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Vol. 54. Issue 1.
Pages 45-58 (January - February 2012)
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Vol. 54. Issue 1.
Pages 45-58 (January - February 2012)
Update in Radiology
DOI: 10.1016/j.rxeng.2012.05.004
Prognostic factors and functional imaging in rectal cancer
Factores pronósticos e imagen funcional del cáncer de recto
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R. García Figueirasa,
Corresponding author
, P. Caro Domíngueza, R. García Dorregoa, A. Vázquez Martína, A. Gómez Caamañob
a Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
b Servicio de Oncología Radioterápica, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Table 1. Imaging-based therapeutic strategy in rectal cancer. Image findings define patient groups with different management.
Table 2. Functional–molecular imaging techniques in RC.
Table 3. Functional–molecular imaging techniques and tumor response to therapies in colorectal cancer. Biological effect of the different therapies and its evaluation with functional–molecular imaging techniques.
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Abstract

The outcome of treatment for rectal cancer in recent years has been improved by diverse advances in the field of surgery and in neoadjuvant oncologic therapies. Heald's introduction of the concept of the mesorectum as an anatomical unit (total mesorectal excision) in 1982 and the generalization of preoperative radiochemotherapy have improved the prognosis in a significant number of patients. Owing to these advances, it has become necessary for imaging studies to define a series of prognostic factors for tumors, both before and after neoadjuvant treatment, to make it possible to tailor treatment for individual patients with rectal tumors.

On the other hand, the advent of functional and molecular imaging techniques has provided a way to study a series of distinctive tumor characteristics in vivo, including the angiogenesis, metabolism, or cellularity of rectal tumors, and these techniques are making a growing contribution to the prognosis, staging, treatment planning, and evaluation of the response to therapy in patients with rectal cancer.

Keywords:
Rectal cancer
Magnetic resonance imaging
Functional imaging
Diffusion
Prognostic factors
Resumen

La evolución del tratamiento de cáncer de recto durante los últimos años ha estado condicionada por diversos avances en el campo de la cirugía y terapias oncológicas neoadyuvantes. La introducción por Heald en 1982 del concepto del mesorrecto como unidad anatómica (escisión mesorrectal total) y la generalización de la radioquimioterapia preoperatoria, han determinado una mejoría del pronóstico en un número significativo de pacientes. Debido a estos avances, ha surgido la necesidad de que la imagen defina una serie de factores pronósticos del tumor, tanto antes como después del tratamiento neoadyuvante, que permitan individualizar el manejo del paciente con neoplasia de recto.

Por otra parte, la irrupción de las técnicas de imagen funcional y molecular permite abrir una vía de estudio in vivo de una serie de características tumorales distintivas como la angiogénesis, el metabolismo o la celularidad en las neoplasias de recto con una aportación creciente en la determinación del pronóstico, la estadificación, la planificación terapéutica y la evaluación de la respuesta al tratamiento en pacientes con cáncer de recto.

Palabras clave:
Cáncer rectal
Resonancia magnética
Imagen funcional
Difusión
Factores pronósticos

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