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Curcean S, Curcean A, Martin D, Fekete Z, Irimie A, Muntean AS, Caraiani C. The Role of Predictive and Prognostic MRI-Based Biomarkers in the Era of Total Neoadjuvant Treatment in Rectal Cancer. Cancers (Basel) 2024; 16:3111. [PMID: 39272969 PMCID: PMC11394290 DOI: 10.3390/cancers16173111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 09/02/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
The role of magnetic resonance imaging (MRI) in rectal cancer management has significantly increased over the last decade, in line with more personalized treatment approaches. Total neoadjuvant treatment (TNT) plays a pivotal role in the shift from traditional surgical approach to non-surgical approaches such as 'watch-and-wait'. MRI plays a central role in this evolving landscape, providing essential morphological and functional data that support clinical decision-making. Key MRI-based biomarkers, including circumferential resection margin (CRM), extramural venous invasion (EMVI), tumour deposits, diffusion-weighted imaging (DWI), and MRI tumour regression grade (mrTRG), have proven valuable for staging, response assessment, and patient prognosis. Functional imaging techniques, such as dynamic contrast-enhanced MRI (DCE-MRI), alongside emerging biomarkers derived from radiomics and artificial intelligence (AI) have the potential to transform rectal cancer management offering data that enhance T and N staging, histopathological characterization, prediction of treatment response, recurrence detection, and identification of genomic features. This review outlines validated morphological and functional MRI-derived biomarkers with both prognostic and predictive significance, while also exploring the potential of radiomics and artificial intelligence in rectal cancer management. Furthermore, we discuss the role of rectal MRI in the 'watch-and-wait' approach, highlighting important practical aspects in selecting patients for non-surgical management.
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Affiliation(s)
- Sebastian Curcean
- Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Department of Radiation Oncology, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Andra Curcean
- Department of Imaging, Affidea Center, 15c Ciresilor Street, 400487 Cluj-Napoca, Romania
| | - Daniela Martin
- Department of Radiation Oncology, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Zsolt Fekete
- Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Department of Radiation Oncology, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Alexandru Irimie
- Department of Oncological Surgery and Gynecological Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
- Department of Oncological Surgery, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Alina-Simona Muntean
- Department of Radiation Oncology, 'Prof. Dr. Ion Chiricuta' Oncology Institute, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Cosmin Caraiani
- Department of Medical Imaging and Nuclear Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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Ramireddy JK, Sathya A, Sasidharan BK, Varghese AJ, Sathyamurthy A, John NO, Chandramohan A, Singh A, Joel A, Mittal R, Masih D, Varghese K, Rebekah G, Ram TS, Thomas HMT. Can Pretreatment MRI and Planning CT Radiomics Improve Prediction of Complete Pathological Response in Locally Advanced Rectal Cancer Following Neoadjuvant Treatment? J Gastrointest Cancer 2024; 55:1199-1211. [PMID: 38856797 DOI: 10.1007/s12029-024-01073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE(S) The treatment response to neoadjuvant chemoradiation (nCRT) differs largely in individuals treated for rectal cancer. In this study, we investigated the role of radiomics to predict the pathological response in locally advanced rectal cancers at different treatment time points: (1) before the start of any treatment using baseline T2-weighted MRI (T2W-MR) and (2) at the start of radiation treatment using planning CT. METHODS Patients on nCRT followed by surgery between June 2017 to December 2019 were included in the study. Histopathological tumour response grading (TRG) was used for classification, and gross tumour volume was defined by the radiation oncologists. Following resampling, 100 and 103 pyradiomic features were extracted from T2W-MR and planning CT images, respectively. Synthetic minority oversampling technique (SMOTE) was used to address class imbalance. Four machine learning classifiers built clinical, radiomic, and merged models. Model performances were evaluated on a held-out test dataset following 3-fold cross-validation using area under the receiver operator characteristic curves (AUC) with bootstrap 95% confidence intervals. RESULTS One hundred and fifty patients were included; 58/150 with TRG 1 were classified as complete responders, and rest were incomplete responders (IR). Clinical models performed better (AUC = 0.68) compared to radiomics models (AUC = 0.62). Overall, the clinical + T2W-MR model showed best performance (AUC = 0.72) in predicting the pathological response prior to therapy. Clinical + Planning CT-merged models could only achieve the highest AUC of 0.66. CONCLUSION Merging clinical and baseline T2W-MR radiomics enhances predicting pathological response in rectal cancer. Validation in larger cohorts is warranted, especially for watch and wait strategies.
