Diffusion-weighted magnetic resonance imaging for prediction of tumor response to neoadjuvant chemoradiotherapy using irinotecan plus S-1 for rectal cancer

Doi,Hiroshi; Beppu,Naohito; Kato,Takashi; Noda,Masashi; Yanagi,Hidenori; Tomita,Naohiro; Kamikonya,Norihiko; Hirota,Shozo

doi:10.3892/mco.2015.604

Diffusion-weighted magnetic resonance imaging for prediction of tumor response to neoadjuvant chemoradiotherapy using irinotecan plus S-1 for rectal cancer

Authors:
- Hiroshi Doi
- Naohito Beppu
- Takashi Kato
- Masashi Noda
- Hidenori Yanagi
- Naohiro Tomita
- Norihiko Kamikonya
- Shozo Hirota
View Affiliations

Affiliations: Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo 663‑8501, Japan, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663‑8501, Japan, Department of Surgery, Meiwa Hospital, Nishinomiya, Hyogo 663‑8186, Japan
Published online on: July 21, 2015 https://doi.org/10.3892/mco.2015.604
Pages: 1129-1134

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The purpose of this study was to investigate the clinical value of diffusion-weighted (DW) magnetic resonance imaging (MRI) as a predictor of tumor response in patients receiving neoadjuvant chemoradiotherapy (NA‑CRT) for rectal cancer (RC) through measurement of the apparent diffusion coefficient (ADC) value in each tumor. Neoadjuvant radiotherapy with a total dose of 45 Gy in 25 fractions was performed in all 16 patients with RC, combined with irinotecan and S‑1. MRI was performed before and after NA‑CRT. multiple factors were assessed to predict the pathological response to NA‑CRT. The pathological response rate was determined in 9 patients (56.3%). Statistical analyses indicated that the ADC value prior to NA‑CRT was significantly lower in patients with a better response to NA‑CRT (P=0.023). A cut‑off value of 0.750x10-3 mm2/sec obtained by a receiver operating characteristic curve analysis indicated a sensitivity of 77.8% and specificity of 85.7% for pathological responders to NA‑CRT. In addition, the patients with lower ADC values exhibited a greater pathological response to NA‑CRT (P=0.041). In conclusion, the ADC value of MRI of RC patients treated with NA‑CRT followed by surgery may provide valuable information to predict the response to NA-CRT.

