Tumor microcirculation and diffusion predict therapy outcome for primary rectal carcinoma

DeVries, Alexander; Kremser, Christian; Hein, Patrick A.; Griebel, Jürgen; Krezcy, Alfons; Öfner, Dietmar; Pfeiffer, Karl P.; Lukáš, Peter; Judmaier, Werner

doi:10.1016/s0360-3016(03)00208-6

Cited by 222 publications

(146 citation statements)

References 28 publications

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“…However, our results showed that the median pre-CRT tumor ADCs of the responder groups were lower than that of nonresponder groups but the pre-CRT tumor ADCs were not significantly different between responders and nonresponders using all reference standards. According to the research reported by DeVries et al (22), it was possible to achieve a significant difference between responder and nonresponder group by using histogram analysis alone. This discrepancy between analytical methods suggests that evaluation of treatment response may be limited when using simply mean or median ADC value.…”

Section: Discussionmentioning

confidence: 99%

Comparison of diffusion‐weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer

Kim

Lim

Keum

et al. 2011

Magnetic Resonance Imaging

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Purpose: To compare diffusion-weighted imaging (DWI) and magnetic resonance (MR) volumetry for predicting treatment outcomes of locally advanced rectal cancers with preoperative chemoradiotherapy (CRT). Materials and Methods:This prospective study was approved by our Institutional Review Board. Thirty-four patients underwent three MR examinations: pre-CRT (before CRT), early CRT (2 weeks after CRT initiation), and post-CRT (before surgery). The tumor apparent diffusion coefficient (ADC), ADC increase rate, and volume reduction rate were compared between responders and nonresponders using three reference standards: downstaging, modified Response Evaluation Criteria in Solid Tumors (mRECIST), and tumor regression grade (TRG). For DWI and volumetry, differences between responders and nonresponders were assessed by receiver operating characteristic analysis.Results: The median early tumor volume reduction rate of responders, subgrouped by downstaging and mRECIST (47.97% and 53.97%, respectively), was significantly higher than that of nonresponders (20.94% and 20.36%; P ¼ 0.0024 and 0.0001, respectively), but there were no significant differences in pre-CRT ADC and early ADC increase rate using all references. When using the downstaging and mRECIST, the diagnostic performance of early tumor volume reduction rate (Az ¼ 0.81 and 0.94, respectively) was higher than that of pre-CRT ADC (Az ¼ 0.55 and 0.62; P ¼ 0.033 and 0.007) and early ADC increase rate (Az ¼ 0.58 and 0.64; P ¼ 0.055 and 0.01) for predicting the treatment outcome. For TRG, there were no significant differences between DWI and volumetry.Conclusion: Early tumor volume reduction rate at the second week after CRT initiation may be a better indicator than DWI based on the mean ADC measurements for predicting CRT treatment outcome.

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Section: Discussionmentioning

confidence: 99%

Comparison of diffusion‐weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer

Kim

Lim

Keum

et al. 2011

Magnetic Resonance Imaging

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“…In general, these studies have shown that there is a progressive decrease in MR parameters such as enhancement or K trans which is associated with a decrease in tumor size following chemotherapy and that an increase or no change in such parameters is seen in those patients with progressive disease (40,41). Other studies have reported similar effects following radiotherapy in rectal and cervix cancers (42)(43)(44)(45) and androgen deprivation in prostate cancer (46). The reasons for these changes in DCE-MRI with a wide variety of different anti-cancer therapies might be because a proportion of their antitumor efficacy is due to direct effects on the vasculature, or that tumor cell kill results in a subsequent change in the tumor microcirculation.…”

Section: Use Of Dce-mri As a Pharmacodynamic Endpoint For Other Anti-mentioning

confidence: 80%

MR in oncology drug development

Galbraith

2006

NMR Biomed.

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This article reviews the use of MR in preclinical and clinical experiments to aid drug development. In particular it concentrates on the use of MR to study tumor microvasculature following treatment with anti-vascular agents and the use of MRS to study tumor metabolism following treatment with a variety of anti-cancer agents. The advantages and disadvantages of a variety of techniques including contrast-and noncontrast-enhanced methods are discussed and the data from clinical trials using these techniques are reviewed. Despite the consensus documents produced to date for both dynamic contrastenhanced MRI and MRS, most of the trials reported used alternative methods, and different nomenclature for the MR parameters used. This continues to inhibit the comparison between novel therapeutics and between different trials with the same compound. Comprehensive data from multicenter trials on the reproducibility of techniques is still lacking in the literature and the implications of the available data on clinical trial design is also discussed.

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“…89 However, the prognostic implications of the pretreatment ADC values Original Article require further validation. 90 Differences in the geographic distribution of high ADC values may account for tumor necrosis and, thus, may indicate a poor response to therapy. 90 An increase in ADC values as a result of therapyinduced tumor cell lysis and necrosis has been demonstrated in both preclinical and clinical studies.…”

Section: Diffusion-weighted Imagingmentioning

confidence: 99%

“…90 Differences in the geographic distribution of high ADC values may account for tumor necrosis and, thus, may indicate a poor response to therapy. 90 An increase in ADC values as a result of therapyinduced tumor cell lysis and necrosis has been demonstrated in both preclinical and clinical studies. 88 Changes in ADC values may precede those in tumor volume, making DWI a potential biomarker for early response to therapy.…”

Section: Diffusion-weighted Imagingmentioning

confidence: 99%

Magnetic resonance imaging as a biomarker in renal cell carcinoma

Pedrosa

Alsop

Rofsky

2009

Cancer

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The ability to noninvasively discriminate the most common types of renal cell carcinoma (RCC) based on their magnetic resonance imaging (MRI) appearances or their magnetic resonance phenotypes is achievable. Intracellular lipids, a histologic characteristic of the clear cell RCC, can be identified on chemical shift MRI. Intratumoral hemosiderin deposition, as observed histologically with papillary RCC, correlates to the low signal intensity on T2-weighted images. In addition to morphologic imaging features, the different subtypes of RCC have distinct patterns of enhancement on dynamic contrast-enhanced MRI. Clear cell tumors demonstrate much greater enhancement than papillary and chromophobe RCCs during the corticomedullary and nephrographic phases. The MRI technique arterial spin labeling (ASL) uses magnetic fields to label the water protons in arterial blood and measures blood flow into tissue; quantitative images of blood flow can be generated without exogenous contrast media. Multiple measurements of tumor perfusion may be repeated before and after a physiologic or drug challenge (ie, antiangiogenic therapy). In RCC xenografts and in patients with metastatic RCC, ASL MRI assessments can be used to monitor blood flow changes in response to antiangiogenic therapies. High blood flow on ASL MRI in RCC xenografts correlates with viable tumor at histopathologic analysis, whereas zones of absent or diminished signal correspond to necrosis. ASL MRI has the potential to serve as a biomarker for patients with metastatic RCC by offering a noninvasive measure of tumor blood flow changes accompanying antiangiogenic therapy. Cancer 2009;115(10 suppl):2334-45.

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Tumor microcirculation and diffusion predict therapy outcome for primary rectal carcinoma

Cited by 222 publications

References 28 publications

Comparison of diffusion‐weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer

Comparison of diffusion‐weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer

MR in oncology drug development

Magnetic resonance imaging as a biomarker in renal cell carcinoma

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