Multimodal Imaging of Pathologic Response to Chemoradiation in Esophageal Cancer

Fang, Penny; Musall, Benjamin C.; Son, Jong Bum; Moreno, Amy C.; Hobbs, Brian P.; Carter, Brett W.; Fellman, Bryan; Mawlawi, Osama; Ma, Jingfei; Lin, Steven H.

doi:10.1016/j.ijrobp.2018.02.029

Cited by 39 publications

(61 citation statements)

References 20 publications

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“…Furthermore, an increase in ADC after nCRT compared with the baseline value seemed to be predictive of gross tumour response, defined as TRG 1–2 or TRG 1–3. However, the results reported for the preoperative selection of complete response (TRG 1 only) using ADC values were poor. In contrast, in the present study, preoperative visual response assessment on DW‐MRI after nCRT had high sensitivity for the detection of residual tumour.…”

Section: Discussioncontrasting

confidence: 66%

“…The present study evaluated oesophageal MRI for the assessment of complete response of the primary tumour by visual interpretation of morphology on T2W‐MRI and restrictive signals on DW‐MRI. Previous studies on this subject did not perform visual assessment, but focused on quantitative DW‐MRI. These studies found that an increase in the apparent diffusion coefficient (ADC, a quantitative measure of the magnitude of diffusion) during nCRT, compared with before nCRT, is a predictor of response.…”

Section: Discussionmentioning

confidence: 99%

“…Although MRI of the oesophagus is technically more challenging, owing to oesophageal motility and motion of the surrounding heart and diaphragm, advances in technology now enable the acquisition of high‐resolution magnetic resonance (MR) images. Previous studies on response prediction with MRI in oesophageal cancer focused on quantitative diffusion‐weighted (DW) MRI parameters. However, visual response assessment on T2‐weighted (T2W) and functional DW‐MRI in rectal cancer yielded higher sensitivity for detecting residual tumour compared with quantitative assessment.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer

Vollenbrock

Voncken

Dieren

et al. 2019

British Journal of Surgery

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Background Patients with a pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) for oesophageal cancer may benefit from non‐surgical management. The aim of this study was to determine the diagnostic performance of visual response assessment of the primary tumour after nCRT on T2‐weighted (T2W) and diffusion‐weighted (DW) MRI. Methods Patients with locally advanced oesophageal cancer who underwent T2W‐ and DW‐MRI (1·5 T) before and after nCRT in two hospitals, between July 2013 and September 2017, were included in this prospective study. Three radiologists evaluated T2W images retrospectively using a five‐point score for the assessment of residual tumour in a blinded manner and immediately rescored after adding DW‐MRI. Histopathology of the resection specimen was used as the reference standard; ypT0 represented a pCR. Sensitivity, specificity, area under the receiver operating characteristic (ROC) curve (AUC) and interobserver agreement were calculated. Results Twelve of 51 patients (24 per cent) had a pCR. The sensitivity and specificity of T2W‐MRI for detection of residual tumour ranged from 90 to 100 and 8 to 25 per cent respectively. Respective values for T2W + DW‐MRI were 90–97 and 42–50 per cent. AUCs for the three readers were 0·65, 0·66 and 0·68 on T2W‐MRI, and 0·71, 0·70 and 0·70 on T2W + DW‐MRI ( P = 0·441, P = 0·611 and P = 0·828 for readers 1, 2 and 3 respectively). The κ value for interobserver agreement improved from 0·24–0·55 on T2W‐MRI to 0·55–0·71 with DW‐MRI. Conclusion Preoperative assessment of residual tumour on MRI after nCRT for oesophageal cancer is feasible with high sensitivity, reflecting a low chance of missing residual tumour. However, the specificity was low; this results in overstaging of complete responders as having residual tumour and, consequently, overtreatment.

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Section: Discussioncontrasting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer

Vollenbrock

Voncken

Dieren

et al. 2019

British Journal of Surgery

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“…MRI scans were performed on a field strength of 1.5 Tesla in nine studies [45][46][47][48][49][50][51][52][53]. 3.0 Tesla MRI scanners were used in four studies [54][55][56][57]. One study did not report on the field strength used [58].…”

Section: General Study Characteristicsmentioning

confidence: 99%

“…The risk of bias regarding patient selection was high in one study, which only included cT4 tumours [47]. Patient selection was scored unclear if an inclusion period and inclusion number were reported without explaining potential exclusions from analyses [45,50,[54][55][56].…”

Section: Quality Of the Included Studiesmentioning

confidence: 99%

Diffusion-weighted MRI with ADC mapping for response prediction and assessment of oesophageal cancer: A systematic review

Vollenbrock

Voncken

Bartels

et al. 2020

Radiotherapy and Oncology

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Chemoradiotherapy with paclitaxel liposome plus cisplatin for locally advanced esophageal squamous cell carcinoma: A retrospective analysis

Liu

Cui

et al. 2022

Cancer Medicine

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Purpose This single‐center retrospective clinical study aimed to evaluate the efficacy and feasibility of chemoradiotherapy with paclitaxel liposome plus cisplatin for locally advanced esophageal squamous cell carcinoma (ESCC). Methods Patients with locally advanced ESCC treated with paclitaxel‐liposome‐based chemoradiotherapy between 2016 and 2019 were retrospectively analyzed. Overall survival (OS) and progression‐free survival (PFS) were evaluated using Kaplan–Meier analysis. Results Thirty‐nine patients with locally advanced ESCC were included in this study. The median follow‐up time was 31.5 months. The median OS time was 38.3 (95% confidence interval [CI]: 32.1–45.1) months, and the 1‐, 2‐, and 3‐year OS rates were 84.6%, 64.1%, and 56.2%, respectively. The median PFS time was 32.1 (95% CI: 25.4–39.0) months, and the 1‐, 2‐, and 3‐year PFS rates were 71.8%, 43.6%, and 43.6%, respectively. The most common Grade IV toxicity was neutropenia (30.8%) followed by lymphopenia (20.5%). There were no cases of Grade III/IV radiation pneumonia, and four patients (10.3%) had Grade III/IV esophagitis. Conclusion Chemoradiotherapy using paclitaxel liposome and cisplatin is a well‐tolerated and effective treatment regimen for locally advanced ESCC.

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Multimodal Imaging of Pathologic Response to Chemoradiation in Esophageal Cancer

Abstract: Quantitative volume ΔADC and TLG during treatment may serve as early imaging biomarkers for discriminating pathologic response to chemoradiation in esophageal cancer. Validation of these data in larger, prospective, multicenter studies is essential.

Cited by 39 publications

References 20 publications

Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer

Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer

Diffusion-weighted MRI with ADC mapping for response prediction and assessment of oesophageal cancer: A systematic review

Chemoradiotherapy with paclitaxel liposome plus cisplatin for locally advanced esophageal squamous cell carcinoma: A retrospective analysis

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