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Utility of Mid-treatment DWI in Selecting Pathological Responders to Neoadjuvant Chemoradiotherapy in Locally Advanced Esophageal Cancer

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Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Purpose

Pathological complete response correlates with better clinical outcomes in locally advanced esophageal cancer (LA-EC). However, there is lack of prognostic markers to identify patients in the current setting of neoadjuvant chemoradiotherapy (NACRT) followed by surgery. This study evaluates the utility of mid-treatment diffusion-weighted imaging (DWI) in identifying pathological responders of NACRT.

Methods

Twenty-four patients with LA-EC on NACRT were prospectively recruited and underwent three MRI (baseline, mid-treatment, end-of-RT) scans. DWI-derived apparent diffusion coefficient (ADC) mean and minimum were used as a surrogate to evaluate the treatment response, and its correlation to pathological response was assessed.

Results

Mid-treatment ADC mean was significantly higher among patients with pathological response compared to non-responders (p = 0.011). ADC difference (ΔADC) between baseline and mid-treatment correlated with tumor response (p = 0.007). ADC at other time points did not correlate to pathological response.

Conclusion

In this study, mid-treatment ADC values show potential to be a surrogate for tumor response in NACRT. However, larger trials are required to establish DW-MRI as a definite biomarker for tumor response.

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Data Availability

Data is unavailable for public access.

Code Availability

Not applicable.

Abbreviations

NACRT:

Neoadjuvant chemoradiotherapy

pCR:

Pathological complete response

TRG:

Tumor regression grade

CT:

Computed tomography

FDG-PET:

Fluorodeoxyglucose–positron emission tomography

DW-MRI:

Diffusion-weighted magnetic resonance imaging

ADC:

Apparent diffusion coefficient

RT:

Radiation therapy

DWI:

Diffusion-weighted imaging

ROI:

Region of interest

SD:

Standard deviation

DFS:

Disease free survival

OS:

Overall survival

3DCRT:

3-Dimensional conformal radiation therapy

IMRT:

Intensity-modulated radiation therapy

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Funding

This study was funded by institutional research grant.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Ida B. Scudder Cancer Centre, Christian Medical College, Tamil Nadu, Vellore, 632004, India

    Neenu Oliver John, Hannah Mary T. Thomas, Balu Krishna Sasidharan, Subhashini John & Simon P. Pavamani

  2. Division of Clinical Radiology, Department of Radiodiagnosis, Christian Medical College, Tamil Nadu, Vellore, 632004, India

    Aparna Irodi

  3. Department of Surgery, Christian Medical College, Tamil Nadu, Vellore, 632004, India

    Vijay Abraham

  4. Department of Upper GI Surgery, The Queen Elizabeth Hospital, Woodville South, Adelaide, 5011, Australia

    Vijay Abraham

Authors
  1. Neenu Oliver John
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  2. Aparna Irodi
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  3. Hannah Mary T. Thomas
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  4. Vijay Abraham
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  5. Balu Krishna Sasidharan
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  6. Subhashini John
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  7. Simon P. Pavamani
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Contributions

SP, AI, VA, and NOJ contributed to the study conception and design. Data collection and preparation of first draft of manuscript was performed by NOJ. Analysis was performed by NOJ, BS, and HMT. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Simon P. Pavamani.

Ethics declarations

Ethics Approval

The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and approved by the institutional review board and ethics committee.

Consent to Participate

Informed consent was obtained from all the patients enrolled in the study.

Consent for Publication

All authors consent to the publication of the manuscript in the Journal of Gastrointestinal Cancer should the article be accepted by the Editor-in-Chief upon completion of the refereeing process.

Conflict of interest

The authors declare no competing interest.

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John, N.O., Irodi, A., Thomas, H.M.T. et al. Utility of Mid-treatment DWI in Selecting Pathological Responders to Neoadjuvant Chemoradiotherapy in Locally Advanced Esophageal Cancer. J Gastrointest Canc 54, 447–455 (2023). https://doi.org/10.1007/s12029-022-00818-y

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  • DOI: https://doi.org/10.1007/s12029-022-00818-y

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