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A prospective feasibility study evaluating the role of multimodality imaging and liquid biopsy for response assessment in locally advanced rectal carcinoma

  • Special Section: Rectal Cancer
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Colorectal cancer is a commonly encountered disease that poses several diagnostic and therapeutic challenges. The inherent heterogeneity of tumor biology and propensity to relapse despite “curative” resection pose significant challenges with regard to response assessment. Although MR imaging already plays a key role in primary staging of patients with rectal carcinoma, its reliability in restaging after neoadjuvant therapy is debatable (Van der broek et al. in Dis Colon Rectum 60(3):274–283, 2017). Therefore, there is significant interest in developing additional methods which may improve diagnostic accuracy. This study aims to evaluate the role of multimodality imaging and liquid biopsy in therapeutic response assessment.

Methods

Seventeen patients were enrolled into the study over a span of 24 months. All underwent hybrid PET-MRI and CT-perfusion (CT-P), prior to and following neoadjuvant therapy for locally advanced rectal carcinoma. Twelve of the 17 patients also underwent liquid biopsy, which consisted of blood sampling and analysis of circulating tumor cells (CTCs) and extracellular vesicles (EVs), including cell fragments and microparticles (MPs), using the Cell Search System (Menarini Silicon Biosystems). SUV, DWI, and ADC were calculated during PET-MRI, and several parameters were evaluated during CT-perfusion, including average perfusion, blood flow (BF), blood volume (BV), mean transit time (MTT), permeability-surface area product (PS), contrast extraction efficiency (E), and K-trans (K). Changes observed pre- and post-neoadjuvant therapy in each modality were compared to tumor response at histopathology using a modified Ryan tumor regression grading system.

Results

Of the 17 patients included in the study, 14 were classified as non-responders, and 3 were classified as responders as determined by the modified Ryan Tumor Regression Grade (TRG) scoring system (Van der broek et al. in Dis Colon Rectum 60(3):274–283, 2017). When combined, blood markers and CT-P parameters (mean transit time (MTT), K-trans, and permeability-surface area product (PS)) produced the strongest models (p < 0.01). PET (SUV measurement) combined with CT-P-derived K-trans produced a marginally significant (p = 0.057) model for predicting response. MRI-derived ADC value did not provide a significant model for response prediction.

Conclusion

A model of CT-P parameters plus liquid biopsy more accurately predicts tumor response than PET-MRI, CT-P alone, or liquid biopsy alone. These results suggest that in the evaluation of treatment response, liquid biopsy could provide additional information to functional imaging modalities such as CT-P and should therefore be explored further in a trial with larger sample size.

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Author information

Authors and Affiliations

  1. Department of Medical Imaging, Schulich School of Medicine, Western University, London, ON, N6A 5W9, Canada

    Zahra Kassam

  2. St. Joseph’s Hospital, 268 Grosvenor Street, London, N6A4V2, ON, Canada

    Zahra Kassam

  3. Robarts Research Institute, Western University, 1151 Richmond St. N, London, ON, N6A5B7, Canada

    Kyle Burgers

  4. Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada

    Joanna C. Walsh

  5. Lawson Health Research Institute and Robarts Research Institute, Western University, 1151 Richmond St. N, London, ON, N6A5B7, Canada

    Ting-Yim Lee

  6. Mayo Clinic Cancer Centre, 200 1st St SW, Rochester, MN, 55905, USA

    Hon S. Leong

  7. Radiation Oncology, London Regional Cancer Program, Western University, 800 Commissioners Road East, London, ON, N6A 5W9, Canada

    Barbara Fisher

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  1. Zahra Kassam
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  2. Kyle Burgers
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  3. Joanna C. Walsh
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Correspondence to Zahra Kassam.

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Kassam, Z., Burgers, K., Walsh, J.C. et al. A prospective feasibility study evaluating the role of multimodality imaging and liquid biopsy for response assessment in locally advanced rectal carcinoma. Abdom Radiol 44, 3641–3651 (2019). https://doi.org/10.1007/s00261-019-02135-8

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  • DOI: https://doi.org/10.1007/s00261-019-02135-8

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