单层面平均表观扩散系数可预测非小细胞肺癌伴脑转移患者全脑放疗的肿瘤反应。

Mean apparent diffusion coefficient in a single slice may predict tumor response to whole-brain radiation therapy in non-small-cell lung cancer patients with brain metastases.

机构信息

Department of Chemoradiation Oncology, The First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, People's Republic of China.

Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, South Baixiang Street, Wenzhou, 325000, People's Republic of China.

出版信息

Eur Radiol. 2021 Aug;31(8):5565-5575. doi: 10.1007/s00330-020-07584-0. Epub 2021 Jan 16.

DOI:10.1007/s00330-020-07584-0

PMID:33452628

Abstract

OBJECTIVES

This study aimed to access the performance of apparent diffusion coefficient (ADC) as a predictor for treatment response to whole-brain radiotherapy (WBRT) in patients with brain metastases (BMs) from non-small-cell lung cancer (NSCLC).

METHODS

A retrospective analysis was conducted of 102 NSCLC patients with BMs who underwent WBRT between 2012 and 2016. Diffusion-weighted MRI were performed pre-WBRT and within 12 weeks after WBRT started. Mean single-plane ADC value of ROIs was evaluated by two radiologists blinded to results of each other. The treatment response rate, intracranial progression-free survival (PFS), and overall survival (OS) were analyzed based on the ADC value and ΔADC respectively. At last, we used COX and logistic regression to do the multivariate analysis.

RESULTS

There was good inter-observer agreement of mean ADC value pre-WBRT, post-WBRT, and ΔADC between the 2 radiologists (Pearson correlation 0.915 [pre-WBRT], 0.950 [post-WBRT], 0.937 [ΔADC], p < 0.001, for each one). High mean ADC value were related with better response rate (72.2% vs 37.5%, p = 0.001) and iPFS (7.6 vs 6.4 months, p = 0.031). High ΔADC were related with better response rate (73.6% vs 36.7%, p < 0.001). Multivariate analysis shows that histopathology, BMs number, high ADC value pre-WBRT, and high ΔADC post-WBRT were related to better treatment response of WBRT, and KPS, BMs number, and low ADC value pre-WBRT increased the risk of developing intracranial relapse.

CONCLUSIONS

The mean single-plane ADC value pre-WBRT and ΔADC post-WBRT were potential predictor for intracranial tumor response to WBRT in NSCLC patients with brain metastases.

KEY POINTS

• ADC value is a potential predictor of intracranial treatment response to WBRT in NSCLC patients with brain metastases. • Higher mean ADC value pre-WBRT and ΔADC post-WBRT of brain metastases were related to better intracranial tumor response. • Prediction of response before WBRT using ADC value can help oncologists to make better therapy plans and avoid missing opportunities for rescue therapy.

摘要

目的

本研究旨在评估表观扩散系数（ADC）在预测非小细胞肺癌（NSCLC）脑转移患者全脑放疗（WBRT）治疗反应中的作用。

方法

回顾性分析了 2012 年至 2016 年间 102 例接受 WBRT 的 NSCLC 脑转移患者。在 WBRT 前和 WBRT 开始后 12 周内进行弥散加权 MRI 检查。由 2 名放射科医生对 ROI 的平均单平面 ADC 值进行评估，彼此之间不了解对方的结果。根据 ADC 值和 ΔADC 值分别分析治疗反应率、颅内无进展生存期（PFS）和总生存期（OS）。最后，我们使用 COX 和逻辑回归进行多变量分析。

结果

两名放射科医生之间 WBRT 前、后 ADC 值和 ΔADC 值的平均 ADC 值具有良好的观察者间一致性（WBRT 前：Pearson 相关系数 0.915；WBRT 后：0.950；ΔADC：0.937，p <0.001，均为每一个）。高平均 ADC 值与更好的反应率（72.2%比 37.5%，p = 0.001）和 iPFS（7.6 比 6.4 个月，p = 0.031）相关。高 ΔADC 值与更好的反应率相关（73.6%比 36.7%，p <0.001）。多变量分析显示，组织病理学、脑转移灶数量、WBRT 前高 ADC 值和 WBRT 后高 ΔADC 值与 WBRT 治疗反应相关，KPS、脑转移灶数量和 WBRT 前低 ADC 值增加颅内复发的风险。