Lorenzo Preda1, Davide Stoppa2, Maria Rosaria Fiore3, Giulia Fontana4, Sofia Camisa2, Roberto Sacchi5, Michele Ghitti5, Gisela Viselner6, Piero Fossati3, Francesca Valvo3, Viviana Vitolo3, Maria Bonora3, Alberto Iannalfi3, Barbara Vischioni3, Alessandro Vai7, Edoardo Mastella7, Guido Baroni8, Roberto Orecchia9. 1. Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO) Pavia, Italy. Electronic address: lorenzo.preda@cnao.it. 2. Diagnostic Radiology Residency School, University of Pavia, Italy. 3. Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO) Pavia, Italy. 4. Bio-Engineering Unit, National Center of Oncological Hadrontherapy (CNAO) Pavia, Italy. 5. Applied Statistics Unit, Department of Earth and Environmental Sciences, University of Pavia, Italy. 6. Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO) Pavia, Italy. 7. Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO) Pavia, Italy. 8. Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy. 9. National Center of Oncological Hadrontherapy (CNAO) Pavia, Italy; European Institute of Oncology, Milano, Italy.
Abstract
BACKGROUND AND PURPOSE: To compare RECIST 1.1 with volume modifications in patients with sacral chordoma not suitable for surgery treated with carbon ions radiotherapy (CIRT) alone. To evaluate patients pain before and after CIRT. To detect if baseline Apparent Diffusion Coefficient values (ADC) from Diffusion Weighted sequences could predict response to treatment. MATERIAL AND METHODS: Patients included had one cycle of CIRT and underwent MRI before and after treatment. For each MRI, lesion maximum diameter and volume were obtained, and ADC values were analyzed within the whole lesion volume. Patients pain was evaluated with Numerical Rating Scale (NRS), considering the upper tumor level at baseline MRIs. RESULTS: 39 patients were studied (mean follow-up 18 months). Considering RECIST 1.1 there was not a significant reduction in tumor diameters (p = 0.19), instead there was a significant reduction in tumor volume (p < 0.001), with a significant reduction in pain (p = 0.021) if the tumors were above vertebrae S2-S3 at baseline MRIs. The assessment of baseline ADC maps demonstrated higher median values and more negative skewness values in progressive disease (PD) patients versus both partial response (PR) and stable disease (SD). CONCLUSIONS: Lesion volume measurement is more accurate than maximum diameter to better stratify the response of sacral chordoma treated with CIRT. Preliminary results suggest that baseline ADC values could be predictive of response to CIRT.
BACKGROUND AND PURPOSE: To compare RECIST 1.1 with volume modifications in patients with sacral chordoma not suitable for surgery treated with carbon ions radiotherapy (CIRT) alone. To evaluate patientspain before and after CIRT. To detect if baseline Apparent Diffusion Coefficient values (ADC) from Diffusion Weighted sequences could predict response to treatment. MATERIAL AND METHODS:Patients included had one cycle of CIRT and underwent MRI before and after treatment. For each MRI, lesion maximum diameter and volume were obtained, and ADC values were analyzed within the whole lesion volume. Patientspain was evaluated with Numerical Rating Scale (NRS), considering the upper tumor level at baseline MRIs. RESULTS: 39 patients were studied (mean follow-up 18 months). Considering RECIST 1.1 there was not a significant reduction in tumor diameters (p = 0.19), instead there was a significant reduction in tumor volume (p < 0.001), with a significant reduction in pain (p = 0.021) if the tumors were above vertebrae S2-S3 at baseline MRIs. The assessment of baseline ADC maps demonstrated higher median values and more negative skewness values in progressive disease (PD) patients versus both partial response (PR) and stable disease (SD). CONCLUSIONS: Lesion volume measurement is more accurate than maximum diameter to better stratify the response of sacral chordoma treated with CIRT. Preliminary results suggest that baseline ADC values could be predictive of response to CIRT.