Skip to main content

Advertisement

SpringerLink
Log in

Simple measurements on diffusion-weighted MR imaging for assessment of complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine diagnostic performance of simple measurements on diffusion-weighted MR imaging (DWI) for assessment of complete tumour response (CR) after neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC) by signal intensity (SI) and apparent diffusion coefficient (ADC) measurements.

Materials and methods

Sixty-five patients with LARC who underwent neoadjuvant CRT and subsequent surgery were included. Patients underwent pre-CRT and post-CRT 3.0 T MRI. Regions of interest of the highest brightness SI were included in the tumour volume on post-CRT DWI to calculate the SIlesion, rSI, ADClesion and rADC; diagnostic performance was compared by using the receiver operating characteristic (ROC) curves. In order to validate the accuracy and reproducibility of the current strategy, the same procedure was reproduced in 80 patients with LARC at 1.5 T MRI.

Results

Areas under the ROC curve for identification of a CR, based on SIlesion, rSI, ADClesion, and rADC, respectively, were 0.86, 0.94, 0.66, and 0.71 at 3.0 T MRI, and 0.92, 0.91, 0.64, and 0.61 at 1.5 T MRI.

Conclusion

Post-CRT DWI SIlesion and rSI provided high diagnostic performance in assessing CR and were significantly more accurate than ADClesion, and rADC at 3.0 T MRI and 1.5 T MRI.

Key Points

• Signal intensity (SI lesion ) and rSI are accurate for assessment of complete response.

• rSI seems to be superior to SI lesion at 3.0 T MRI.

• ADC or rADC measurements are not accurate for assessment of complete response.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

DWI:

Diffusion-weighted MR imaging

SI:

Signal intensity

ADC:

Apparent diffusion coefficient

CR:

Complete response

LARC:

Locally advanced rectal cancer

References

  1. Maas M et al (2010) Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 11(9):835–844

    Article  PubMed  Google Scholar 

  2. Tulchinsky H et al (2008) An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol 15(10):2661–2667

    Article  PubMed  Google Scholar 

  3. de Campos-Lobato LF et al (2011) Neoadjuvant therapy for rectal cancer: the impact of longer interval between chemoradiation and surgery. J Gastrointest Surg 15(3):444–450

    Article  PubMed  Google Scholar 

  4. Wolthuis AM et al (2012) Impact of interval between neoadjuvant chemoradiotherapy and TME for locally advanced rectal cancer on pathologic response and oncologic outcome. Ann Surg Oncol 19(9):2833–2841

    Article  PubMed  Google Scholar 

  5. Rodel C et al (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23(34):8688–8696

    Article  PubMed  Google Scholar 

  6. Valentini V et al (2002) Does downstaging predict improved outcome after preoperative chemoradiation for extraperitoneal locally advanced rectal cancer? A long-term analysis of 165 patients. Int J Radiat Oncol Biol Phys 53(3):664–674

    Article  PubMed  Google Scholar 

  7. Govindarajan A et al (2006) Population-based assessment of the surgical management of locally advanced colorectal cancer. J Natl Cancer Inst 98(20):1474–1481

    Article  PubMed  Google Scholar 

  8. Guillem JG et al (2005) Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 241(5):829–836, discussion 836-8

    Article  PubMed  PubMed Central  Google Scholar 

  9. Marijnen CA et al (2002) Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 20(3):817–825

    Article  PubMed  CAS  Google Scholar 

  10. Larsen SG et al (2008) Prognostic factors after preoperative irradiation and surgery for locally advanced rectal cancer. Eur J Surg Oncol 34(4):410–417

    Article  PubMed  CAS  Google Scholar 

  11. Habr-Gama A et al (2006) Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg 10(10):1319–1328, discussion 1328-9

    Article  PubMed  Google Scholar 

  12. O'Neill BD et al (2007) Non-operative treatment after neoadjuvant chemoradiotherapy for rectal cancer. Lancet Oncol 8(7):625–633

    Article  PubMed  Google Scholar 

  13. Borschitz T et al (2008) Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer. Ann Surg Oncol 15(3):712–720

    Article  PubMed  Google Scholar 

  14. Dalton RS et al (2012) A single-centre experience of chemoradiotherapy for rectal cancer: is there potential for nonoperative management? Color Dis 14(5):567–571

