Diffusion-weighted imaging in evaluating the efficacy of concurrent chemoradiotherapy in the treatment of non-small cell lung cancer

Abstract

Tumori 2017; 00(00): 000-000 ORIGINAL RESEARCH ARTICLEcountries, although it is decreasing in developed countries. In addition to smoking, sex, nationality, and histology also account for NSCLC (3)(4)(5). Despite advances in standard treatment and early detection, NSCLC is often diagnosed at an advanced stage. Patients typically have poor prognosis, with a 5-year survival rate of less than 15% (6). Concurrent chemoradiotherapy (CCRT) is a new model developed in recent decades. A clinical study reported that the 5-year survival rate of patients with stage III NSCLC receiving CCRT was 15%-25%. This response was clearly better than other treatments, and CCRT was established as the standard treatment for stage III NSCLC (7).Diffusion-weighted imaging (DWI) is a type of functional imaging modality involving magnetic resonance imaging (MRI) (8). Diffusion-weighted imaging characterizes the restriction of the random thermal motion of water molecules within biological tissues and has been applied to the detection and characterization of focal pulmonary lesions (9-12). Diffusionweighted imaging provides quantitative and qualitative functional information about water microscopic movement at the cellular level (13). The apparent diffusion coefficient (ADC) is proposed to qualify differences in water mobility, which reflects the signal loss on DWI (14). The ADC value is inversely associated with tumor cellularity and can potentially be used

Volumetric Analysis of Intravoxel Incoherent Motion Diffusion-Weighted Imaging for Predicting the Response to Chemotherapy in Patients With Locally Advanced Non–Small Cell Lung Cancer

“…This may be due to the cytotoxic effect of chemotherapeutic drugs destroying the integrity of tumor cells, increasing intracellular necrosis, inducing tumor cell apoptosis, or directly killing tumor cells, resulting in decreased cell density and increased water molecule diffusion movement after effective chemotherapy. The results for ADC were the same with previous studies 3–7 in patients with primary and recurrent lung tumors. Theoretically, the D value is more representative of the water molecular diffusion than ADC because of the separation of water molecule diffusion and microcirculation perfusion.…”

“…The reason for this was likely the low cell density or the existence of minor cystoid variation and necrosis, which are less sensitive to chemotherapy because of hypoxia and acidosis. The findings were the same as the results obtained for ADC in lung cancer 6,10,13 and for D in nasopharyngeal carcinoma [29][30][31] and rectal cancer 26,38 but different from the results obtained in other studies. 27,28,32,33 The contradictory results may be due to the diverse research objectives, the heterogeneous scanning and postprocessing techniques, and the different evaluation criteria.…”

“…First, the number of patients was relatively small, and the pathology was not concordant. However, one study 6 revealed that there was no difference in ADC evaluating the curative effect of lung cancer with different histological types. Second, the advanced patients were recruited in the study, and the prognosis is relatively poor.…”

“…3,4 Diffusion-weighted imaging (DWI) is a radiation-and contrastfree functional imaging technique for quantitative evaluating the movement of water molecules within tissues. Studies [3][4][5][6][7][8] have shown that apparent diffusion coefficient (ADC) changes before the decrease of tumor size and thus can potentially monitor the curative effect of chemotherapy in lung cancer patients and predict prognoses at early stages. However, the ADC is based on a monoexponential model of DWI and is influenced by perfusion effects.…”

Perfusion bias in the apparent diffusion coefficient measurements of diffusion-weighted magnetic resonance imaging

“…Recently, an interesting article by Xu and colleagues (1) reported on the usefulness of diffusion-weighted magnetic resonance imaging (MRI) in evaluating patients with non-small-cell lung cancer treated with concurrent chemoradiotherapy. In a large cohort of 192 patients, by measuring the apparent diffusion coefficient (ADC) on parametric ADC maps, the authors found that quantitative diffusion-weighted MRI has predictive value in evaluating the short-term efficacy of concurrent chemoradiotherapy.…”