![]() The main aim of CRT is to downsize and downstage the tumor to increase the chance of a complete resection and consequently reduce the local recurrence risk. Neoadjuvant treatment can consist of a short course of radiotherapy (5 × 5 Gy) +/− a prolonged waiting interval or a long course of combined chemoradiotherapy (CRT). Neoadjuvant therapy has become the standard of care for patients with locally advanced rectal cancer. In this pictorial review, we discuss the strengths and weaknesses of modern MR imaging, including functional imaging sequences such as diffusion-weighted MRI, for response evaluation after chemoradiation treatment and provide the main pearls and pitfalls for image interpretation. Hence, MR sequences such as diffusion-weighted imaging are increasingly adopted in clinical MR protocols to improve the differentiation between tumor and fibrosis. MRI is one of the main tools used to assess response, but has difficulties in assessing response within areas of post-radiation fibrosis. To facilitate such personalized treatment planning, there is now an increased demand for more detailed radiological response evaluation after chemoradiation. In patients that respond very well to CRT, organ-preserving treatments such as watch-and-wait are increasingly considered as an alternative to surgery. Nowadays, treatment is tailored depending on the response to chemoradiotherapy. Until recently, patients routinely proceeded to surgical resection after CRT, regardless of the response. ![]() In recent years, neoadjuvant chemoradiotherapy (CRT) has become the standard of care for patients with locally advanced rectal cancer. ![]()
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