The major advancement in the treatment of rectal cancer is total mesorectal excision (TME), which involves complete removal of the tumour along with the mesorectal tissue which contains the lymphatics. The other advancement is the shift from adjuvant to neoadjuvant chemoradiotherapy. Both have dramatically changed the local recurrence rates and survival outcomes in patients with rectal cancer. The issue whether a patient with rectal cancer is a candidate for TME only or for preoperative chemoradiotherapy followed by TME can be answered by magnetic resonance imaging (MRI) findings, since it is the most accurate imaging technique for the local staging of rectal cancer.
TME is the best surgical treatment for rectal cancer provided that the resection margin is free of tumour. In this module, the author elaborates on: patients with rectal cancer who are at risk of local recurrence; post treatment assessment of the circumferential resection margin by MRI; the prognostic significance of MRI-detected parameters; the comparison of MRI-detected factors vs. pathology after neoadjuvant therapy for rectal cancer.
Furthermore, the module addresses the following questions: what should be considered as a good response and a pathological complete response. What is the timing for assessment after chemoradiotherapy; when is a maximum response reached; disease-free survival in good vs. poor responders and the impact of pathology and MRI; factors associated with tumour response, and the selection of patients for deferral of surgery.
The module is illustrated by examples from clinical research in the field. At the end of the presentation, the author puts an effort on reporting standards.
This E-learning module is part of ESMO commitment to educate oncology professionals across disciplines in a particular tumour type; in this case imaging specialists, surgical oncologists, radiation oncologists, medical oncologists and other members of the multidisciplinary team, on key MRI markers for outcome at baseline and post neoadjuvant chemoradiotherapy for rectal cancer.
The author, with demonstrated excellence in teaching in this topic, emphasises the importance of a dedicated colorectal multidisciplinary team and policy implementation of a preoperative multidisciplinary team review of all rectal cancers, using high resolution MRI with specialised colorectal radiologists committed to work within the multidisciplinary team. In addition, Prof Brown argues on the importance of patient education in terms of preoperative assessment and scans repetition when necessary. Team member training and support are needed; in this regard multidisciplinary workshops are effective and most effective when surgeons and radiologists learn together. Participation and support in clinical trials are an important part of the learning process as well.
