With 50 patients included, this trial would be the largest pilot study evaluating the value of MRI PET in locally advanced rectal cancer. On the other hand, it would be the only pilot study performing several MRI PET during neoadjuvant treatment. Presumably, the response assessed at the 2nd MRI PET (before cycle 4 or induction chemotherapy) would be predictive of the overall response at the end of neoadjuvant treatment. Then, it would be possible to predict precociously the tumor response.
The management of localized rectal cancer is done in two phases. The first phase, medical, combines a possible first chemotherapy, followed by a concomitant chemoradiotherapy. The second phase, 6 to 8 weeks later, consists of surgery of the rectum. Magnetic resonance imaging (MRI) of the pelvis allows staging of the tumor and its possible lymph node extensions. MRI can also be used to assess tumor response after the first phase of treatment and before surgery. But MRI of the pelvis is partially imperfect. PET-MRI is an examination that combines MRI with an injection of \[18 F\]fluorodeoxyglucose (18F-FDG). It is known to be more sensitive in assessing tumor stage and lymph node extensions compared to MRI and more sensitive in assessing tumor response before surgery. The aim of this study is to determine predictive parameters for response to the first phase of treatment by accurately identifying the characteristics of tumors that have responded or not to treatment with chemotherapy and chemoradiotherapy.
Study Type
OBSERVATIONAL
Enrollment
50
Each patient will have a pre-treatment PET-MRI (PET-MRI 1) within 21 days before the start of treatment. Induction chemotherapy may be performed at another center than the investigating center. After 3 cycles of induction chemotherapy and before the 4th cycle, a second PET MRI (PET MRI 2) will be performed. In patients who have received less than 3 cycles of induction chemotherapy, this mid-therapy PET-MRI will not be performed. A 3rd PET-MRI will be performed prior to radiation therapy (PET-MRI 3). A final MRI PET (MRI PET 4) will take place before surgery. A total of 4 PET MRI scans will be performed.
Institut de cancérologie Strasbourg Europe
Strasbourg, France
RECRUITINGDescription of the correlation between the PET-MRI changes after neo-adjuvant treatment and the histological response after surgery in terms of metabolic criteria.
The purpose of this study is to determine predictive parameters for response to the first phase of treatment by accurately identifying the characteristics of tumors that have responded or not to chemotherapy and chemoradiotherapy. Metabolic criteria will be measured with the SUVmax values that will be determined on the 4 PET-MRI scans.
Time frame: At the surgery
Description of the correlation between the PET-MRI changes after neo-adjuvant treatment and the histological response after surgery in terms of MRI criteria.
MRI criteria will be measured with the Apparent Diffusion Coefficient (ADC) values that will be determined on the 4 PET-MRI scans.
Time frame: At the surgery
Description of the correlation between the PET-MRI changes after neo-adjuvant treatment and the histological response after surgery in terms of anatomopathological criteria.
Anatomopathological criteria will be measured with the histopathological response to treatment which will be defined according to the tumor regression grade (TRG)
Time frame: At the surgery
Comparison of the first PET-MRI staging with standard of care imaging, namely pelvic MRI in terms of tumor volumes
Record of tumor volumes on MRI PET 1
Time frame: At the PET MRI pretherapy (= PET MRI 1)
Comparison of the first PET-MRI staging with standard of care imaging, namely pelvic MRI in terms of SUVmax values
Record of SUVmax on MRI PET 1
Time frame: At the PET MRI pretherapy (= PET MRI 1)
Comparison of the first PET-MRI staging with standard of care imaging, namely pelvic MRI in terms of ADC values
Record of ADC on MRI PET 1
Time frame: At the PET MRI pretherapy (= PET MRI 1)
Description of the specific PET-MRI responses at mid-treatment of the neoadjuvant chemotherapy in terms of delta tumor volume
Record of delta tumor volume, compared to baseline (PET MRI 1)
Time frame: At the 2nd PET (PET2), up to 28 months
Description of the specific PET-MRI responses at mid-treatment of the neoadjuvant chemotherapy in terms of delta SUVmax values
Record of delta SUVmax, compared to baseline (PET MRI 1)
Time frame: At the 2nd PET (PET2), up to 28 months
Description of the specific PET-MRI responses at mid-treatment of the neoadjuvant chemotherapy in terms of delta ADC values
Record of delta ADC, compared to baseline (PET MRI 1)
Time frame: At the 2nd PET (PET2), up to 28 months
Description of the specific PET-MRI responses to neoadjuvant chemotherapy in terms of delta tumor volume
Record of delta tumor volume, compared to baseline (PET MRI 1)
Time frame: At the 3rd PET (PET3), up to 28 months
Description of the specific PET-MRI responses to neoadjuvant chemotherapy in terms of delta SUVmax values
Record of delta SUVmax, compared to baseline (PET MRI 1)
Time frame: At the 3rd PET (PET3), up to 28 months
Description of the specific PET-MRI responses to neoadjuvant chemotherapy in terms of delta ADC values
Record of delta ADC, compared to baseline (PET MRI 1)
Time frame: At the 3rd PET (PET3), up to 28 months
Description of the specific PET-MRI responses to neoadjuvant radiochemotherapy in terms of delta tumor volume
Record of delta tumor volume, compared to PET3
Time frame: At the 4th PET (PET4), up to 28 months
Description of the specific PET-MRI responses to neoadjuvant radiochemotherapy in terms of delta SUVmax values
Record of delta SUVmax, compared to PET3
Time frame: At the 4th PET (PET4), up to 28 months
Description of the specific PET-MRI responses to neoadjuvant radiochemotherapy in terms of delta ADC values
Record of delta ADC, compared to PET3
Time frame: At the 4th PET (PET4), up to 28 months
Propose standardized criteria to differentiate responders from non-responders
Record of clinical and iconographic data predictive of good response to treatment
Time frame: Data record throughout the study, up to 28 months
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