MRI tumor volume reduction rate vs tumor regression grade in the pre-operative re-staging of locally advanced rectal cancer after chemo-radiotherapy

Neri, Emanuele; Guidi, Elisa; Pancrazi, Francesca; Castagna, Maura; Castelluccio, Elisa; Balestri, Riccardo; Buccianti, P; Masi, Luca; Falcone, Alfredo; Manfredi, B.; Faggioni, Lorenzo; Bartolozzi, Carlo

doi:10.1016/j.ejrad.2015.08.008

Cited by 34 publications

(19 citation statements)

References 26 publications

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“…However, measurement of tumor size is subject to intrinsic errors due to irregular tumor shape, nonuniform treatment-related shrinkage, and the different methods of manual measurement performed by radiologists; these factors make it difficult to identify all subtle tumor size changes induced by CRT. Many studies have evaluated the relationship between TVR on T2-weighted images and tumor response to CRT; the results have been conflicting (12)(13)(14)(15)(16). Our study demonstrated significant tumor volume changes after CRT, but, unlike other reports, we observed no significant relationship between tumor volume (in cubic centimeters) and histopathologic TRG.…”

Section: Discussioncontrasting

confidence: 90%

“…Our study demonstrated significant tumor volume changes after CRT, but, unlike other reports, we observed no significant relationship between tumor volume (in cubic centimeters) and histopathologic TRG. Kang et al (12) and Neri et al (13) showed a significant association between complete response and a TVR ratio of more than 75% and a TVR rate of 86%, respectively, whereas Kim et al (14) reported that the percentage volume reduction rate does not correlate with histopathologic TRG. Our study showed a significant increase in the percentage TVR after CRT; however, the multiple regression model failed to identify the percentage TVR as an independent predictor of percentage of residual tumor.…”

Section: Discussionmentioning

confidence: 99%

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MR Imaging with Apparent Diffusion Coefficient Histogram Analysis: Evaluation of Locally Advanced Rectal Cancer after Chemotherapy and Radiation Therapy

et al. 2018

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Purpose To determine response to neoadjuvant chemotherapy and radiation therapy in patients with locally advanced rectal cancer (LARC) by using magnetic resonance (MR) apparent diffusion coefficient (ADC) histogram analysis. Materials and Methods Ninety-two patients with LARC underwent MR imaging with rectal barium before and after chemotherapy and radiation therapy (CRT). Rectal expansion with barium expanded the lumen, provided similar imaging geometry before and after CRT, and eliminated fecal matter, air, and residual fluid. T2-weighted images, the percentage change in ADC, and ADC histogram skewness and kurtosis were assessed. The histopathologic tumor regression grade (TRG) ranged from 1a (66%-99% residual tumor cells) to 3 (no residual cells). The Wilcoxon signed-rank test, the Spearman correlation test, multivariable linear regression, and one-way analysis of variance were used to determine post- and pretreatment differences and correlations between tumor size and ADC. Results Of the 92 patients, 16 (17.4%) had TRG 3, 27 (29.3%) had TRG 2b, 24 (26.1%) had TRG 2a, 14 (15.2%) had TRG 1b, and 11 (12%) had TRG 1a. Post-CRT skewness (regression coefficient = 10.9, P = .06) and percentage ADC change (regression coefficient = -0.18, P = .03) were associated with the percentage of residual tumor. Post-CRT skewness and percentage ADC change, respectively, showed negative and positive correlation with histopathologic TRG (post-CRT skewness: P = .024; percentage ADC change: P = .001). Conclusion In patients with LARC, post-CRT skewness of the ADC histogram and percentage change in ADC were useful for predicting a favorable response to neoadjuvant CRT. RSNA, 2018 Online supplemental material is available for this article.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

MR Imaging with Apparent Diffusion Coefficient Histogram Analysis: Evaluation of Locally Advanced Rectal Cancer after Chemotherapy and Radiation Therapy

et al. 2018

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“…The ratio of pathologic responsive to nonresponsive patients significantly differed according to the MR imaging TRG score (P = .023, patients into the group who showed response at pathologic evaluation (pathologic responsive group, or those with Mandard grade 1 or 2) and those who did not show response (pathologic TRG 4 score was associated with pathologic TRG 1, 2, 3, 4, and 5 in 0, two, four, three, and zero patients, respectively) ( Table 1). To enhance the clarity of analysis, we recategorized these (27)(28)(29)(30). Our comparisons of the pre-and post-CCRT MR images for RMAC revealed a considerable degree of reduction in volume (mean volume reduction, 47.3%; P , .001).…”

