Chen YunBin, Liu Xiangyi, Zheng Dechun, Xu Luying, Hong Liang, Xu Yun, Pan Jianji
Department of Radiology, Fujian Medical University Teaching Hospital, Fujian Provincial Cancer Hospital, 350014, Fujian, P.R. China.
Department of Radiology, Fujian Medical University Teaching Hospital, Fujian Provincial Cancer Hospital, 350014, Fujian, P.R. China.
Magn Reson Imaging. 2014 Jul;32(6):630-7. doi: 10.1016/j.mri.2014.02.009. Epub 2014 Feb 11.
To prospectively evaluate the feasibility of diffusion-weighted magnetic resonance imaging (DWI) for monitoring early treatment response to chemoradiotherapy (CRT) of nasopharyngeal carcinoma (NPC).
Thirty-one patients with stage III and IV NPC were enrolled in this study from February 2012 to November 2012．T2-weighted and DWI sequences with diffusion factor of 0 and 800mm²/s were performed using a 3.0 T Philips Achieva TX scanner at baseline and 3 days, 20 days (after the first cycle of chemotherapy), 50 days (6 days after radiotherapy initiation) after neoadjuvant chemotherapy (NAC) initiation. The diameter of each primary lesion and target metastatic lymph node before and after the first cycle of NAC was measured and classified into stable disease (SD), partial response (PR) or completed response (CR) based on RECIST 1.1. The apparent diffusion coefficient (ADC) values and changes compared to baseline at each time point were compared between responders (CR and PR) and non-responders (SD). The rates of residual at the end of CRT were compared between these two groups.
A significant increase in ADC was observed at each stage of therapy (P=.001) in lesions of primary and metastatic. The ADC values (ADC), ADC changes (ΔADC) and percentage ADC changes (Δ%ADC) of day 20 in responders were significantly higher than in non-responders for both primary lesions (p=.005, p=.006, p=.008, respectively) and metastatic lymph nodes (p=.002, p=.002, p=.003). Non-responders showed a higher rate of residual for both primary lesions (p=.008) and metastatic lymph nodes (p=.024) than responders.
DW MR imaging allows for detecting early treatment response of NPC. Patients with high ADC values and large ADC increase early after NAC initiation tended to respond better to CRT. Thus, accessing the curative effect of NAC in advanced NPC provides the opportunity to adjust following CRT regimen.
前瞻性评估扩散加权磁共振成像（DWI）监测鼻咽癌（NPC）放化疗（CRT）早期治疗反应的可行性。
2012年2月至2012年11月，31例III期和IV期NPC患者纳入本研究。使用3.0T飞利浦Achieva TX扫描仪在新辅助化疗（NAC）开始时的基线、3天、20天（第一个化疗周期后）、50天（放疗开始后6天）进行扩散因子为0和800mm²/s的T2加权和DWI序列扫描。测量第一个NAC周期前后每个原发灶和靶转移淋巴结的直径，并根据RECIST 1.1标准分为疾病稳定（SD）、部分缓解（PR）或完全缓解（CR）。比较缓解者（CR和PR）与未缓解者（SD）在每个时间点的表观扩散系数（ADC）值及与基线相比的变化。比较两组在CRT结束时的残留率。
在原发灶和转移灶的各治疗阶段均观察到ADC显著增加（P = 0.001）。对于原发灶（分别为p = 0.005、p = 0.006、p = 0.008）和转移淋巴结（p = 0.002、p = 0.002、p = 0.003），缓解者在第20天的ADC值（ADC）、ADC变化（ΔADC）和ADC变化百分比（Δ%ADC）均显著高于未缓解者。未缓解者的原发灶（p = 0.008）和转移淋巴结（p = 0.024）残留率高于缓解者。
DW MR成像可检测NPC的早期治疗反应。NAC开始后早期ADC值高且ADC增加大的患者对CRT反应往往更好。因此，评估晚期NPC中NAC的疗效为调整后续CRT方案提供了机会。
