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MR imaging perfusion and diffusion analysis to assess preoperative Short Course Radiotherapy response in locally advanced rectal cancer: Standardized Index of Shape by DCE-MRI and intravoxel incoherent motion-derived parameters by DW-MRI

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Abstract

Our aim is to assess preoperative Short Course Radiotherapy (SCR) tumor response in locally advanced rectal cancer (LARC) through Standardized Index of Shape (SIS) by DCE-MRI, apparent diffusion coefficient (ADC) and intravoxel incoherent motion-derived parameters by DW-MRI. 35 patients with LARC underwent MR scan before and after SCR followed by delayed surgery, retrospectively, were enrolled. SIS, ADC, tissue diffusion (D t), pseudodiffusion (D p), and perfusion fraction (f) were extracted by MRI for each patient before and after SCR. Tumor regression grade (TRG) was estimated. Receiver operating characteristic curve and linear classification were performed. Sixteen patients were classified as responders (TRG ≤ 2) and 19 as non-responders. Seven patients had TRG1 [pathological complete response (pCR)]. The best parameter to discriminate responders by non-responders was SIS (sensitivity 94%, specificity 84%, accuracy 89%, cutoff value = − 7.8%). SIS obtained the best diagnostic performance also to discriminate pCR (sensitivity 86%, specificity 89%, accuracy 89%, cutoff value = 68.2%). No accuracy increase was obtained combining linearly each possible parameters couple or all functional MR-derived parameters. SIS is a hopeful DCE-MRI angiogenic biomarker to assess preoperative treatment response after SCR with delayed surgery, and it permits to discriminate pCR allowing to direct surgery for tailored and conservative treatment.

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Acknowledgements

Writing/editorial support in the preparation of this manuscript was provided by Di Giovanni Manuela, University of Technology, Sydney, Australia.

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Authors and Affiliations

  1. Radiology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy

    Antonella Petrillo, Roberta Fusco, Vincenza Granata & Sergio Venanzio Setola

  2. Department of Electrical Engineering and Information Technologies, University “Federico II” of Naples, Via Claudio, Naples, Italy

    Mario Sansone

  3. Gastrointestinal Surgical Oncology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy

    Daniela Rega, Paolo Delrio, Francesco Bianco & Giovanni Maria Romano

  4. Diagnostic Pathology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy

    Fabiana Tatangelo

  5. Gastrointestinal Medical Oncology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy

    Antonio Avallone

  6. Radiotherapy Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy

    Biagio Pecori

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  1. Antonella Petrillo
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  2. Roberta Fusco
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  3. Vincenza Granata
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  5. Mario Sansone
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  7. Paolo Delrio
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  8. Francesco Bianco
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  10. Fabiana Tatangelo
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  11. Antonio Avallone
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Correspondence to Roberta Fusco.

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Ethical standards

Patients were included in the study in accordance with the approved guidelines of the local ethical committee of National Cancer Institute of Naples “Pascale Foundation.” All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Patients were included in the study in accordance with the approved guidelines of the local ethical committee of National Cancer Institute of Naples “Pascale Foundation” and gave their written informed consent.

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Petrillo, A., Fusco, R., Granata, V. et al. MR imaging perfusion and diffusion analysis to assess preoperative Short Course Radiotherapy response in locally advanced rectal cancer: Standardized Index of Shape by DCE-MRI and intravoxel incoherent motion-derived parameters by DW-MRI. Med Oncol 34, 198 (2017). https://doi.org/10.1007/s12032-017-1059-2

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