Pre-therapeutic MRI assessment of Early-Stage Rectal Cancer and Significant Rectal Polyps to avoid major resectional surgery
IRAS Number: 256736
CPMS ID: 41403
ClinicalTrials.gov ID: NCT04103372
Trial Start Date: Feb-24
Recruitment End Date: Dec-26
Trial End date: Apr-32
When patients are diagnosed with rectal (bowel) cancer radiology doctors read MRI scans to describe how deeply the cancer invades into the bowel wall – this is the ‘stage’ of the cancer. Almost 1/3 of screen detected rectal cancers are limited to the bowel wall without nodal spread yet many patients with Early Rectal Cancer (ERC) are currently over-treated, as demonstrated below.
Current management of ERC – based on a recent study (Detering et al (2020))[1] , data from the UK national NBOCA audit and local audit data from a typical NHS hospital
The main cause of over-treatment of ERC is over-staging of the MRI, which occurs due to lack of certainty or experience by radiology doctors. There is a tendency to over-estimate the stage of the cancer to err on the side of caution, but this leads to over-treatment. Patients then undergo major surgery or unnecessary radiotherapy when local excision surgery to preserve the patient’s rectum, and quality of life, would have been possible. As a consequence, only 10% of patients with ERC are currently staged accurately and offered local excision.
We have created and tested a more accurate staging system for ERC – the PRESERVE MRI Specialised Reporting Tool (mrSRT). Our pilot work (Balyasnikova et al) showed this improved identification of ERC suitable for local excision, with 89% accuracy.
We will train radiologists in the PRESERVE mrSRT to prevent over-staging. By providing patients with accurate information about their cancer and stage this empowers patients to make informed decisions about their treatment, and in particular in avoiding major surgery. The mrSRT will lead to reduced health inequality, as it will reduce variability in reports and allow all patients access to high quality staging reports.
Balyasnikova, S., Read, J., Wotherspoon, A., Rasheed, S., Tekkis, P., Tait, D., . . . Brown, G. (2017). Diagnostic accuracy of high-resolution MRI as a method to predict potentially safe endoscopic and surgical planes in patients with early rectal cancer. BMJ OPEN GASTROENTEROLOGY, 4(1), 9 pages. doi:10.1136/bmjgast-2017-000151
