Department of Radiotherapy, University Medical Center Utrecht, Netherlands.
Department of Radiotherapy, University Medical Center Utrecht, Netherlands; Department of Surgery, University Medical Center Utrecht, Netherlands.
Radiother Oncol. 2016 Jul;120(1):128-35. doi: 10.1016/j.radonc.2016.05.009. Epub 2016 Jun 10.
To explore and evaluate the potential value of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for the prediction of pathologic response to neoadjuvant chemoradiotherapy (nCRT) in oesophageal cancer.
Twenty-six patients underwent DCE-MRI before, during (week 2-3) and after nCRT, but before surgery (pre/per/post, respectively). Histopathologic tumour regression grade (TRG) was assessed after oesophagectomy. Tumour area-under-the-concentration time curve (AUC), time-to-peak (TTP) and slope were calculated. The ability of these DCE-parameters to distinguish good responders (GR, TRG 1-2) from poor responders (noGR, TRG⩾3), and pathologic complete responders (pCR) from no-pCR was assessed.
Twelve patients (48%) showed GR of which 8 patients (32%) pCR. Analysis of AUC change throughout treatment, AUCper-pre, was most predictive for GR, at a threshold of 22.7% resulting in a sensitivity of 92%, specificity of 77%, PPV of 79%, and a NPV of 91%. AUCpost-pre was most predictive for pCR, at a threshold of -24.6% resulting in a sensitivity of 83%, specificity of 88%, PPV of 71%, and a NPV of 93%. TTP and slope were not associated with pathologic response.
This study demonstrates that changes in AUC throughout treatment are promising for prediction of histopathologic response to nCRT for oesophageal cancer.
探讨和评估动态对比增强（DCE）磁共振成像（MRI）在预测食管癌新辅助放化疗（nCRT）病理反应中的潜在价值。
26 例患者在 nCRT 前（pre）、期间（week 2-3，per）和之后（post）进行 DCE-MRI 检查，但在手术前。在食管癌切除术后评估组织病理学肿瘤消退分级（TRG）。计算肿瘤浓度时间曲线下面积（AUC）、达峰时间（TTP）和斜率。评估这些 DCE 参数区分良好反应者（GR，TRG 1-2）和不良反应者（noGR，TRG≥3）以及病理完全缓解者（pCR）和非 pCR 的能力。
12 例患者（48%）表现为 GR，其中 8 例（32%）为 pCR。分析整个治疗过程中 AUC 的变化（AUCper-pre）对 GR 最具预测性，阈值为 22.7%时，敏感性为 92%，特异性为 77%，阳性预测值为 79%，阴性预测值为 91%。AUCpost-pre 对 pCR 最具预测性，阈值为-24.6%时，敏感性为 83%，特异性为 88%，阳性预测值为 71%，阴性预测值为 93%。TTP 和斜率与病理反应无关。
本研究表明，整个治疗过程中 AUC 的变化对预测食管癌 nCRT 的组织病理学反应具有很大的潜力。
