New MRI techniques improve selection process for organ-sparing treatment of rectal cancer

Thanks to relatively new MRI techniques, patients with rectal cancer may benefit from an improved selection process for organ-sparing treatment. These techniques were also used to determine whether this treatment offers a safe alternative to standard surgical procedures for patients with rectal cancer. Milou Martens from the Faculty of Health, Medicine and Life Sciences carried out the research under the supervision of professors R. Beets-Tan (radiologist) and G. Beets (surgeon) and was awarded a PhD.

Organ-sparing treatment

In her doctoral research, Martens investigated the possibility of using relatively new MRI techniques to select patients for an organ-sparing procedure and researched whether this treatment option was a good alternative to conventional surgery. During the study, the patients were first administered standard treatment in the form of radiation therapy and chemotherapy. This was followed by a colonoscopy and an MRI scan using a specific technique known as diffusion MRI to check the status of the tumour. For a large tumour, patients would receive a standard operation. For a very small tumour, patients would be offered an alternative and less-invasive operation to remove a small portion of the rectum. If the tumour was gone, no operation would be performed. The last two treatment options are organ-saving in that the majority if not all of the rectum is spared. Patients then receive regular MRI scans and colonoscopies to determine whether the tumour successfully responded to treatment.

The study examined 100 patients, 85 of whom remained tumour-free. The other 15 patients experienced early-stage tumour growth and underwent surgery. The survival rate was high for all 100 patients and comparable to that of patients who underwent conventional surgery. 'Several of these techniques proved to be extremely promising,' says Martens. 'But further research is needed to determine their reliability in daily practice.'

Standard treatment

The standard treatment option for advanced rectal cancer is radiation and chemotherapy. This is followed by an operation to remove the entire rectum and the surrounding lymph nodes. Roughly one-third of these patients receive a permanent stoma and the remaining two-thirds receive a temporary stoma. Tissue biopsies after the operation found that radiation and chemotherapy had completely removed the tumour in approximately 15% of patients who underwent this type of treatment, making surgery unnecessary.

The organ-sparing research was conducted at Maastricht UMC+ and has been available since August in Amsterdam's NKI-AVL, where professors Beets and Beets-Tan currently work. The therapy is in high demand, with patients from around the country travelling to Maastricht and Amsterdam for treatment. The goal is to offer these treatments in more hospitals throughout the Netherlands. The research team led by Professor Beets recently acquired funding from the Dutch Cancer Society.

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