Kine Mari Bakke1,2, Knut Håkon Hole3, Svein Dueland4, Krystyna Kotanska Grøholt5, Kjersti Flatmark6,7,8, Anne Hansen Ree1,7, Therese Seierstad3, Kathrine Røe Redalen1,9. 1. a Department of Oncology , Akershus University Hospital , Lørenskog , Norway. 2. b Department of Physics , University of Oslo , Oslo , Norway. 3. c Department of Radiology and Nuclear Medicine , Oslo University Hospital , Oslo , Norway. 4. d Department of Oncology , Oslo University Hospital , Oslo , Norway. 5. e Department of Pathology , Oslo University Hospital , Oslo , Norway. 6. f Department of Tumor Biology , Institute for Cancer Research, Oslo University Hospital , Oslo , Norway. 7. g Faculty of Medicine , University of Oslo , Oslo , Norway. 8. h Department of Gastroenterological Surgery , Oslo University Hospital , Oslo , Norway. 9. i Department of Physics , Norwegian University of Science and Technology , Trondheim , Norway.
Abstract
BACKGROUND: In locally advanced rectal cancer (LARC), responses to preoperative treatment are highly heterogeneous and more accurate diagnostics are likely to enable more individualised treatment approaches with improved responses. We investigated the potential of diffusion-weighted magnetic resonance imaging (DW MRI), with quantification of the apparent diffusion coefficient (ADC) and perfusion fraction (F), as well as volumetry from T2-weighted (T2W) MRI, for prediction of therapeutic outcome. MATERIAL AND METHODS: In 27 LARC patients receiving neoadjuvant chemotherapy (NACT) before chemoradiotherapy (CRT), T2W- and DW MRI were obtained before and after NACT. Tumour volumes were delineated in T2W MRI and ADCs and Fs were estimated from DW MRI using a simplified approach to the intravoxel incoherent motion (IVIM) model. Mean tumour values and histogram analysis of whole-tumour heterogeneity were correlated with histopathologic tumour regression grade (TRG) and 5-year progression-free survival (PFS). RESULTS: At baseline, high tumour F predicted good tumour response (TRG1-2) (AUC = 0.79, p = 0.01), with a sensitivity of 69% and a specificity of 100%. The combination of F and tumour volume (Fpre/Vpre) gave the highest prediction of poor tumour response (AUC = 0.93, p < 0.001) with a sensitivity of 88% and a specificity of 91%, and also predicted PFS (p < 0.01). Baseline tumour ADC was not significantly related to therapeutic outcome, whereas a positive change in ADC from baseline to after NACT, ΔADC, significantly predicted good tumour response (AUC = 0.83, p < 0.01, 83% sensitivity, 73% specificity), but not PFS. CONCLUSIONS: The MRI parameter F/V at baseline was a remarkably strong predictor of both histopathologic tumour response and 5-year PFS in patients with LARC.
BACKGROUND: In locally advanced rectal cancer (LARC), responses to preoperative treatment are highly heterogeneous and more accurate diagnostics are likely to enable more individualised treatment approaches with improved responses. We investigated the potential of diffusion-weighted magnetic resonance imaging (DW MRI), with quantification of the apparent diffusion coefficient (ADC) and perfusion fraction (F), as well as volumetry from T2-weighted (T2W) MRI, for prediction of therapeutic outcome. MATERIAL AND METHODS: In 27 LARC patients receiving neoadjuvant chemotherapy (NACT) before chemoradiotherapy (CRT), T2W- and DW MRI were obtained before and after NACT. Tumour volumes were delineated in T2W MRI and ADCs and Fs were estimated from DW MRI using a simplified approach to the intravoxel incoherent motion (IVIM) model. Mean tumour values and histogram analysis of whole-tumour heterogeneity were correlated with histopathologic tumour regression grade (TRG) and 5-year progression-free survival (PFS). RESULTS: At baseline, high tumour F predicted good tumour response (TRG1-2) (AUC = 0.79, p = 0.01), with a sensitivity of 69% and a specificity of 100%. The combination of F and tumour volume (Fpre/Vpre) gave the highest prediction of poor tumour response (AUC = 0.93, p < 0.001) with a sensitivity of 88% and a specificity of 91%, and also predicted PFS (p < 0.01). Baseline tumour ADC was not significantly related to therapeutic outcome, whereas a positive change in ADC from baseline to after NACT, ΔADC, significantly predicted good tumour response (AUC = 0.83, p < 0.01, 83% sensitivity, 73% specificity), but not PFS. CONCLUSIONS: The MRI parameter F/V at baseline was a remarkably strong predictor of both histopathologic tumour response and 5-year PFS in patients with LARC.
Authors: Sebastian Meltzer; Kine Mari Bakke; Karina Lund Rød; Anne Negård; Kjersti Flatmark; Arne Mide Solbakken; Annette Torgunrud Kristensen; Anniken Jørlo Fuglestad; Christian Kersten; Svein Dueland; Therese Seierstad; Knut Håkon Hole; Lars Gustav Lyckander; Finn Ole Larsen; Jakob Vasehus Schou; Dawn Patrick Brown; Hanna Abrahamsson; Kathrine Røe Redalen; Anne Hansen Ree Journal: Clin Transl Radiat Oncol Date: 2019-12-02
Authors: Vetri Sudar Jayaprakasam; Sidra Javed-Tayyab; Natalie Gangai; Junting Zheng; Marinela Capanu; David D B Bates; James L Fuqua; Viktoriya Paroder; Jennifer Golia-Pernicka; Marc J Gollub; Iva Petkovska Journal: Abdom Radiol (NY) Date: 2020-09-14
Authors: T Bostel; C Dreher; D Wollschläger; A Mayer; F König; S Bickelhaupt; H P Schlemmer; P E Huber; F Sterzing; P Bäumer; J Debus; N H Nicolay Journal: Radiat Oncol Date: 2020-07-11 Impact factor: 3.481