Could early tumour volume changes assessed on morphological MRI predict the response to chemoradiation therapy in locally-advanced rectal cancer?

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Abstract

Aim: To investigate the potential role of an additional magnetic resonance imaging (MRI) examination performed during neoadjuvant chemoradiation therapy (CRT) in the prediction of pathological response in locally advanced rectal cancer (LARC). Material and methods: Forty-eight consecutive patients with LARC underwent neoadjuvant CRT. MRI studies at 1.5 T, including high-resolution T2-weighted sequences that were acquired parallel and perpendicular to the main axis of the tumour were performed before (preMRI), during (midMRI), and 6–8 weeks after the end of CRT (postMRI). Cancer volumes (V pre , V mid , V post ) were drawn manually and the reduction rate calculated (ΔV mid , ΔV post ). According to Rödel's pathological tumour regression grade (TRG), patients were considered non-responders (NR; TRG0-2), partial responders (PR; TRG3), and complete responders (CR; TRG4). Multivariate regression analysis was performed to identify the best MRI predictors of NR, PR, and CR. Results: Twenty-five patients were considered PR (52%), 13 CR (27%), and 10 NR (22%). Tumour shrinkage mainly occurred shortly after CRT (ΔV mid : CR: 80±10% versus PR: 56±19% versus NR: 28±22%, p=2.2×10 −16 ). V mid , V post , ΔV mid , and ΔV post correlated with TRG (p <0.001). At multivariate analysis, the combined assessment of V mid and ΔV mid was selected as the best predictor of response to CRT, in that it distinguishes CR, PR, and NR early and accurately (81.5%). Conclusion: MidMRI allows final response assessment to neoadjuvant CRT earlier and better than the MRI performed after the end of CRT. MRI findings at midMRI may be useful to tailor patient treatment. © 2018 The Royal College of Radiologists
Original languageEnglish
Pages (from-to)555-563
Number of pages9
JournalClinical Radiology
Volume73
Issue number6
DOIs
Publication statusPublished - 2018

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Rectal Neoplasms
Tumor Burden
Magnetic Resonance Imaging
Neoadjuvant Therapy
Neoplasms
Multivariate Analysis
Therapeutics
Regression Analysis

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@article{208d3b234aa7481ebf406b2082d6dc44,
title = "Could early tumour volume changes assessed on morphological MRI predict the response to chemoradiation therapy in locally-advanced rectal cancer?",
abstract = "Aim: To investigate the potential role of an additional magnetic resonance imaging (MRI) examination performed during neoadjuvant chemoradiation therapy (CRT) in the prediction of pathological response in locally advanced rectal cancer (LARC). Material and methods: Forty-eight consecutive patients with LARC underwent neoadjuvant CRT. MRI studies at 1.5 T, including high-resolution T2-weighted sequences that were acquired parallel and perpendicular to the main axis of the tumour were performed before (preMRI), during (midMRI), and 6–8 weeks after the end of CRT (postMRI). Cancer volumes (V pre , V mid , V post ) were drawn manually and the reduction rate calculated (ΔV mid , ΔV post ). According to R{\"o}del's pathological tumour regression grade (TRG), patients were considered non-responders (NR; TRG0-2), partial responders (PR; TRG3), and complete responders (CR; TRG4). Multivariate regression analysis was performed to identify the best MRI predictors of NR, PR, and CR. Results: Twenty-five patients were considered PR (52{\%}), 13 CR (27{\%}), and 10 NR (22{\%}). Tumour shrinkage mainly occurred shortly after CRT (ΔV mid : CR: 80±10{\%} versus PR: 56±19{\%} versus NR: 28±22{\%}, p=2.2×10 −16 ). V mid , V post , ΔV mid , and ΔV post correlated with TRG (p <0.001). At multivariate analysis, the combined assessment of V mid and ΔV mid was selected as the best predictor of response to CRT, in that it distinguishes CR, PR, and NR early and accurately (81.5{\%}). Conclusion: MidMRI allows final response assessment to neoadjuvant CRT earlier and better than the MRI performed after the end of CRT. MRI findings at midMRI may be useful to tailor patient treatment. {\circledC} 2018 The Royal College of Radiologists",
author = "A Palmisano and A Esposito and {Di Chiara}, A and A Ambrosi and P Passoni and N Slim and C Fiorino and L Albarello and {Di Muzio}, N and R Calandrino and R Rosati and {Del Maschio}, A and {De Cobelli}, F",
year = "2018",
doi = "10.1016/j.crad.2018.01.007",
language = "English",
volume = "73",
pages = "555--563",
journal = "Clinical Radiology",
issn = "0009-9260",
publisher = "W.B. Saunders Ltd",
number = "6",

}

TY - JOUR

T1 - Could early tumour volume changes assessed on morphological MRI predict the response to chemoradiation therapy in locally-advanced rectal cancer?

