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Eur J Surg Oncol. 2013 Oct;39(10):1071-8. doi: 10.1016/j.ejso.2013.07.090. Epub 2013 Aug 15.

Diffusion-weighted magnetic resonance for prediction of response after neoadjuvant chemoradiation therapy for locally advanced rectal cancer: preliminary results of a monoinstitutional prospective study.

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1
Radiation Oncology Department, "G. d'Annunzio" University of Chieti, "SS. Annunziata" Hospital, Chieti, Italy. Electronic address: d.genovesi@unich.it.

Abstract

PURPOSE:

To evaluate diffusion-weighted imaging (DWI) for assessment of treatment response in locally advanced rectal cancer (LARC) 8 weeks after neoadjuvant chemoradiotherapy (CRT).

METHODS AND MATERIALS:

A total of 28 patients with LARC underwent magnetic resonance imaging (MRI) prior to and 8 weeks after CRT. Tumor volume (TV) was calculated on T2-weighted MRI scans as well as the apparent diffusion coefficient (ADC) was calculated using Echo-planar DWI-sequences. All data were correlated to surgical results and histopathologic tumor regression grade (TRG), according to Mandard's classification. Post-treatment difference ADC (%ΔADC) and TV (%ΔTV) changes at 8 weeks were compared complete response (CR; TRG1) and non-complete response tumors (non-CR; TRG2-5).

RESULTS:

The mean % ADC increase of CR group was significantly higher compared to non-CR group (77.2 ± 54.63% vs. 36.0 ± 29.44%; p = 0.05). Conversely, the mean % TV reduction did not significantly differ in CR group from non-CR group (73.7% vs. 63.77%; p = 0.21). Accordingly, the diagnostic accuracy of the mean % ADC increase to discriminate CR from non-CR group was significantly higher than that of the mean % TV reduction (0.913 vs. 0.658; p = 0.022). No correlation was found between mean % TV reduction and TRG (rho = 0.22; p = 0.3037), whereas a negative correlation between mean % ADC increase and TRG was recorded (r = -0.69; p = 0.006).

CONCLUSION:

The mean % ADC increase appears to be a reliable tool to differentiate CR from non-CR after CRT in patients with LARC.

KEYWORDS:

Chemoradiation; Diffusion-weighted imaging; MRI; Rectal cancer

PMID:
23953231
DOI:
10.1016/j.ejso.2013.07.090
[Indexed for MEDLINE]
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