View Figures

View References

1	National Comprehensive Cancer Network, . Rectal Cancer, Version 3. 2015.http://www.nccn.org/professionals/physician_gls/pdf/rectal.pdfJune 23–2015
2	Glimelius B, Tiret E, Cervantes A and Arnold D: ESMO Guidelines Working Group: Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 24:(Sul 6). vi81–vi88. 2013. View Article : Google Scholar : PubMed/NCBI
3	Marijnen CA and Glimelius B: The role of radiotherapy in rectal cancer. Eur J Cancer. 38:943–952. 2002. View Article : Google Scholar : PubMed/NCBI
4	Sauer R, Becker H, Hohenberger W, et al: German Rectal Cancer Study Group: Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 351:1731–1740. 2004. View Article : Google Scholar : PubMed/NCBI
5	Wagman R, Minsky BD, Cohen AM, Guillem JG and Paty PP: Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: Long term follow-up. Int J Radiat Oncol Biol Phys. 42:51–57. 1998. View Article : Google Scholar : PubMed/NCBI
6	Frykholm GJ, Isacsson U, Nygård K, et al: Preoperative radiotherapy in rectal carcinoma - aspects of acute adverse effects and radiation technique. Int J Radiat Oncol Biol Phys. 35:1039–1048. 1996. View Article : Google Scholar : PubMed/NCBI
7	Ceelen W, Fierens K, Van Nieuwenhove Y and Pattyn P: Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer: A systematic review and meta-analysis. Int J Cancer. 124:2966–2972. 2009. View Article : Google Scholar : PubMed/NCBI
8	Wada H, Nemoto K, Nomiya T, et al: A phase I trial of S-1 with concurrent radiotherapy in patients with locally recurrent rectal cancer. Int J Clin Oncol. 18:273–278. 2013. View Article : Google Scholar : PubMed/NCBI
9	Morimoto S, Shimada M, Kurita N, et al: Preoperative radiotherapy combined with S-1 for advanced lower rectal cancer: Phase I trial. Hepatogastroenterology. 59:1428–1432. 2012.PubMed/NCBI
10	Doi H, Beppu N, Odawara S, et al: Neoadjuvant short-course hyperfractionated accelerated radiotherapy (SC-HART) combined with S-1 for locally advanced rectal cancer. J Radiat Res (Tokyo). 54:1118–1124. 2013. View Article : Google Scholar
11	Beppu N, Matsubara N, Noda M, et al: The timing of surgery after preoperative short-course S-1 chemoradiotherapy with delayed surgery for T3 lower rectal cancer. Int J Colorectal Dis. 29:1459–1466. 2014. View Article : Google Scholar : PubMed/NCBI
12	Beppu N, Matsubara N, Kakuno A, et al: Feasibility of modified short-course radiotherapy combined with a chemoradiosensitizer for T3 rectal cancer. Dis Colon Rectum. 58:479–487. 2015. View Article : Google Scholar : PubMed/NCBI
13	Sato T, Ozawa H, Hatate K, et al: A Phase II trial of neoadjuvant preoperative chemoradiotherapy with S-1 plus irinotecan and radiation in patients with locally advanced rectal cancer: Clinical feasibility and response rate. Int J Radiat Oncol Biol Phys. 79:677–683. 2011. View Article : Google Scholar : PubMed/NCBI
14	Chenevert TL, Stegman LD, Taylor JM, et al: Diffusion magnetic resonance imaging: An early surrogate marker of therapeutic efficacy in brain tumors. J Natl Cancer Inst. 92:2029–2036. 2000. View Article : Google Scholar : PubMed/NCBI
15	Hamstra DA, Rehemtulla A and Ross BD: Diffusion magnetic resonance imaging: A biomarker for treatment response in oncology. J Clin Oncol. 25:4104–4109. 2007. View Article : Google Scholar : PubMed/NCBI
16	DeSouza NM, Riches SF, Vanas NJ, et al: Diffusion-weighted magnetic resonance imaging: A potential non-invasive marker of tumour aggressiveness in localized prostate cancer. Clin Radiol. 63:774–782. 2008. View Article : Google Scholar : PubMed/NCBI
17	Kim SH, Lee JM, Hong SH, et al: Locally advanced rectal cancer: Added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy. Radiology. 253:116–125. 2009. View Article : Google Scholar : PubMed/NCBI
18	Monguzzi L, Ippolito D, Bernasconi DP, et al: Locally advanced rectal cancer: Value of ADC mapping in prediction of tumor response to radiochemotherapy. Eur J Radiol. 82:234–240. 2013. View Article : Google Scholar : PubMed/NCBI
19	Lambregts DM, Maas M, Riedl RG, et al: Value of ADC measurements for nodal staging after chemoradiation in locally advanced rectal cancer - a per lesion validation study. Eur Radiol. 21:265–273. 2011. View Article : Google Scholar : PubMed/NCBI
20	Curvo-Semedo L, Lambregts DM, Maas M, et al: Rectal cancer: Assessment of complete response to preoperative combined radiation therapy with chemotherapy - conventional MR volumetry versus diffusion-weighted MR imaging. Radiology. 260:734–743. 2011. View Article : Google Scholar : PubMed/NCBI
21	Cai G, Xu Y, Zhu J, Gu WL, Zhang S, Ma XJ, Cai SJ and Zhang Z: Diffusion-weighted magnetic resonance imaging for predicting the response of rectal cancer to neoadjuvant concurrent chemoradiation. World J Gastroenterol. 19:5520–5527. 2013. View Article : Google Scholar : PubMed/NCBI
22	Dzik-Jurasz A, Domenig C, George M, et al: Diffusion MRI for prediction of response of rectal cancer to chemoradiation. Lancet. 360:307–308. 2002. View Article : Google Scholar : PubMed/NCBI
23	Barbaro B, Vitale R, Valentini V, et al: Diffusion-weighted magnetic resonance imaging in monitoring rectal cancer response to neoadjuvant chemoradiotherapy. Int J Radiat Oncol Biol Phys. 83:594–599. 2012. View Article : Google Scholar : PubMed/NCBI
24	Ha HI, Kim AY, Yu CS, Park SH and Ha HK: Locally advanced rectal cancer: Diffusion-weighted MR tumour volumetry and the apparent diffusion coefficient for evaluating complete remission after preoperative chemoradiation therapy. Eur Radiol. 23:3345–3353. 2013. View Article : Google Scholar : PubMed/NCBI
25	Lambregts DM, Vandecaveye V, Barbaro B, et al: Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: A multicenter study. Ann Surg Oncol. 18:2224–2231. 2011. View Article : Google Scholar : PubMed/NCBI
26	Kim SH, Lee JY, Lee JM, Han JK and Choi BI: Apparent diffusion coefficient for evaluating tumour response to neoadjuvant chemoradiation therapy for locally advanced rectal cancer. Eur Radiol. 21:987–995. 2011. View Article : Google Scholar : PubMed/NCBI
27	Lambrecht M, Deroose C, Roels S, et al: The use of FDG-PET/CT and diffusion-weighted magnetic resonance imaging for response prediction before, during and after preoperative chemoradiotherapy for rectal cancer. Acta Oncol. 49:956–963. 2010. View Article : Google Scholar : PubMed/NCBI
28	Lambregts DM, Beets GL, Maas M, et al: Tumour ADC measurements in rectal cancer: Effect of ROI methods on ADC values and interobserver variability. Eur Radiol. 21:2567–2574. 2011. View Article : Google Scholar : PubMed/NCBI
29	Kim JC, Lim JS, Keum KC, et al: Comparison of diffusion-weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer. J Magn Reson Imaging. 34:570–576. 2011. View Article : Google Scholar : PubMed/NCBI
30	DeVries AF, Kremser C, Hein PA, et al: Tumor microcirculation and diffusion predict therapy outcome for primary rectal carcinoma. Int J Radiat Oncol Biol Phys. 56:958–965. 2003. View Article : Google Scholar : PubMed/NCBI
31	Eisenhauer EA, Therasse P, Bogaerts J, et al: New response evaluation criteria in solid tumours: Revised RECIST guideline (v1.1). Eur J Cancer. 45:228–247. 2009. View Article : Google Scholar : PubMed/NCBI
32	Toiyama Y, Inoue Y, Saigusa S, et al: C-reactive protein as predictor of recurrence in patients with rectal cancer undergoing chemoradiotherapy followed by surgery. Anticancer Res. 33:5065–5074. 2013.PubMed/NCBI
33	Beppu N, Matsubara N, Noda M, et al: Pathologic evaluation of the response of mesorectal positive nodes to preoperative chemoradiotherapy in patients with rectal cancer. Surgery. 157:743–751. 2015. View Article : Google Scholar : PubMed/NCBI