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European Radiology

, Volume 23, Issue 12, pp 3336–3344 | Cite as

Prognostic Aspects of DCE-MRI in Recurrent Rectal Cancer

  • M. J. GollubEmail author
  • K. Cao
  • D. H. Gultekin
  • D. Kuk
  • M. Gonen
  • M. Sohn
  • L. H. Schwartz
  • M. R. Weiser
  • L. K. Temple
  • G. M. Nash
  • J. G. Guillem
  • M. Wang
  • J. Garcia-Aguilar
  • K. Goodman
  • P. B. Paty
Gastrointestinal

Abstract

Objective

To explore whether pre-reoperative dynamic contrast-enhanced (DCE)-MRI findings correlate with clinical outcome in patients who undergo surgical treatment for recurrent rectal carcinoma.

Methods

A retrospective study of DCE-MRI in patients with recurrent rectal cancer was performed after obtaining an IRB waiver. We queried our PACS from 1998 to 2012 for examinations performed for recurrent disease. Two radiologists in consensus outlined tumour regions of interest on perfusion images. We explored the correlation between Ktrans, Kep, Ve, AUC90 and AUC180 with time to re-recurrence of tumour, overall survival and resection margin status. Univariate Cox PH models were used for survival, while univariate logistic regression was used for margin status.

Results

Among 58 patients with pre-treatment DCE-MRI who underwent resection, 36 went directly to surgery and 18 had positive margins. Ktrans (0.55, P = 0.012) and Kep (0.93, P = 0.04) were inversely correlated with positive margins. No significant correlations were noted between Ktrans, Kep, Ve, AUC90 and AUC180 and overall survival or time to re-recurrence of tumour.

Conclusion

Ktrans and Kep were significantly associated with clear resection margins; however overall survival and time to re-recurrence were not predicted. Such information might be helpful for treatment individualisation and deserves further investigation.

Key Points

• Morphological MRI features are not sufficiently predictive of complete rectal tumour resection.

• Survival and time to re-recurrence of tumour were not predicted by DCE-MRI.

• But perfusion data from dynamic enhanced MRI may provide more helpful information.

• Ktrans/Kep were shown to be significantly associated with clear resection margins.

• Functional information from DCE-MRI might be helpful for treatment individualisation.

