MRI evaluation of the neoadjuvant chemoradiation therapy result in a patient with rectal cancer, supplemented with T2-WI texture analysis of the tumor: a clinical case

The article presents a clinical case of using the active follow-up strategy (the so-called watch & wait) in a 73-year-old patient with cancer of the lower rectum with a good response to neoadjuvant chemoradiation therapy (NCRT). After 3 years of regular follow-up, including digital rectal examination, rectoscopy and MRI, indicating the absence of tumor progression, PET/ CT with 18F-FDG was obtained, which revealed a region of hypermetabolic activity in the lower rectum (SUVmax 27.1), in connection with which it was decided to carry out surgical treatment. When discussing the issue of the volume of the operation, MRI data were taken into account, supplemented by the results of T2-weighted texture analysis, which confirmed the absence of progression. The patient underwent organ-preserving treatment in the amount of transanal tumor resection. Pathomorphological examination after surgery established the inflammatory changes in the intestinal wall and absence of tumor. This case demonstrates the effectiveness of the standard examination volume when using the watch & wait strategy and the possibility of using T2-WI texture analysis to increase the reliability of MRI assessment of tumor response to chemotherapy.