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Affiliation(s)
- Jeba Karunya Ramireddy
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - A Sathya
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Balu Krishna Sasidharan
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Amal Joseph Varghese
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Arvind Sathyamurthy
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Neenu Oliver John
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | - Anjana Joel
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | - Rohin Mittal
- Department of General Surgery, Christian Medical College, Vellore, India
| | - Dipti Masih
- Department of Pathology, Christian Medical College, Vellore, India
| | - Kripa Varghese
- Department of Pathology, Christian Medical College, Vellore, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Thomas Samuel Ram
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Hannah Mary T Thomas
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India.
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Nougaret S, Lambregts DMJ, Beets GL, Beets-Tan RGH, Blomqvist L, Burling D, Denost Q, Gambacorta MA, Gui B, Klopp A, Lakhman Y, Maturen KE, Manfredi R, Petkovska I, Russo L, Shinagare AB, Stephenson JA, Tolan D, Venkatesan AM, Quyn AJ, Forstner R. Imaging in pelvic exenteration-a multidisciplinary practice guide from the ESGAR-SAR-ESUR-PelvEx collaborative group. Eur Radiol 2024:10.1007/s00330-024-10940-z. [PMID: 39181949 DOI: 10.1007/s00330-024-10940-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/04/2024] [Accepted: 06/16/2024] [Indexed: 08/27/2024]
Abstract
Pelvic exenteration (PE) is a radical surgical approach designed for the curative treatment of advanced pelvic malignancies, requiring en-bloc resection of multiple pelvic organs. While the procedure is radical, it has shown promise in enhancing long-term survival and is now comparable in surgical mortality to elective resections for primary pelvic cancers. Imaging plays a crucial role in preoperative planning, with MRI, CT, and PET/CT being pivotal in assessing the extent of cancer and formulating a surgical roadmap. This paper presents clinical practice guidelines for imaging in the context of PE, developed jointly by ESGAR, SAR, ESUR, and the PelvEx Collaborative. These guidelines aim to standardize imaging protocols and reporting to improve the preoperative assessment and facilitate decision-making in the multidisciplinary treatment of pelvic cancers. Our recommendations underscore the importance of a multidisciplinary approach and the need for clear and precise imaging reports to optimize patient care. CLINICAL RELEVANCE STATEMENT: Our recommendations underscore the importance of a multidisciplinary approach and the need for clear and precise imaging reports to optimize patient care. KEY POINTS: MRI is mandatory for local staging in pelvic exenteration. Structured reporting (using the template provided in this guide) is recommended. Multidisciplinary review of imaging is critical for surgical planning.
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Affiliation(s)
- Stephanie Nougaret
- Department of Radiology, PINKCC lab, U1194, Montpellier Cancer Center, Montpellier, France.
| | - Doenja M J Lambregts
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden & Department of Radiation Physics/Nuclear Medicine, Karolinska University Hospital, Solna, Sweden
| | - David Burling
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare NHS, London, UK
| | - Quentin Denost
- Bordeaux ColoRectal institute, Clinique Tivoli, Bordeaux, France
| | - Maria A Gambacorta
- Department of Radiation Oncology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | - Benedetta Gui
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ann Klopp
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kate E Maturen
- Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Riccardo Manfredi
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luca Russo
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Atul B Shinagare
- Department of Radiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - James A Stephenson
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds, UK
| | - Aradhana M Venkatesan
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Aaron J Quyn