AU - Palmisano, A

AU - Esposito, A

AU - Di Chiara, A

AU - Ambrosi, A

AU - Passoni, P

AU - Slim, N

AU - Fiorino, C

AU - Albarello, L

AU - Di Muzio, N

AU - Calandrino, R

AU - Rosati, R

AU - Del Maschio, A

AU - De Cobelli, F

PY - 2018

Y1 - 2018

N2 - Aim: To investigate the potential role of an additional magnetic resonance imaging (MRI) examination performed during neoadjuvant chemoradiation therapy (CRT) in the prediction of pathological response in locally advanced rectal cancer (LARC). Material and methods: Forty-eight consecutive patients with LARC underwent neoadjuvant CRT. MRI studies at 1.5 T, including high-resolution T2-weighted sequences that were acquired parallel and perpendicular to the main axis of the tumour were performed before (preMRI), during (midMRI), and 6–8 weeks after the end of CRT (postMRI). Cancer volumes (V pre , V mid , V post ) were drawn manually and the reduction rate calculated (ΔV mid , ΔV post ). According to Rödel's pathological tumour regression grade (TRG), patients were considered non-responders (NR; TRG0-2), partial responders (PR; TRG3), and complete responders (CR; TRG4). Multivariate regression analysis was performed to identify the best MRI predictors of NR, PR, and CR. Results: Twenty-five patients were considered PR (52%), 13 CR (27%), and 10 NR (22%). Tumour shrinkage mainly occurred shortly after CRT (ΔV mid : CR: 80±10% versus PR: 56±19% versus NR: 28±22%, p=2.2×10 −16 ). V mid , V post , ΔV mid , and ΔV post correlated with TRG (p <0.001). At multivariate analysis, the combined assessment of V mid and ΔV mid was selected as the best predictor of response to CRT, in that it distinguishes CR, PR, and NR early and accurately (81.5%). Conclusion: MidMRI allows final response assessment to neoadjuvant CRT earlier and better than the MRI performed after the end of CRT. MRI findings at midMRI may be useful to tailor patient treatment. © 2018 The Royal College of Radiologists

AB - Aim: To investigate the potential role of an additional magnetic resonance imaging (MRI) examination performed during neoadjuvant chemoradiation therapy (CRT) in the prediction of pathological response in locally advanced rectal cancer (LARC). Material and methods: Forty-eight consecutive patients with LARC underwent neoadjuvant CRT. MRI studies at 1.5 T, including high-resolution T2-weighted sequences that were acquired parallel and perpendicular to the main axis of the tumour were performed before (preMRI), during (midMRI), and 6–8 weeks after the end of CRT (postMRI). Cancer volumes (V pre , V mid , V post ) were drawn manually and the reduction rate calculated (ΔV mid , ΔV post ). According to Rödel's pathological tumour regression grade (TRG), patients were considered non-responders (NR; TRG0-2), partial responders (PR; TRG3), and complete responders (CR; TRG4). Multivariate regression analysis was performed to identify the best MRI predictors of NR, PR, and CR. Results: Twenty-five patients were considered PR (52%), 13 CR (27%), and 10 NR (22%). Tumour shrinkage mainly occurred shortly after CRT (ΔV mid : CR: 80±10% versus PR: 56±19% versus NR: 28±22%, p=2.2×10 −16 ). V mid , V post , ΔV mid , and ΔV post correlated with TRG (p <0.001). At multivariate analysis, the combined assessment of V mid and ΔV mid was selected as the best predictor of response to CRT, in that it distinguishes CR, PR, and NR early and accurately (81.5%). Conclusion: MidMRI allows final response assessment to neoadjuvant CRT earlier and better than the MRI performed after the end of CRT. MRI findings at midMRI may be useful to tailor patient treatment. © 2018 The Royal College of Radiologists

U2 - 10.1016/j.crad.2018.01.007

DO - 10.1016/j.crad.2018.01.007

M3 - Article

VL - 73

SP - 555

EP - 563

JO - Clinical Radiology

JF - Clinical Radiology

SN - 0009-9260

IS - 6

ER -