Section: Gastrointestinal Imaging: Mr Imaging Of Mucinous Rectal Cancmentioning

confidence: 99%

Rectal Mucinous Adenocarcinoma: MR Imaging Assessment of Response to Concurrent Chemotherapy and Radiation Therapy—A Hypothesis-generating Study

et al. 2017

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Purpose To develop a system for assessment of tumor regression grade (TRG) with magnetic resonance (MR) imaging that is applicable to rectal mucinous adenocarcinoma (RMAC) and to obtain a preliminary evaluation of the association of MR imaging assessment of TRG with response to preoperative concurrent chemotherapy and radiation therapy (CCRT). Materials and Methods This retrospective study was approved by the institutional review board, and informed consent was waived. Pre- and post-CCRT MR images of 59 patients with RMAC (median age, 59 years; range, 29-80 years; 42 men [median age, 59 years; range, 36-80 years] and 17 women [median age, 57 years; range, 29-79 years]) who underwent CCRT and subsequent elective resection from July 2005 to June 2015 were analyzed. Two experienced gastrointestinal radiologists independently analyzed imaging parameters such as T stage, mesorectal fascia status, extramural vascular invasion status, and TRG by using modified criteria developed for assessment of RMAC. Interobserver variability was calculated with weighted κ analysis, and disagreement was settled in consensus. MR imaging TRG results were compared with those from pathologic TRG analysis (Mandard grade). Logistic regression analyses were performed to evaluate associations between imaging parameters and pathologic TRG. Results There was moderate to substantial agreement for imaging parameters (post-CCRT T stage-weighted κ, 0.7134; post-CCRT mesorectal fascia status, 0.618; TRG, 0.5023). Modified MR imaging TRG results were significantly associated with pathologic responsiveness (responsive group, Mandard grade 1 or 2; nonresponsive group, Mandard grades 3-5; P = .023). Results of univariate and multivariate logistic regression analyses indicated that MR imaging TRG was the only factor significantly associated with CCRT responsiveness (univariate analysis, P = .023; multivariate analysis, P = .0261). Conclusion The modified MR imaging assessment of TRG was associated with treatment response to CCRT in patients with RMAC. RSNA, 2017 Online supplemental material is available for this article.

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“…The tumor regression rate was calculated as follows [15]: MRI examination was conducted before treatment and 1 month after treatment for all patients. The long diameter of the tumor was determined by selecting the largest layer of the tumor in transverse position.…”

Section: Curative Efficacy Evaluationmentioning

confidence: 99%

Evaluation of Short-Term Efficacy of Concurrent Chemoradiotherapy in Primary Fallopian Tube Carcinoma by Diffusion-Weighted Imaging: A Retrospective Study

Zhang

Fang

et al. 2017

Oncol Res Treat

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Background: This study aims to evaluate the short-term efficacy of concurrent chemoradiotherapy (CCRT) in primary fallopian tube carcinoma (PFTC) using magnetic resonance diffusion-weighted imaging (MR-DWI). Patients and Methods: Total abdominal irradiation was performed for 61 PFTC patients after surgery, and paclitaxel and carboplatin were used for CCRT. According to the response evaluation criteria in solid tumors (RECIST1.1), patients were divided into a sensitive (n = 36) and a resistant group (n = 25). Pearson correlation analysis was conducted to assess the correlations of tumor regression rate with apparent diffusion coefficient (ADC)_pre, ADC_post, and ∆ADC_post. The efficacy of CCRT in PFTC using MR-DWI was evaluated by ROC curve, logistic regression analysis, Kaplan-Meier survival curve, and Cox regression model. Results: The ADC_pre in both the sensitive and the resistant group was negatively associated with the tumor regression rate (r = -0.508), while the ADC_post (r = 0.454) and ∆ADC_post (r = 0.769) were positively associated with the tumor regression rate (all p < 0.05). Histopathological type, FIGO stage, lymphatic metastasis, tumor regression rate, ADC_pre, ADC_post, and ∆ADC_post were confirmed as key factors for CCRT in PFTC (all p < 0.05). Conclusion: Our retrospective study demonstrates the predictive value of MR-DWI in CCRT for PFTC patients.

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MRI tumor volume reduction rate vs tumor regression grade in the pre-operative re-staging of locally advanced rectal cancer after chemo-radiotherapy

Cited by 34 publications

References 26 publications

MR Imaging with Apparent Diffusion Coefficient Histogram Analysis: Evaluation of Locally Advanced Rectal Cancer after Chemotherapy and Radiation Therapy

MR Imaging with Apparent Diffusion Coefficient Histogram Analysis: Evaluation of Locally Advanced Rectal Cancer after Chemotherapy and Radiation Therapy

Rectal Mucinous Adenocarcinoma: MR Imaging Assessment of Response to Concurrent Chemotherapy and Radiation Therapy—A Hypothesis-generating Study

Evaluation of Short-Term Efficacy of Concurrent Chemoradiotherapy in Primary Fallopian Tube Carcinoma by Diffusion-Weighted Imaging: A Retrospective Study

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