A TCP-based early regression index predicts the pathological response in neo-adjuvant radio-chemotherapy of rectal cancer

C Fiorino, C Gumina, P Passoni, A Palmisano, S Broggi, GM Cattaneo, A Di Chiara, A Esposito, M Mori, Roberta Raso, M Ronzoni, R Rosati, N Slim, F De Cobelli, R Calandrino, NG Di Muzio

Research output: Contribution to journalArticle

Abstract

Purpose: Introducing a radiobiological index based on early tumor regression during neo-adjuvant radio-chemotherapy (RCT, including oxaliplatin) of rectal adenocarcinoma and testing its discriminative power in predicting the tumor response. Methods: Seventy-four patients were treated with Helical Tomotherapy following an adaptive (ART) protocol (41.4 Gy/18 fr, 2.3 Gy/fr) delivering a simultaneous integrated boost on the residual tumor in the last 6 fractions up to 45.6 Gy. T2-weighted MRI were taken before (MRIpre) and at mid (MRImid) therapy and the corresponding tumor volumes were considered (Vpre,Vmid). The “Early Regression Index” (ERITCP=-ln[(1-(Vmid/Vpre))Vpre]) was introduced and its discriminative power was assessed in terms of AUC, sensitivity/specificity, positive/negative predictive value (PPV/NPV). Two end-points were considered: (a) pathological complete response (pCR) or clinical complete response followed by watch-and-wait, (cCR); (b) limited response (residual vital cells (RVC) in the surgical specimen >10%). Results: Complete data were available for 65 patients: pCR, cCR and RVC >10% were 20, 2 and 19 respectively. The discriminative power of ERITCPwas moderately high (AUC = 0.81/0.75 for /pCRorcCR/RVC >10% respectively, p <0.0005). ERITCPwas highly sensitive (86–89%) with very high NPV (90–94%). The discriminative power of ERITCPwas confirmed on a subgroup of 44/65 patients when considering tumor volumes delineated by a skilled radiologist. Conclusion: A radiobiologically consistent index based on early regression showed high performances in predicting the pathological response after neo-adjuvant RCT for rectal cancer with relevant potentialities for ART/treatment customization. © 2018 Elsevier B.V.
Original languageEnglish
Pages (from-to)564-568
Number of pages5
JournalRadiotherapy and Oncology
Volume128
Issue number3
DOIs
Publication statusPublished - 2018

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Adjuvant Chemotherapy
Rectal Neoplasms
Radio
oxaliplatin
Tumor Burden
Area Under Curve
Intensity-Modulated Radiotherapy
Residual Neoplasm
Neoplasms
Adenocarcinoma
Sensitivity and Specificity
Therapeutics

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A TCP-based early regression index predicts the pathological response in neo-adjuvant radio-chemotherapy of rectal cancer. / Fiorino, C; Gumina, C; Passoni, P; Palmisano, A; Broggi, S; Cattaneo, GM; Di Chiara, A; Esposito, A; Mori, M; Raso, Roberta; Ronzoni, M; Rosati, R; Slim, N; De Cobelli, F; Calandrino, R; Di Muzio, NG.

In: Radiotherapy and Oncology, Vol. 128, No. 3, 2018, p. 564-568.

Research output: Contribution to journalArticle

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title = "A TCP-based early regression index predicts the pathological response in neo-adjuvant radio-chemotherapy of rectal cancer",
abstract = "Purpose: Introducing a radiobiological index based on early tumor regression during neo-adjuvant radio-chemotherapy (RCT, including oxaliplatin) of rectal adenocarcinoma and testing its discriminative power in predicting the tumor response. Methods: Seventy-four patients were treated with Helical Tomotherapy following an adaptive (ART) protocol (41.4 Gy/18 fr, 2.3 Gy/fr) delivering a simultaneous integrated boost on the residual tumor in the last 6 fractions up to 45.6 Gy. T2-weighted MRI were taken before (MRIpre) and at mid (MRImid) therapy and the corresponding tumor volumes were considered (Vpre,Vmid). The “Early Regression Index” (ERITCP=-ln[(1-(Vmid/Vpre))Vpre]) was introduced and its discriminative power was assessed in terms of AUC, sensitivity/specificity, positive/negative predictive value (PPV/NPV). Two end-points were considered: (a) pathological complete response (pCR) or clinical complete response followed by watch-and-wait, (cCR); (b) limited response (residual vital cells (RVC) in the surgical specimen >10{\%}). Results: Complete data were available for 65 patients: pCR, cCR and RVC >10{\%} were 20, 2 and 19 respectively. The discriminative power of ERITCPwas moderately high (AUC = 0.81/0.75 for /pCRorcCR/RVC >10{\%} respectively, p <0.0005). ERITCPwas highly sensitive (86–89{\%}) with very high NPV (90–94{\%}). The discriminative power of ERITCPwas confirmed on a subgroup of 44/65 patients when considering tumor volumes delineated by a skilled radiologist. Conclusion: A radiobiologically consistent index based on early regression showed high performances in predicting the pathological response after neo-adjuvant RCT for rectal cancer with relevant potentialities for ART/treatment customization. {\circledC} 2018 Elsevier B.V.",
author = "C Fiorino and C Gumina and P Passoni and A Palmisano and S Broggi and GM Cattaneo and {Di Chiara}, A and A Esposito and M Mori and Roberta Raso and M Ronzoni and R Rosati and N Slim and {De Cobelli}, F and R Calandrino and {Di Muzio}, NG",
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T1 - A TCP-based early regression index predicts the pathological response in neo-adjuvant radio-chemotherapy of rectal cancer

