Limited accuracy of DCE-MRI in identification of pathological complete responders after chemoradiotherapy treatment for rectal cancer.

Autor: Gollub MJ; Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. gollubm@mskcc.org., Tong T; Department of Radiology, Fudan University Medical Center, Shanghai, China., Weiser M; Department of Surgery, Divison of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA., Zheng J; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA., Gonen M; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA., Zakian KL; Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2017 Apr; Vol. 27 (4), pp. 1605-1612. Date of Electronic Publication: 2016 Jul 20.
DOI: 10.1007/s00330-016-4493-1
Abstrakt: Objectives: To examine whether post-chemoradiotherapy (CRT) DCE-MRI can identify rectal cancer patients with pathologic complete response (pCR).
Methods: From a rectal cancer surgery database 2007-2014, 61 consecutive patients that met the following inclusion criteria were selected for analysis: (1) stage II/III primary rectal adenocarcinoma; (2) received CRT; (3) underwent surgery (4); underwent rectal DCE-MRI on a 1.5-T MRI scanner. Two experienced radiologists, in consensus, drew regions of interest (ROI) on the sagittal DCE-MRI image in the tumour bed. These were exported from ImageJ to in-house Matlab code for modelling using the Tofts model. K trans , K ep and v e values were compared to pathological response.
Results: Of the 61 initial patients, 37 had data considered adequate for fitting to obtain perfusion parameters. Among the 13 men and 24 women, median age 53 years, there were 8 pCR (22 %). K trans could not distinguish patients with pCR. For patients with 90 % or greater response, mean K trans and K ep values were statistically significant (p = 0.032 and 0.027, respectively). Using a cutoff value of K trans  = 0.25 min -1 , the AUC was 0.71.
Conclusion: K trans could be used to identify patients with 90 % or more response to chemoradiotherapy for rectal cancer with an AUC of 0.7.
Key Points: • Chemoradiotherapy for rectal cancer causes decreased blood flow and permeability in the tumour bed. • Lower values of blood flow and permeability correlate with good tumour response. • K trans of 0.25min -1 best identifies patients with ≥90 % response with AUC 0.71.
Databáze: MEDLINE
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