扩散加权磁共振成像预测食管癌新辅助放化疗的病理反应

Diffusion-weighted magnetic resonance imaging for the prediction of pathologic response to neoadjuvant chemoradiotherapy in esophageal cancer.

作者信息

van Rossum Peter S N, van Lier Astrid L H M W, van Vulpen Marco, Reerink Onne, Lagendijk Jan J W, Lin Steven H, van Hillegersberg Richard, Ruurda Jelle P, Meijer Gert J, Lips Irene M

机构信息

Department of Radiotherapy, University Medical Center Utrecht, The Netherlands; Department of Surgery, University Medical Center Utrecht, The Netherlands.

Department of Radiotherapy, University Medical Center Utrecht, The Netherlands.

出版信息

Radiother Oncol. 2015 May;115(2):163-70. doi: 10.1016/j.radonc.2015.04.027. Epub 2015 May 19.

DOI:10.1016/j.radonc.2015.04.027

PMID:26002307

Abstract

PURPOSE

To explore the value of diffusion-weighted magnetic resonance imaging (DW-MRI) for the prediction of pathologic response to neoadjuvant chemoradiotherapy (nCRT) in esophageal cancer.

MATERIAL AND METHODS

In 20 patients receiving nCRT for esophageal cancer DW-MRI scanning was performed before nCRT, after 8-13 fractions, and before surgery. The median tumor apparent diffusion coefficient (ADC) was determined at these three time points. The predictive potential of initial tumor ADC, and change in ADC (ΔADC) during and after treatment for pathologic complete response (pathCR) and good response were assessed. Good response was defined as pathCR or near-pathCR (tumor regression grade [TRG] 1 or 2).

RESULTS

A pathCR after nCRT was found in 4 of 20 patients (20%), and 8 patients (40%) showed a good response to nCRT. The ΔADCduring was significantly higher in pathCR vs. non-pathCR patients (34.6%±10.7% [mean±SD] vs. 14.0%±13.1%, p=0.016), as well as in good vs. poor responders (30.5%±8.3% vs. 9.5%±12.5%, p=0.002). The ΔADCduring was predictive of residual cancer at a threshold of 29% (sensitivity of 100%, specificity of 75%, PPV of 94%, and NPV of 100%), and for poor pathologic response at a threshold of 21% (sensitivity of 82%, specificity of 100%, PPV of 100%, and NPV of 80%).

CONCLUSIONS

In this exploratory study, the treatment-induced change in ADC during the first 2-3weeks of nCRT for esophageal cancer seemed highly predictive of histopathologic response. Larger series are warranted to verify these results.

摘要

目的

探讨扩散加权磁共振成像（DW-MRI）在预测食管癌新辅助放化疗（nCRT）病理反应中的价值。

材料与方法

对20例接受食管癌nCRT的患者在nCRT前、8 - 13次分割放疗后及手术前进行DW-MRI扫描。在这三个时间点测定肿瘤的中位表观扩散系数（ADC）。评估初始肿瘤ADC以及治疗期间和治疗后ADC的变化（ΔADC）对病理完全缓解（pathCR）和良好反应的预测潜力。良好反应定义为pathCR或接近pathCR（肿瘤退缩分级[TRG]为1或2）。

结果

20例患者中有4例（20%）在nCRT后达到pathCR，8例（40%）对nCRT表现出良好反应。pathCR患者与非pathCR患者相比，治疗期间的ΔADC显著更高（34.6%±10.7%[均值±标准差]对14.0%±13.1%，p = 0.016），良好反应者与反应较差者相比也是如此（30.5%±8.3%对9.5%±12.5%，p = 0.002）。治疗期间的ΔADC在阈值为29%时可预测残留癌（敏感性为100%，特异性为75%，阳性预测值为94%，阴性预测值为100%），在阈值为21%时可预测病理反应较差（敏感性为82%，特异性为100%，阳性预测值为100%，阴性预测值为80%）。