Jessica M Winfield1,2, Jennifer C Wakefield1,2, James D Brenton3,4,5, Khalid AbdulJabbar6,7, Antonella Savio8, Susan Freeman9, Erika Pace1,2, Kerryn Lutchman-Singh10, Katherine M Vroobel8, Yinyin Yuan6,7, Susana Banerjee11, Nuria Porta12, Shan E Ahmed Raza6,7,13, Nandita M deSouza14,15. 1. Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK. 2. MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK. 3. Cancer Research UK Cambridge Institute, Cambridge, CB2 0RE, UK. 4. Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK. 5. Department of Oncology, University of Cambridge, Cambridge, CB2 0XZ, UK. 6. Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK. 7. Division of Molecular Pathology, The Institute of Cancer Research, London, UK. 8. Department of Pathology, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK. 9. Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK. 10. Swansea Gynaecological Oncology Centre, Swansea Bay University Health Board, Singleton Hospital, Swansea, SA2 8QA, UK. 11. Gynaecology Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK. 12. Clinical Trials and Statistics Unit, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK. 13. Department of Computer Science, University of Warwick, Coventry, UK. 14. Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK. nandita.desouza@icr.ac.uk. 15. MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK. nandita.desouza@icr.ac.uk.
Abstract
BACKGROUND: Diffusion-weighted magnetic resonance imaging (DW-MRI) potentially interrogates site-specific response to neoadjuvant chemotherapy (NAC) in epithelial ovarian cancer (EOC). METHODS: Participants with newly diagnosed EOC due for platinum-based chemotherapy and interval debulking surgery were recruited prospectively in a multicentre study (n = 47 participants). Apparent diffusion coefficient (ADC) and solid tumour volume (up to 10 lesions per participant) were obtained from DW-MRI before and after NAC (including double-baseline for repeatability assessment in n = 19). Anatomically matched lesions were analysed after surgical excision (65 lesions obtained from 25 participants). A trained algorithm determined tumour cell fraction, percentage tumour and percentage necrosis on histology. Whole-lesion post-NAC ADC and pre/post-NAC ADC changes were compared with histological metrics (residual tumour/necrosis) for each tumour site (ovarian, omental, peritoneal, lymph node). RESULTS: Tumour volume reduced at all sites after NAC. ADC increased between pre- and post-NAC measurements. Post-NAC ADC correlated negatively with tumour cell fraction. Pre/post-NAC changes in ADC correlated positively with percentage necrosis. Significant correlations were driven by peritoneal lesions. CONCLUSIONS: Following NAC in EOC, the ADC (measured using DW-MRI) increases differentially at disease sites despite similar tumour shrinkage, making its utility site-specific. After NAC, ADC correlates negatively with tumour cell fraction; change in ADC correlates positively with percentage necrosis. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT01505829.
BACKGROUND: Diffusion-weighted magnetic resonance imaging (DW-MRI) potentially interrogates site-specific response to neoadjuvant chemotherapy (NAC) in epithelial ovarian cancer (EOC). METHODS:Participants with newly diagnosed EOC due for platinum-based chemotherapy and interval debulking surgery were recruited prospectively in a multicentre study (n = 47 participants). Apparent diffusion coefficient (ADC) and solid tumour volume (up to 10 lesions per participant) were obtained from DW-MRI before and after NAC (including double-baseline for repeatability assessment in n = 19). Anatomically matched lesions were analysed after surgical excision (65 lesions obtained from 25 participants). A trained algorithm determined tumour cell fraction, percentage tumour and percentage necrosis on histology. Whole-lesion post-NACADC and pre/post-NACADC changes were compared with histological metrics (residual tumour/necrosis) for each tumour site (ovarian, omental, peritoneal, lymph node). RESULTS:Tumour volume reduced at all sites after NAC. ADC increased between pre- and post-NAC measurements. Post-NACADC correlated negatively with tumour cell fraction. Pre/post-NAC changes in ADC correlated positively with percentage necrosis. Significant correlations were driven by peritoneal lesions. CONCLUSIONS: Following NAC in EOC, the ADC (measured using DW-MRI) increases differentially at disease sites despite similar tumour shrinkage, making its utility site-specific. After NAC, ADC correlates negatively with tumour cell fraction; change in ADC correlates positively with percentage necrosis. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT01505829.
Authors: Dominic Carlin; Alexander Weller; Gem Kramer; Yan Liu; John C Waterton; Arturo Chiti; Martina Sollini; A Joop de Langen; Mary E R O'Brien; Maria Urbanowicz; Bart Km Jacobs; Nandita deSouza Journal: BJR Open Date: 2019-07-20
Authors: Vincent Vandecaveye; Raphaëla C Dresen; Elin Pauwels; Sofie Van Binnebeek; Ragna Vanslembrouck; Kristof Baete; Felix M Mottaghy; Paul M Clement; Kristiaan Nackaerts; Eric Van Cutsem; Chris Verslype; Frederik De Keyzer; Christophe M Deroose Journal: Radiol Imaging Cancer Date: 2022-05