Multiparametric MRI for prediction of treatment response to neoadjuvant FOLFIRINOX therapy in borderline resectable or locally advanced pancreatic cancer

Abstract

Objectives To identify multiparametric MRI biomarkers to predict the tumor response to neoadjuvant FOLFIRINOX therapy in patients with borderline resectable (BR) or locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Methods From May 2016 to March 2018, adult patients with BR or LA PDAC were prospectively enrolled in this study. They received eight cycles of FOLFIRINOX therapy and underwent multiparametric MRI twice (at baseline and after the second cycle). MRI evaluations included dynamic contrast-enhanced MRI, intravoxel incoherent motion diffusion-weighted imaging, and assessment of T2* relaxivity (R2*) and the change in T1 relaxivity (ΔR1, equilibrium phase R1 minus non-enhanced R1) of the tumors. Factors to predict the responders determined by the best overall response during FOLFIRINOX therapy and those to predict progression-free survival (PFS) and overall survival (OS) were evaluated using multivariable logistic regression and the Cox proportional hazard model. Results Forty-one patients (mean age, 60.3 years ± 9.3; 24 men) were included. Among the clinical and MRI factors, the baseline ΔR1 (adjusted odds ratio, 31.07; p = 0.008) was the only independent predictor for tumor response. The baseline ΔR1 was also an independent predictor for PFS (adjusted hazard ratio, 0.40; p = 0.033) along with R0 resection. The use of a cutoff ΔR1 value of ≥ 1.31 s-1 enabled prognostic stratification (median PFS, 16.0 months vs.10.0 months; p = 0.029; median OS, 34.9 months vs. 16.6 months; p = 0 .023, respectively). Conclusions The baseline tumor ΔR1 value may be useful to predict tumor response and survival in patients with BR or LA PDAC receiving FOLFIRINOX neoadjuvant therapy. Key Points • Baseline ΔR1 was an independent predictor for tumor response (adjusted odds ratio, 31.07; p = 0.008) and progression-free survival (adjusted hazard ratio, 0.40; p = 0.033) in patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma receiving neoadjuvant FOLFIRINOX therapy. • The criterion of baseline ΔR1 value ≥ 1.31 s-1 allowed for the prediction of favorable tumor response and survival outcome after neoadjuvant FOLFIRINOX therapy.

CT in the prediction of margin-negative resection in pancreatic cancer following neoadjuvant treatment: a systematic review and meta-analysis

“…Quantitative evaluation might be effective to lessen this difficulty of CT. A few previous studies [31,32] that used radiomics and deep learning to differentiate pancreatic cancer from non-cancerous lesion showed high sensitivity (79-100%) and high specificity (97-100%). In addition, there were several quantitative parameters associated with the margin status of pancreatic cancer in recent studies [13,[33][34][35]. This study had several limitations.…”

Quantitative Magnetic Resonance Imaging for the Pancreas

“…Three studies examining tumor response to gemcitabine-based chemotherapy 140,141 or antiangiogenic therapy 137 showed that tumor K trans and v e were significantly higher in responders versus the nonresponders. Conversely, Kang et al 139 reported that DCE-MRI did not contribute to the prediction of response to FOLFIRINOX (folinic acid, fluorouracil, irinotecan, and oxaliplatin) chemotherapy. Further investigation is warranted to determine the usefulness of DCE-MRI for predicting tumor response to different chemotherapy regimens or therapeutic modalities.…”

“…4). 31,[137][138][139][140][141][142][143][144][145][146][147][148][149][150] Currently, the use of DCE-MRI-derived estimation in chronic pancreatitis remains poorly investigated. Kim et al 146 demonstrated that chronic pancreatitis is associated with a significantly lower K trans and k ep than the healthy pancreas; however, there were no significant differences found in v e .…”

Application of Magnetic Resonance Imaging in Neoadjuvant Treatment of Pancreatic Ductal Adenocarcinoma

“…Compared with the single‐index model, the evaluation efficiency and application value of the double‐index model may be broader. In 2020, Kang et al 45 also used multiparameter MRI to predict the response of borderline resectable or locally advanced PDAC to neoadjuvant FOLFIRINOX therapy. The MRI evaluation modes they used include dynamic contrast‐enhanced MRI, IVIM DWI, as well as the assessment of the tumor's T 2* relaxation ( R 2*) and T 1 relaxation (∆ R 1).…”