Annals of Coloproctology

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Original Article

Colorectal cancer

Effects of clinical information on the treatment decisions for good responders to neoadjuvant chemoradiotherapy among rectal cancer patients: Eon Bin Kim, In Ja Park, Hwa Jung Kim, Jong Keon Jang, Seong Ho Park, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu; Ann Coloproctol. 2025;41(5):473-482. Published online July 10, 2025; DOI: https://doi.org/10.3393/ac.2024.00276.0039

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Purpose
The decision for treatment after neoadjuvant chemoradiotherapy (nCRT) in rectal cancer is intricately linked to tumor response and clinical parameters. This study was designed to elucidate determinants influencing treatment decisions for good responders to nCRT, while concurrently evaluating the ramifications of modifications in magnetic resonance imaging (MRI) tumor response evaluation protocols.
Methods
A survey was constructed with 5 cases of good responder after nCRT based on the magnetic resonance–based tumor regression grade (mrTRG) criteria. A total of 35 colorectal surgeons in Korea participated in the survey via email, and they were introduced to 2 discrete MRI-based tumor response evaluation methodologies: the conventional mrTRG and an emergent complete response (CR)/non-CR classification system. Surgeons were directed to select between total mesorectal excision, local excision, or a watch and wait strategy.
Results
Treatment decisions varied significantly (P<0.01), as gradually more clinical information was provided with mrTRG. The paradigm shift from mrTRG to CR/non-CR evaluation criterion instigated the highest alteration in decision (P<0.01). Even comparing with other sets of information, decision change with different tumor response assessment (i.e., mrTRG vs. CR/non-CR) was statistically significant (P<0.01). Three particular cases consistently displayed a declining predilection for total mesorectal excision, favoring a more pronounced inclination towards watch and wait strategy or local excision. Nonetheless, the magnitude of these decisional shifts oscillated depending on the specific endoscopic imagery present.
Conclusion
Our current findings underscore the significant role of tumor response assessment methods in shaping treatment decisions for rectal cancer patients who respond well to nCRT. This highlights the need for clear and accurate tools to interpret MRI results.

Citations

Citations to this article as recorded by

Prognostic significance of integrating pretreatment biopsy-derived Immunoscore and Pan-Immune-Inflammation value in locally advanced rectal cancer after neoadjuvant chemoradiotherapy
Min Joon Kim, Hye Won Lee, Da In Shin, Woon Kyung Jeong, Seong Kyu Baek, Sung Uk Bae
Clinical and Translational Radiation Oncology.2026; 59: 101172. CrossRef
Oncologic outcomes of colorectal cancer during the coronavirus pandemic: a multicenter retrospective study
Chungyeop Lee, In Ja Park, Ju Yeon Choi, Woo Yong Lee, Dae Hee Pyo, Hyo Seon Ryu, Jin Kim, Jun Seok Park, Yoon Suk Lee, Jung Hoon Bae, Gyung Mo Son, Chang Hyun Kim, Eun Jung Park
International Journal of Surgery.2026;[Epub] CrossRef
Clinical implications of radiologic criteria and prognostic factors for lateral lymph node metastasis in low rectal cancer
Gyung Mo Son
Annals of Coloproctology.2025; 41(6): 489. CrossRef

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