The current standard in treating patients with metastatic colorectal cancer in the liver involves conducting a CT scan to determine the most suitable treatment, such as surgery and/or thermal ablation therapy. Based on data collected by the Dutch Quality Registration of Liver Operations and Ablations (DHBA), sometimes an additional MRI scan is performed, however, this practice varies considerably between hospitals.
Leading investigators, Professors Jaap Stoker and Marc Besselink from Cancer Center Amsterdam, and Professor Kees Verhoef of Erasmus MC, set out to determine if the information provided by an MRI scan, in addition to the standard CT scan, contributes sufficient value to warrant a change in the national guidelines.
CT and MRI medical imaging methods rely on distinct detection methods to visualize internal organs. CT scanners using X-rays, which provides better spatial resolution for examining tissue such as bone structures. MRI scanners utilize radio waves plus a strong magnetic field. This offers superior soft tissue contrast, making it more effective in identifying subtle differences and providing more detailed images. "While MRI scans are known to detect small metastases more frequently than CT scans, there was a lack of large-scale research to determine whether an additional MRI should be part of standard treatment protocols," says Professor Verhoef.
Adding Contrast-Enhanced MRI Scan
The international CAMINO study, involving hospitals in the Netherlands, Belgium, Italy, and Norway, enrolled 298 patients who were scheduled for surgical intervention and/or thermal ablation therapy based on a CT scan.
The study revealed significant benefits of conducting a contrast-enhanced MRI scan, as it led to changes in treatment plans for a substantial number of patients. 13% required more and 4% less extensive local therapy. For 9% of the patients, the option for local therapy with curative intent was withdrawn upon discovering the metastases were too extensive for such treatment. Also, in 8 patients (3%) the contrast-enhanced MRI indicated the observed liver lesions were benign.
The 11 Dutch hospitals that participated in the study were: Cancer Center Amsterdam; Erasmus MC; Rotterdam; Albert Schweitzer hospital; Dordrecht, Jeroen Bosch hospital, 's-Hertogenbosch; Leiden University Medical Center; Medisch Spectrum Twente, Enschede; Amphia hospital, Breda; Nederlands Cancer Institute/Antoni van Leeuwenhoek hospital, Amsterdam; Máxima Medisch Centrum, Veldhoven; OLVG, Amsterdam; IJsselland
hospital, Capelle aan den IJssel.
For more information, contact Prof. Marc Besselink or Prof. Jaap Stoker, or read the scientific publication:
Görgec, Burak Ayez, Ninos et al. (2023) MRI in addition to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO): an international, multicentre, prospective, diagnostic accuracy trial. The Lancet Oncology, https://doi.org/10.1016/S1470-2045(23)00572-7.
Funding
Funding for this study was provided by Dutch Cancer Society (KWF Kankerbestrijding) and Bayer AG-Pharmaceuticals.
Researchers involved at Cancer Center Amsterdam – Amsterdam UMC
Burak Görgec
Karin Horsthuis
Martijn Meijerink
Jasper P Sijberden
Otto M van Delden
Janneke E van den Bergh
Inge J S Vanhooymissen
Marcel G W Dijkgraaf
Patrick M Bossuyt
Rutger-Jan Swijnenburg
Marc G Besselink
Jaap Stoker
This article is based on ‘MRI-scan verbetert nauwkeurigheid behandelplan bij lever-uitzaaiingen van darmkanker’, translated and adapted by Henri van de Vrugt.
Follow Cancer Center Amsterdam on LinkedIn & Twitter / X.