MRI in the prognostic evaluation of patients with rectal cancer

We read with interest the Article in The Lancet Oncology by Amy C Lord and colleagues, 1 Lord AC Corr A Chandramohan A et al. Assessment of the 2020 NICE criteria for preoperative radiotherapy in patients with rectal cancer treated by surgery alone in comparison with proven MRI prognostic factors: a retrospective cohort study. Lancet Oncol. 2022; 23: 793-801 Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar including comments related to their study. 1 Lord AC Corr A Chandramohan A et al. Assessment of the 2020 NICE criteria for preoperative radiotherapy in patients with rectal cancer treated by surgery alone in comparison with proven MRI prognostic factors: a retrospective cohort study. Lancet Oncol. 2022; 23: 793-801 Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar , 2 Davies J Chew C Bromham N Hoskin P NICE 2020 guideline for the management of colorectal cancer. Lancet Oncol. 2022; 23: e247 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar , 3 Hupkens BJP Breukink SO Personalised care for high-risk rectal cancer: does one size fit all?. Lancet Oncol. 2022; 23: 697-698 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar The authors compared the prognostic significance of the National Institute for Health and Care Excellence (NICE) guidelines and conventional MRI in patients with rectal cancer who did not undergo preoperative radiotherapy. They concluded that MRI was superior to the NICE guidelines as a prognostic assessment tool. Although this Article 1 Lord AC Corr A Chandramohan A et al. Assessment of the 2020 NICE criteria for preoperative radiotherapy in patients with rectal cancer treated by surgery alone in comparison with proven MRI prognostic factors: a retrospective cohort study. Lancet Oncol. 2022; 23: 793-801 Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar provided important clinical information, several issues have been brought to our attention. Assessment of the 2020 NICE criteria for preoperative radiotherapy in patients with rectal cancer treated by surgery alone in comparison with proven MRI prognostic factors: a retrospective cohort studyCompared to previous guidelines, implementation of the 2020 NICE guidelines will result in significantly more patients receiving preoperative radiotherapy. High-quality MRI selects patients with good outcomes (particularly low local recurrence) without radiotherapy, with little margin for improvement. Overuse of radiotherapy could occur with this unselective approach. The high-risk group, with the most chance of benefiting from preoperative radiotherapy, is not well selected on the basis of NICE 2020 criteria and is better identified with proven MRI prognostic factors (extramural venous invasion, tumour deposits, and circumferential resection margin). Full-Text PDF Open AccessMRI in the prognostic evaluation of patients with rectal cancer – Authors' replyWe thank Qingkun Gao and colleagues for their interest in our Article. We did not investigate the reason for T1N0 tumours undergoing primary surgery rather than local excision as this was beyond the scope of this paper. However, we know that rates of local excision for T1 cancer are low and recognise that, in future, MRI might assist in the selection of more patients for local excision.1 The ability of MRI assessment to recognise tumours with an absence of risk factors is just as important because patients can then benefit from de-escalation of therapy. Full-Text PDF