    Article  CAS  Google Scholar 

  15. Maas M et al (2011) Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 29(35):4633–4640

    Article  PubMed  Google Scholar 

  16. Barbaro B et al (2010) Restaging locally advanced rectal cancer with MR imaging after chemoradiation therapy. Radiographics 30(3):699–716

    Article  PubMed  Google Scholar 

  17. Chen CC et al (2005) How accurate is magnetic resonance imaging in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy? Dis Colon Rectum 48(4):722–728

    Article  PubMed  Google Scholar 

  18. Maretto I et al (2007) The potential of restaging in the prediction of pathologic response after preoperative chemoradiotherapy for rectal cancer. Ann Surg Oncol 14(2):455–461

    Article  PubMed  Google Scholar 

  19. Kim SH et al (2009) Accuracy of MRI for predicting the circumferential resection margin, mesorectal fascia invasion, and tumor response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer. J Magn Reson Imaging 29(5):1093–1101

    Article  PubMed  Google Scholar 

  20. Dresen RC et al (2009) Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy. Part I. Are we able to predict tumor confined to the rectal wall? Radiology 252(1):71–80

    Article  PubMed  Google Scholar 

  21. Curvo-Semedo L et al (2011) Rectal cancer: assessment of complete response to preoperative combined radiation therapy with chemotherapy–conventional MR volumetry versus diffusion-weighted MR imaging. Radiology 260(3):734–743

    Article  PubMed  Google Scholar 

  22. Kim SH et al (2009) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy. Radiology 253(1):116–125

    Article  PubMed  Google Scholar 

  23. Lambregts DM et al (2011) Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol 18(8):2224–2231

    Article  PubMed  PubMed Central  Google Scholar 

  24. Vandecaveye V et al (2007) Detection of head and neck squamous cell carcinoma with diffusion weighted MRI after (chemo)radiotherapy: correlation between radiologic and histopathologic findings. Int J Radiat Oncol Biol Phys 67(4):960–971

    Article  PubMed  Google Scholar 

  25. Mandard AM et al (1994) Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 73(11):2680–2686

    Article  PubMed  CAS  Google Scholar 

  26. Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70(4):213–220

    Article  PubMed  CAS  Google Scholar 

  27. DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44(3):837–845

    Article  PubMed  CAS  Google Scholar 

  28. Engin G et al (2012) Can diffusion-weighted MRI determine complete responders after neoadjuvant chemoradiation for locally advanced rectal cancer? Diagn Interv Radiol 18(6):574–581

    PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Pei-Rong Ding. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by Nature Science Foundation of China [No. 81101591]; Natural Science Foundation of Guangdong Province, China [No.S2011040005278; No.9151008901000157]; Science and Technology Planning Project of Guangdong Province, China [No.2010B060900043]; and Medical Scientific Research Foundation of Guangdong Province, China (WSTJJ20101107440520197505093916). One (Pei-Rong Ding) of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was not required for this study because it is a retrospective analysis. Approval from the institutional animal care committee was not required because the study is not on animals. The study subjects or cohorts have not been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

Pei-Qiang Cai, Yao-Pan Wu and Xin An contributed equally to this work.

Author information

Authors and Affiliations

  1. State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Peoples Republic of China

    Pei-Qiang Cai, Yao-Pan Wu, Xin An, Xue Qiu, Ling-Heng Kong, Guo-Chen Liu, Chuan-Miao Xie, Zhi-Zhong Pan, Pei-Hong Wu & Pei-Rong Ding

  2. Department of Medical Imaging & Interventional Radiology, Guangzhou, Peoples Republic of China

    Pei-Qiang Cai, Yao-Pan Wu, Chuan-Miao Xie & Pei-Hong Wu

  3. Department of Medical Oncology, Guangzhou, Peoples Republic of China

    Xin An

  4. Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, 510060, Guangzhou, Peoples Republic of China

    Xue Qiu, Ling-Heng Kong, Guo-Chen Liu, Zhi-Zhong Pan & Pei-Rong Ding

Authors
  1. Pei-Qiang Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yao-Pan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xin An
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xue Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ling-Heng Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guo-Chen Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chuan-Miao Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zhi-Zhong Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Pei-Hong Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Pei-Rong Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Pei-Hong Wu or Pei-Rong Ding.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cai, PQ., Wu, YP., An, X. et al. Simple measurements on diffusion-weighted MR imaging for assessment of complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Eur Radiol 24, 2962–2970 (2014). https://doi.org/10.1007/s00330-014-3251-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3251-5

Keywords

Search

Navigation