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. 2022 Nov 13;14(22):5565.
doi: 10.3390/cancers14225565.

Features on Endoscopy and MRI after Treatment with Contact X-ray Brachytherapy for Rectal Cancer: Explorative Results

Petra A Custers  1   2   3 , Monique Maas  4 , Doenja M J Lambregts  4 , Regina G H Beets-Tan  3   4 , Geerard L Beets  1   3 , Femke P Peters  2   5 , Corrie A M Marijnen  2   5 , Monique E van Leerdam  6   7 , Inge L Huibregtse  6 , Baukelien van Triest  2
Affiliations

Features on Endoscopy and MRI after Treatment with Contact X-ray Brachytherapy for Rectal Cancer: Explorative Results

Petra A Custers et al. Cancers (Basel). .

Abstract

After neoadjuvant (chemo)radiotherapy for rectal cancer, contact X-ray brachytherapy (CXB) can be applied aiming at organ preservation. This explorative study describes the early features on endoscopy and MRI after CXB. Patients treated with CXB following (chemo)radiotherapy and a follow-up of ≥12 months were selected. Endoscopy and MRI were performed every 3 months. Expert readers scored all the images according to structured reporting templates. Thirty-six patients were included, 15 of whom obtained a cCR. On endoscopy, the most frequently observed feature early in follow-up was an ulcer, regardless of whether patients developed a cCR. A flat, white scar and tumor mass were common at 6 months. Focal tumor signal on T2W-MRI and mass-like high signal on DWI were generally absent in patients with a cCR. An ulceration on T2W-MRI and "reactive" mucosal signal on DWI were observed early in follow-up regardless of the final tumor response. The distinction between a cCR and a residual tumor generally can be made at 6 months. Features associated with a residual tumor are tumor mass on endoscopy, focal tumor signal on T2W-MRI, and mass-like high signal on DWI. Early recognition of these features is necessary to identify patients who will not develop a cCR as early as possible.

Keywords: MRI; contact X-ray brachytherapy; endoscopy; imaging; organ preservation; rectal cancer.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Features on endoscopy, T2W-MRI, and DWI. (A) Flat, white scar on endoscopy; (B) adenomatous tissue on endoscopy; (C) ulcer with regular borders on endoscopy; (D) ulcer with irregular borders on endoscopy; (E) tumor mass on endoscopy; (F) regular homogeneous fibrosis on T2W-MRI; (G) layered fibrosis on T2W-MRI; (H) irregular fibrosis on T2W-MRI; (I) heterogeneous fibrosis on T2W-MRI; (J) ulceration on T2W-MRI; (K) no high signal on DWI; (L) small spots of high signal on DWI; (M) linear high signal on DWI; (N) mass-like high signal on DWI; (O) a diffuse “reactive” mucosal diffusion signal on DWI.
Figure 2
Figure 2
Features on endoscopy during follow-up. * No further follow-up on endoscopy and MRI of patients with histopathological confirmation of carcinoma obtained by biopsy or surgery.
Figure 3
Figure 3
Case of a healing ulcer on endoscopy and the presence of a more diffuse “reactive” mucosal signal on DWI after contact X-ray brachytherapy. Three months following CXB (A), an irregular ulcer on endoscopy, irregular heterogeneous fibrosis (black arrows) on T2W-MRI, and small focal spots of high signal within the fibrosis (white arrowhead) in combination with a diffuse “reactive” mucosal signal on DWI were observed. Later, during follow-up at 7 (B) and 11 (C) months, the ulcer on endoscopy healed into a flat, white scar, the fibrosis on T2W-MRI became more regular and homogeneous, and, on DWI, the small focal spots and the diffuse “reactive” mucosal signal disappeared.
Figure 4
Figure 4
Features on endoscopy prior to and during follow-up after contact X-ray brachytherapy per patient. * Patients with histopathological confirmation of residual tumor.
Figure 5
Figure 5
The morphology of the diffusion signal prior to and during follow-up after contact X-ray brachytherapy per patient. * Patients with histopathological confirmation of residual tumor.
Figure 6
Figure 6
The morphology of the diffusion signal during follow-up. * No further follow-up on endoscopy and MRI of patients with histopathological confirmation of carcinoma obtained by biopsy or surgery.
See this image and copyright information in PMC

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