Keywords

Rectal cancer DCE-MRI Recurrence Biomarker Resection margin 

References

  1. 1.
    Rodriguez-Bigas MA, Chang GJ, Skibber JM (2010) Multidisciplinary approach to recurrent/unresectable cancer: how to prepare for the resection. Surg Oncol Clin N Am 19:847–859PubMedCrossRefGoogle Scholar
  2. 2.
    Moore HG, Shoup M, Riedel E et al (2004) Colorectal cancer pelvic recurrences: determinants of resectability. Dis Colon Rectum 47:1599–1606PubMedCrossRefGoogle Scholar
  3. 3.
    Goh V, Padhani AR, Rasheed S (2007) Functional imaging of colorectal cancer angiogenesis. Lancet Oncol 8:245–255PubMedCrossRefGoogle Scholar
  4. 4.
    Kierkels RG, Backes WH, Janssen MHM et al (2010) Comparison between perfusion computed tomography and dynamic contrast enhanced magnetic resonance imaging in rectal cancer. Int J Radiat Oncol Biol Phys 77:400–408PubMedCrossRefGoogle Scholar
  5. 5.
    De Lussanet QG, Backes WH, Griffen AW et al (2005) Dynamic contrast-enhanced magnetic resonance imaging of radiation therapy-induced microcirculation changes in rectal cancer. Int J Radiat Oncol Biol Phys 13:1309–1315CrossRefGoogle Scholar
  6. 6.
    Atkin G, Taylor NJ, Daley FM et al (2006) Dynamic contrast enhanced magnetic resonance imaging is a poor measure of rectal cancer angiogenesis. Br J Surg 93:992–1000PubMedCrossRefGoogle Scholar
  7. 7.
    Kremser C, Trieb T, Rudisch A et al (2007) Dynamic T1 mapping predicts outcome of chemoradiation therapy in primary rectal carcinoma: sequence implementation and data analysis. J Magn Reson Imaging 26:662–671PubMedCrossRefGoogle Scholar
  8. 8.
    Sahani DV, Kalva SP, Hamberg LM et al (2005) Assessing tumor perfusion and treatment response in rectal cancer with multisection CT: initial observations. Radiology 234:785–792PubMedCrossRefGoogle Scholar
  9. 9.
    Dinter DJ, Horisberger K, Zechmann C et al (2009) Can dynamic MR imaging predict response in patients with rectal cancer undergoing Cetuximab-based neoadjuvant chemoradiation? Onkologie 32:86–93PubMedCrossRefGoogle Scholar
  10. 10.
    De Vries A, Griebel J, Kremser C et al (2000) Monitoring of tumor microcirculation during fractionated radiation therapy in patients with rectal carcinoma: preliminary results and implications for therapy. Radiology 217:385–391PubMedCrossRefGoogle Scholar
  11. 11.
    DeVries AF, Griebel J, Kremser C et al (2001) Tumor microcirculation evaluated by dynamic magnetic resonance imaging predicts therapy outcome for primary rectal carcinoma. Cancer Res 61:2513–2516PubMedGoogle Scholar
  12. 12.
    Habr-Gama A, Perez RO, Wynn G et al (2010) Complete clinical response after neoadjuvant chemoradiation therapy for distal rectal cancer: characterization of clinical and endoscopic findings for standardization. Dis Colon Rectum 53:1692–1698PubMedCrossRefGoogle Scholar
  13. 13.
    Capirci C, Valentini V, Cionini L et al (2008) Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 72:99–107PubMedCrossRefGoogle Scholar
  14. 14.
    Rödel C, Martus P, Papadoupolos T et al (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23(8688–96):17Google Scholar
  15. 15.
    Kety SS (1951) The theory and applications of the exchange of inert gas at the lungs and tissues. Pharmacol Rev 3:1–41PubMedGoogle Scholar
  16. 16.
    Weinmann HJ, Laniado M, Mützel W (1984) Pharmacokinetics of Gd DTPA/dimeglumine after intravenous injection into healthy volunteers. Physiol Chem Phys Med NMR 16:167–172PubMedGoogle Scholar
  17. 17.
    Tofts PS, Kermode AG (1991) Measurement of the blood–brain barrier permeability and leakage space using dynamic MR imaging. 1. Fundamental concepts. Magn Reson Med 17:357–367PubMedCrossRefGoogle Scholar
  18. 18.
    Jarnagin WR, Schwartz LH, Gultekin DH et al (2009) Regional chemotherapy for unresectable primary liver cancer: results of a phase II clinical trial and assessment of DCE-MRI as a biomarker of survival. Ann Oncol 20:1589–1595PubMedCrossRefGoogle Scholar
  19. 19.
    Lockhart AC, Rothenberg ML, Dupont J et al (2010) Phase I study of intravenous vascular endothelial growth factor trap, aflibercept, in patients with advanced solid tumors. J Clin Oncol 28:207–214PubMedCrossRefGoogle Scholar
  20. 20.
    Henry LR, Sigurdson E, Ross EA, Lee JS, Watson JC, Cheng JD, Freedman GM, Konski A, Hoffman JP (2007) Resection of isolated pelvic recurrences after colorectal surgery: long-term results and predictors of improved clinical outcome. Ann Surg Oncol 14:2000–2009PubMedCrossRefGoogle Scholar
  21. 21.
    Caricato M, Borzomati D, Ausania F, Valeri S, Rosignoli A, Coppola R (2006) Prognostic factors after surgery for locally recurrent rectal cancer: an overview. Eur J Surg Oncol 32:126–132PubMedCrossRefGoogle Scholar
  22. 22.
    Hawnaur JM, Zhu XP, Hutchinson CE (1998) Quantitative dynamic contrast enhanced MRI of recurrent pelvic masses in patients treated for cancer. Br J Radiol 71:1136–1142PubMedGoogle Scholar
  23. 23.
    Kanemitsu Y, Hirai T, Komor K, Kato T (2010) Prediction of residual disease or distant metastasis after resection of locally recurrent rectal cancer. Dis Colon Rectum 53:779–789PubMedCrossRefGoogle Scholar
  24. 24.
    Kusters M, Marinjen CAM, van de Velde CJH et al (2010) Pattern of local recurrence in rectal cancer: a study of the Dutch TME trial. Eur J Surg Oncol 36:470–476PubMedCrossRefGoogle Scholar
  25. 25.
    Smith JD, Nash GM, Weiser MR, Temple LK, Guillem JG, Paty PB (2012) Multivisceral resections for rectal cancer. Br J Surg 99:1137–1143PubMedCrossRefGoogle Scholar
  26. 26.
    Kusters M, Dresen RC, Martin H et al (2009) Radicality of resection and survival after multimodality treatment is influenced by subsite of locally recurrent rectal cancer. Int J Radiat Oncol Biol Phys 75:1444–1449PubMedCrossRefGoogle Scholar
  27. 27.
    Hahnloser D, Nelson H, Gunderson LL et al (2003) Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg 237:502–508PubMedGoogle Scholar
  28. 28.
    Georgiou PA, Tekkis PP, Brown G (2011) Pelvic colorectal recurrence: crucial role of radiologists in oncologic and surgical treatment options. Cancer Imaging 11:S103–S111PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • M. J. Gollub
    • 1
    Email author
  • K. Cao
    • 2
  • D. H. Gultekin
    • 1
  • D. Kuk
    • 3
  • M. Gonen
    • 3
  • M. Sohn
    • 1
  • L. H. Schwartz
    • 4
  • M. R. Weiser
    • 5
  • L. K. Temple
    • 5
  • G. M. Nash
    • 5
  • J. G. Guillem
    • 5
  • M. Wang
    • 6
  • J. Garcia-Aguilar
    • 5
  • K. Goodman
    • 7
  • P. B. Paty
    • 5
  1. 1.Department of RadiologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of RadiologyPeking University Cancer Hospital & InstituteBeijingChina
  3. 3.Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  4. 4.Department of RadiologyColumbia University Medical Center/New York Presbyterian HospitalNew YorkUSA
  5. 5.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  6. 6.Department of Colorectal SurgeryFudan University Shanghai Cancer CenterShanghaiChina
  7. 7.Department of Radiation OncologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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