Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Department of Radiology, Clinical Hospital Center Zemun, Vukova 9, Belgrade, 11080, Serbia.
Eur Radiol. 2019 Apr;29(4):1733-1742. doi: 10.1007/s00330-018-5726-2. Epub 2018 Oct 2.
To determine the appearance of rectal cancer on MRI after oxaliplatin-based chemotherapy (ICT) and make a preliminary assessment of MRI's value in predicting response to total neoadjuvant treatment (TNT).
In this IRB-approved, HIPAA-compliant, retrospective study between 1 January 2010-20 October 2014, pre- and post-ICT tumour T2 volume, relative T2 signal intensity (rT2SI), node size, signal intensity and border characteristics were assessed in 63 patients (65 tumours) by three readers. The strength of association between the reference standard of histopathological percent tumour response and tumour volume change, rT2SI and lymph node characteristics was assessed with Spearman's correlation coefficient and Wilcoxon's rank sum test. Cox regression was used to assess association between DFS and radiological measures.
Change in T2 volume was not associated with TNT response. Change in rT2SI showed correlation with TNT response for one reader only using selective regions of interest (ROIs) and borderline correlation with response using total volume ROI. There was a significant negative correlation between baseline and post-ICT node size and TNT response (r = -0.25, p = 0.05; r = -0.35, p = 0.005, readers 1 and 2, respectively). Both baseline and post-induction median node sizes were significantly smaller in complete responders (p = 0.03, 0.001; readers 1 and 2, respectively). Change in largest baseline node size and decrease in post-ICT node signal heterogeneity were associated with 100% tumour response (p = 0.04). Nodal sizes at baseline and post-ICT MRI correlated with DFS.
In patients undergoing post-ICT MRI, tumour volume did not correlate with TNT response, but decreased lymph node sizes were significantly associated with complete response to TNT as well as DFS. Relative T2SI showed borderline correlation with TNT response.
• MRI-based tumour volume after induction chemotherapy and before chemoradiotherapy did not correlate with overall tumour response at the end of all treatment. • Lymph node size after induction chemotherapy and before chemoradiotherapy was strongly associated with complete pathological response after all treatment. • Lymph node sizes at baseline and post-induction chemotherapy MRI correlated with disease-free survival.
确定奥沙利铂为基础的化疗（ICT）后直肠癌在 MRI 上的表现，并初步评估 MRI 预测全新辅助治疗（TNT）反应的价值。
在这项经机构审查委员会批准、符合 HIPAA 规定的回顾性研究中，我们评估了 2010 年 1 月至 2014 年 10 月 20 日期间的 63 例患者（65 个肿瘤）在 ICT 前后的肿瘤 T2 体积、相对 T2 信号强度（rT2SI）、淋巴结大小、信号强度和边界特征。通过三位读者使用 Spearman 相关系数和 Wilcoxon 秩和检验评估参考标准的组织病理学肿瘤反应百分比与肿瘤体积变化、rT2SI 和淋巴结特征之间的关联强度。使用 Cox 回归评估 DFS 与影像学指标之间的关系。
T2 体积的变化与 TNT 反应无关。只有一位读者使用选择性感兴趣区（ROI）时，rT2SI 的变化与 TNT 反应相关，而使用全容积 ROI 时，rT2SI 的变化与反应相关。基线和 ICT 后淋巴结大小与 TNT 反应呈显著负相关（r = -0.25，p = 0.05；r = -0.35，p = 0.005，读者 1 和 2）。完全缓解者的基线和诱导后中位淋巴结大小均显著较小（p = 0.03，0.001；读者 1 和 2）。最大基线淋巴结大小的变化和 ICT 后淋巴结信号异质性的降低与肿瘤 100%反应相关（p = 0.04）。基线和 ICT 后淋巴结大小与 DFS 相关。
在接受 ICT 后 MRI 检查的患者中，肿瘤体积与 TNT 反应无关，但淋巴结体积减小与 TNT 反应完全缓解和 DFS 显著相关。rT2SI 与 TNT 反应呈边缘相关。
ICT 后和放化疗前的基于 MRI 的肿瘤体积与所有治疗结束时的总体肿瘤反应无相关性。
ICT 后和放化疗前的淋巴结大小与所有治疗后完全病理缓解反应密切相关。
基线和诱导化疗后 MRI 的淋巴结大小与无病生存率相关。
