Background Diffusion-weighted (DW) imaging is useful in detecting tumor in the primary tumor bed in locally advanced rectal cancer (LARC) after neoadjuvant therapy, but its value in detecting extramural venous invasion (EMVI) and tumor deposit is not well validated. Purpose To evaluate diagnostic accuracy and association with patient prognosis of viable EMVI and tumor deposit on DW images in patients with LARC after neoadjuvant therapy using whole-mount pathology specimens. Materials and Methods This retrospective study included patients who underwent neoadjuvant therapy and surgery from 2018 to 2021. Innovative five-point Likert scale was used by two radiologists to independently evaluate the likelihood of viable EMVI and tumor deposit on restaging DW MRI scans in four axial quadrants (12 to 3 o'clock, 3 to 6 o'clock, 6 to 9 o'clock, and 9 to 12 o'clock). Diagnostic accuracy was assessed at both the per-quadrant and per-patient level, with whole-mount pathology as the reference standard. Weighted κ values for interreader agreement and Cox regression models for disease-free survival and overall survival analyses were used. Results A total of 117 patients (mean age, 56 years ± 12 [SD]; 70 male, 47 female) were included. Pathologically proven viable EMVI and tumor deposit was detected in 29 of 117 patients (25%) and in 44 of 468 quadrants (9.4%). Per-quadrant analyses showed an area under the receiver operating characteristics curve of 0.75 (95% CI: 0.68, 0.83), with sensitivity and specificity of 55% and 96%, respectively. Good interreader agreement was observed between the radiologists (κ = 0.62). Per-patient analysis showed sensitivity and specificity of 62% and 93%, respectively. The presence of EMVI and tumor deposit on restaging DW MRI scans was associated with worse disease-free survival (hazard ratio [HR], 5.6; 95% CI: 2.4, 13.3) and overall survival (HR, 8.9; 95% CI: 1.6, 48.5). Conclusion DW imaging using the five-point Likert scale showed high specificity and moderate sensitivity in the detection of viable extramural venous invasion and tumor deposits in LARC after neoadjuvant therapy, and its presence on restaging DW MRI scans is associated with worse prognosis. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Méndez and Ayuso in this issue.

Restaging MRI can stratify patients treated with total neoadjuvant therapy into clinical response categories predictive of organ preservation, local regrowth, and survival.

A small proportion of rectal adenocarcinomas develop in patients many years after the treatment of a previous cancer using pelvic radiation, and the incidence of these rectal cancers depends on the length of follow-up from the end of radiotherapy. The risk of radiation-associated rectal cancer (RARC) is higher in patients treated with prostate external beam radiotherapy than it is in patients treated with brachytherapy. The molecular features of RARC have not been fully investigated, and survival is lower compared to non-irradiated rectal cancer patients. Ultimately, it is unclear whether the worse outcomes are related to differences in patient characteristics, treatment-related factors, or tumor biology. Radiation is widely used in the management of rectal adenocarcinoma; however, pelvic re-irradiation of RARC is challenging and carries a higher risk of treatment complications. Although RARC can develop in patients treated for a variety of malignancies, it is most common in patients treated for prostate cancer. This study will review the incidence, molecular characteristics, clinical course, and treatment outcomes of rectal adenocarcinoma in patients previously treated with radiation for prostate cancer. For clarity, we will distinguish between rectal cancer not associated with prostate cancer (RCNAPC), rectal cancer in non-irradiated prostate cancer patients (RCNRPC), and rectal cancer in irradiated prostate cancer patients (RCRPC). RARC represents a unique but understudied subset of rectal cancer, and thus requires a more comprehensive investigation in order to improve its treatment and prognosis.

Background: Although emerging studies link air pollution to mortality in patients with breast cancer, large-scale evidence remains limited. We aimed to evaluate associations between chronic exposures to three key regulated air pollutants, fine particulate matter, ozone, and nitrogen dioxide, and mortality in a nationwide cohort of older patients with breast cancer. Methods: We constructed a cohort of patients with primary diagnosis of breast cancer aged 65 years or older between 2000 and 2016 using the Surveillance, Epidemiology, and End Results–Medicare database. High-resolution ambient concentrations of annual fine particulate matter, warm-season ozone, and annual nitrogen dioxide were estimated using hybrid models and linked to patients’ residential zip codes as proxy exposures. A 3-pollutant Cox model was fitted to estimate hazard ratios for mortality associated with each pollutant, adjusting for demographics, tumor characteristics, cancer treatments, comorbidities, lifestyle factors, meteorological variables, and neighborhood-level characteristics. Results: Among 593 333 patients with breast cancer, a 1-µg/m3 increase in annual fine particulate matter, a 1-part per billion increase in warm-season ozone, and a 1-part per billion increase in annual nitrogen dioxide were associated with hazard ratios for mortality of 1.0048 (95% CI = 1.0026 to 1.0070), 1.0021 (95% CI = 1.0013 to 1.0029), and 1.0022 (95% CI = 1.0014 to 1.0030), respectively. This finding translated to 49 annual excess deaths attributable to fine particulate matter, 21 to ozone, and 22 to nitrogen dioxide within the cohort. Effects were substantially larger at low exposure levels. Fine particulate matter and nitrogen dioxide had greater effects in younger patients, individuals who received chemotherapy or radiation, and individuals with disease diagnosed at later stages. Conclusion: Our findings identified air pollution as a risk factor for mortality in older patients with breast cancer. Protective measures and air pollution control strategies may help reduce exposure and improve outcomes.

Childhood cancer survivors (CCSs) are at increased risk for chronic health issues due to late effects of cancer and its treatment. We address the impact of environmental exposures, such as air pollution, tobacco smoke, extreme weather events, and pesticides, on the health and survival of CCSs. These environmental hazards have been associated with worsening health outcomes and decreased survival among CCSs on a global scale. We also highlight that providers at a major pediatric cancer center in the United States have limited knowledge and practical skills about environmental risk factors and how to reduce exposures. Our survey results show that pediatric oncology providers would find an environmental referral service helpful and useful in their department. Integrating environmental health into pediatric cancer care can empower patients and families, promote healthier behaviors, and potentially reduce morbidity and mortality in this vulnerable population.