AU - Fiorino, C

AU - Gumina, C

AU - Passoni, P

AU - Palmisano, A

AU - Broggi, S

AU - Cattaneo, GM

AU - Di Chiara, A

AU - Esposito, A

AU - Mori, M

AU - Raso, Roberta

AU - Ronzoni, M

AU - Rosati, R

AU - Slim, N

AU - De Cobelli, F

AU - Calandrino, R

AU - Di Muzio, NG

PY - 2018

Y1 - 2018

N2 - Purpose: Introducing a radiobiological index based on early tumor regression during neo-adjuvant radio-chemotherapy (RCT, including oxaliplatin) of rectal adenocarcinoma and testing its discriminative power in predicting the tumor response. Methods: Seventy-four patients were treated with Helical Tomotherapy following an adaptive (ART) protocol (41.4 Gy/18 fr, 2.3 Gy/fr) delivering a simultaneous integrated boost on the residual tumor in the last 6 fractions up to 45.6 Gy. T2-weighted MRI were taken before (MRIpre) and at mid (MRImid) therapy and the corresponding tumor volumes were considered (Vpre,Vmid). The “Early Regression Index” (ERITCP=-ln[(1-(Vmid/Vpre))Vpre]) was introduced and its discriminative power was assessed in terms of AUC, sensitivity/specificity, positive/negative predictive value (PPV/NPV). Two end-points were considered: (a) pathological complete response (pCR) or clinical complete response followed by watch-and-wait, (cCR); (b) limited response (residual vital cells (RVC) in the surgical specimen >10%). Results: Complete data were available for 65 patients: pCR, cCR and RVC >10% were 20, 2 and 19 respectively. The discriminative power of ERITCPwas moderately high (AUC = 0.81/0.75 for /pCRorcCR/RVC >10% respectively, p <0.0005). ERITCPwas highly sensitive (86–89%) with very high NPV (90–94%). The discriminative power of ERITCPwas confirmed on a subgroup of 44/65 patients when considering tumor volumes delineated by a skilled radiologist. Conclusion: A radiobiologically consistent index based on early regression showed high performances in predicting the pathological response after neo-adjuvant RCT for rectal cancer with relevant potentialities for ART/treatment customization. © 2018 Elsevier B.V.

AB - Purpose: Introducing a radiobiological index based on early tumor regression during neo-adjuvant radio-chemotherapy (RCT, including oxaliplatin) of rectal adenocarcinoma and testing its discriminative power in predicting the tumor response. Methods: Seventy-four patients were treated with Helical Tomotherapy following an adaptive (ART) protocol (41.4 Gy/18 fr, 2.3 Gy/fr) delivering a simultaneous integrated boost on the residual tumor in the last 6 fractions up to 45.6 Gy. T2-weighted MRI were taken before (MRIpre) and at mid (MRImid) therapy and the corresponding tumor volumes were considered (Vpre,Vmid). The “Early Regression Index” (ERITCP=-ln[(1-(Vmid/Vpre))Vpre]) was introduced and its discriminative power was assessed in terms of AUC, sensitivity/specificity, positive/negative predictive value (PPV/NPV). Two end-points were considered: (a) pathological complete response (pCR) or clinical complete response followed by watch-and-wait, (cCR); (b) limited response (residual vital cells (RVC) in the surgical specimen >10%). Results: Complete data were available for 65 patients: pCR, cCR and RVC >10% were 20, 2 and 19 respectively. The discriminative power of ERITCPwas moderately high (AUC = 0.81/0.75 for /pCRorcCR/RVC >10% respectively, p <0.0005). ERITCPwas highly sensitive (86–89%) with very high NPV (90–94%). The discriminative power of ERITCPwas confirmed on a subgroup of 44/65 patients when considering tumor volumes delineated by a skilled radiologist. Conclusion: A radiobiologically consistent index based on early regression showed high performances in predicting the pathological response after neo-adjuvant RCT for rectal cancer with relevant potentialities for ART/treatment customization. © 2018 Elsevier B.V.

U2 - 10.1016/j.radonc.2018.06.019

DO - 10.1016/j.radonc.2018.06.019

M3 - Article

VL - 128

SP - 564

EP - 568

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

SN - 0167-8140

IS - 3

ER -