- John Goligher Colorectal Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Nahas CSR, Nahas SC, Marques CFS, Ribeiro Junior U, Bustamante-Lopez L, Cotti GC, Imperiale AR, Pinto RA, Cecconello I. Prognostic factors for local recurrence in patients with rectal cancer submitted to neoadjuvant chemoradiotherapy and total mesorectal excision. Clinics (Sao Paulo) 2024; 79:100464. [PMID: 39126876 PMCID: PMC11369368 DOI: 10.1016/j.clinsp.2024.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/13/2024] [Accepted: 07/14/2024] [Indexed: 08/12/2024] Open
Abstract
Prognostic factors for local recurrence in patients with rectal cancer submitted to neoadjuvant chemoradiotherapy and total mesorectal excision. BACKGROUND The standard curative treatment for locally advanced rectal cancer of the middle and lower thirds is long-course chemoradiotherapy followed by total mesorectal excision. PURPOSE To evaluate the prognostic factors associated with local recurrence in patients with rectal cancer submitted to neoadjuvant chemoradiotherapy and total mesorectal excision. METHODS Retrospective study including patients with rectal cancer T3-4N0M0 or T (any)N + M0 located within 10 cm from the anal border, or patients with T2N0M0 located within 5 cm, treated by long course chemoradiotherapy followed by total mesorectal excision with curative intent. Clinical, demographic, radiologic, surgical, and anatomopathological data were collected. Local recurrence was estimated using the Kaplan-Meier function, and risk was estimated according to each characteristic using univariate and multivariate analyses. RESULTS 270 patients were included, 57.8% male and mean age 61.7 (30‒88) years. At initial staging, 6.7% of patients were stage I, 21.5% stage II, and 71.8% stage III. Open surgery was performed in 65.2%, with sphincter preservation in 78.1%. Mortality within 30 postoperative days was 0.7%. After 49.4 (0.5‒86.1) months of median follow-up, overall and local recurrences were 26.3% and 5.9%. On multivariate analyses, local recurrence was associated with involvement of the mesorectal fascia on restaging MRI (HR = 9.11, p = 0.001) and with pathologic involvement of radial surgical margin (HR = 8.19, p < 0.001). CONCLUSION Local recurrence of rectal cancer treated with long-course chemoradiation and total mesorectal excision is low and is associated with pathologic involvement of the radial surgical margin and can be predicted on restaging MRI.
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Hamada M, Kurokawa H, Kobayashi T, Uemura Y. MRI navigation surgery, including lateral pelvic lymph node dissection following chemoradiotherapy, improves local control and functional preservation of the middle to low rectal cancer. Surg Oncol 2024; 55:102093. [PMID: 38885561 DOI: 10.1016/j.suronc.2024.102093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/02/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE The purpose of this study is to examine the appropriateness of MRI navigation surgery following chemoradiotherapy (CRT), including lateral pelvic lymph node dissection (LLND) for middle to low rectal cancer. METHODS Forty-three consecutive patients with cT2-4b rectal cancer within 10 cm from the anal verge who underwent laparoscopic radical surgery following CRT (45-50.4Gy + S1 80mg/m2) from January 2014 and February 2020 were analyzed. We decided on the operative procedure, including LLND, based on the restaging MRI. We examined the rates of 3-year postoperative local pelvic recurrence, permanent stoma, and recurrent risk factors (Group S). We also compared the results to that of the fourteen patients who enrolled in the previous phase II trial and underwent laparoscopic radical surgery following CRT (40Gy + S-1 (80mg/m2) or UFT (300 mg/m2)) for consecutive cT2-4b rectal cancer below the peritoneal reflection. The operative procedure was decided at the initial MRI diagnosis, and the LLND was not performed (Group P). RESULTS We had no local pelvic recurrence in Group S, and the three-year local pelvic recurrence-free survival was significantly better in Group S than P (100 % in S 85.1 % in P, p < 0.05). The permanent stoma rate was not different between the Groups, irrespective of the significantly high rate of cCRM(+) in Group S. The Cox proportional hazards model for significant factors of recurrence on the univariate analysis revealed that ycM and ycEMVI scores were independently significant (p < 0.001). CONCLUSION MRI navigation surgery, including LLND for rectal cancer following chemoradiotherapy, improves local control and functional preservation.
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Affiliation(s)
- Madoka Hamada
- Department of Gastrointestinal Surgery, Kansai Medical University Hospital, Hirakata, Osaka, Japan.
