130 Chapter 7 Conclusion In conclusion, this multicenter and multireader study has shown that visual morphologic methods to predict response to chemoradiotherapy on baseline staging MRI have a moderate-good diagnostic performance to estimate the likelihood that patients will achieve a (near-)complete response to CRT. Specificity is relatively high, indicating that imaging is mainly good in identifying the more high-risk patients that are unlikely to achieve organ preservation. Overall interobserver agreement is moderate, with better results for more experienced radiologists. Compared to a previously published confidence-based scoring system, study readers preferred a more simplified 4-point risk score based on high risk T-stage, MRF involvement, nodal involvement and EMVI. While results are obviously too premature to base clinical decision making on, they warrant further multidisciplinary research focused on combining imaging with other clinical predictors of response.
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