRI machines, thus I use him as my personal consultant.
He’s on the cutting edge of medicine, now beta testing Artificial Intelligence in MRI and Pet Scans to generate 3D images for use during biopsies and surgical procedures. It’s amazing how far medicine has advanced.
I recently attended a radiology conference where he presented on these topics.
“Makes it super important to get all info possible before choosing a route.”
ABSOLUTELY...
The days of I have a hammer and everything looks like a nail are gone in medicine. No more pushing one treatment for everyone.
It’s complex, based upon the degree it has metastasized and the type of cancer.
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