Joye Ines, Debucquoy Annelies, Deroose Christophe M, Vandecaveye Vincent, Cutsem Eric Van, Wolthuis Albert, D'Hoore André, Sagaert Xavier, Zhou Mu, Gevaert Olivier, Haustermans Karin
KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; University Hospitals Leuven, Radiation Oncology, B-3000 Leuven, Belgium.
KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium.
Radiother Oncol. 2017 Jul;124(1):104-109. doi: 10.1016/j.radonc.2017.06.013. Epub 2017 Jun 21.
To explore the integration of imaging and molecular data for response prediction to chemoradiotherapy (CRT) for rectal cancer.
Eighty-five rectal cancer patients underwent preoperative CRT. F-FDG PET/CT and diffusion-weighted imaging (DWI) were acquired before (TP1) and during CRT (TP2) and prior to surgery (TP3). Inflammatory cytokines and gene expression were analysed. Tumour response was defined as ypT0-1N0. Multivariate models were built combining the obtained parameters. Final models were calculated on the data combination with the highest AUC.
Twenty-two patients (26%) achieved ypT0-1N0 response. F-FDG PET/CT had worse predictive performance than DWI and T2-volumetry (AUC 0.61±0.04, 0.72±0.03, and 0.72±0.02, respectively). Combining all imaging parameters increased the AUC to 0.81±0.03. Adding cytokines or gene expression did not improve the AUC (AUC of 0.72±0.06 and 0.79±0.04 respectively). Final models combining F-FDG PET/CT, DWI, and T2-weighted volumetry at all TPs and using only TP1 and TP3, allowed ypT0-1N0 prediction with a 75% sensitivity, 94% specificity and PPV of 80%.
Combining F-FDG PET/CT, DWI, and T2-weighted MRI volumetry obtained before CRT and prior to surgery may help physicians in selecting rectal cancer patients for organ-preservation.
探讨整合影像和分子数据以预测直肠癌放化疗（CRT）疗效。
85例直肠癌患者接受术前CRT。在CRT前（TP1）、CRT期间（TP2）及手术前（TP3）进行¹⁸F-FDG PET/CT和扩散加权成像（DWI）检查。分析炎性细胞因子和基因表达。肿瘤反应定义为ypT0-1N0。结合所获参数建立多变量模型。基于AUC最高的数据组合计算最终模型。
22例患者（26%）达到ypT0-1N0反应。¹⁸F-FDG PET/CT的预测性能不如DWI和T2容积测量（AUC分别为0.61±0.04、0.72±0.03和0.72±0.02）。综合所有影像参数可将AUC提高至0.81±0.03。加入细胞因子或基因表达未改善AUC（分别为0.72±0.06和0.79±0.04）。最终模型结合所有TP时的¹⁸F-FDG PET/CT、DWI和T2加权容积测量，且仅使用TP1和TP3，预测ypT0-1N0的灵敏度为75%，特异度为94%，阳性预测值为80%。
整合CRT前及手术前获得的¹⁸F-FDG PET/CT、DWI和T2加权MRI容积测量结果，可能有助于医生选择适合保留器官的直肠癌患者。