| | - Hiroaki Kurokawa
- Department of Radiology, Kansai Medical University Hospital, Hirakata, Osaka, Japan
| | - Toshinori Kobayashi
- Department of Gastrointestinal Surgery, Kansai Medical University Hospital, Hirakata, Osaka, Japan
| | - Yoshiko Uemura
- Department of Pathology, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
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Shen Y, Gong X, He Y, Meng W, Zeng H, Wei M, Qiu M, Wang Z. MRI Tumor Regression Response to Neoadjuvant Chemotherapy Alone without Radiation for Rectal Adenocarcinoma. Radiology 2024; 312:e232908. [PMID: 39189908 DOI: 10.1148/radiol.232908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Background Neoadjuvant chemotherapy (NCT) is gaining acceptance for the management of locally advanced rectal cancer (LARC) in patients without negative prognostic factors. However, the value of MRI in evaluating tumor response after NCT remains unclear. Purpose To investigate the accuracy of MRI in assessing pathologic complete response in participants with LARC who underwent surgery after NCT without radiation. Materials and Methods A retrospective imaging substudy was conducted within two consecutive prospective clinical trials: the expanded phase II trial (from December 2017 to May 2021) and the COPEC trial (comparison of tumor response to two or four cycles of neoadjuvant chemotherapy alone, ongoing from August 2021). All included participants received four cycles of capecitabine combined with oxaliplatin (or CAPOX) before surgery. Three radiologists who were blinded to the clinicopathologic data independently evaluated the tumor response using five methods, namely, MR tumor regression grade (MR-TRG) alone, diffusion-weighted imaging (DWI) alone, DWI-modified MR-TRG (DWImodMR-TRG), MRI complete response, and radiologic neoadjuvant response score. With pathologic assessment serving as the reference standard, the positive and negative predictive values, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were determined to evaluate the accuracy and performance of these models. The AUCs of the models were compared using the DeLong test. Results A total of 224 participants were included, comprising 119 from the expanded phase II trial (median age, 61 years [IQR, 53-67]; 89 male) and 105 from the COPEC trial (median age, 59 years [IQR, 53-67]; 65 male). MR-TRG, DWI, DWImodMR-TRG, MRI complete response, and the radiologic neoadjuvant response score were associated with pathologic complete response. DWImodMR-TRG achieved the highest AUC of 0.90 (95% CI: 0.85, 0.95), with a specificity of 89% (162 of 182) and a negative predictive value of 93% (162 of 174). Conclusion MRI-based models were accurate for determining pathologic complete response in participants with LARC following NCT. DWI improved the predictive performance of MRI-based assessment. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Santiago and Shur in this issue.
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Affiliation(s)
- Yu Shen
- From the Colorectal Cancer Center, Department of General Surgery (Y.S., W.M., M.W., M.Q., Z.W.), and Department of Radiology (X.G., H.Z.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang St, Chengdu 86610000, China; and Department of Epidemiology and Medical Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China (Y.H.)
| | - Xiaoling Gong
- From the Colorectal Cancer Center, Department of General Surgery (Y.S., W.M., M.W., M.Q., Z.W.), and Department of Radiology (X.G., H.Z.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang St, Chengdu 86610000, China; and Department of Epidemiology and Medical Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China (Y.H.)
| | - Yazhou He
- From the Colorectal Cancer Center, Department of General Surgery (Y.S., W.M., M.W., M.Q., Z.W.), and Department of Radiology (X.G., H.Z.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang St, Chengdu 86610000, China; and Department of Epidemiology and Medical Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China (Y.H.)
| | - Wenjian Meng
- From the Colorectal Cancer Center, Department of General Surgery (Y.S., W.M., M.W., M.Q., Z.W.), and Department of Radiology (X.G., H.Z.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang St, Chengdu 86610000, China; and Department of Epidemiology and Medical Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China (Y.H.)
| | - Hanjiang Zeng
- From the Colorectal Cancer Center, Department of General Surgery (Y.S., W.M., M.W., M.Q., Z.W.), and Department of Radiology (X.G., H.Z.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang St, Chengdu 86610000, China; and Department of Epidemiology and Medical Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China (Y.H.)
| | - Mingtian Wei
- From the Colorectal Cancer Center, Department of General Surgery (Y.S., W.M., M.W., M.Q., Z.W.), and Department of Radiology (X.G., H.Z.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang St, Chengdu 86610000, China; and Department of Epidemiology and Medical Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China (Y.H.)
| | - Meng Qiu
- From the Colorectal Cancer Center, Department of General Surgery (Y.S., W.M., M.W., M.Q., Z.W.), and Department of Radiology (X.G., H.Z.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang St, Chengdu 86610000, China; and Department of Epidemiology and Medical Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China (Y.H.)
| | - Ziqiang Wang
- From the Colorectal Cancer Center, Department of General Surgery (Y.S., W.M., M.W., M.Q., Z.W.), and Department of Radiology (X.G., H.Z.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang St, Chengdu 86610000, China; and Department of Epidemiology and Medical Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China (Y.H.)
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Kim HY, Cho SH, Jang JK, Kim B, Lee CM, Lim JS, Moon SK, Oh SN, Seo N, Park SH. Interpretation of Complete Tumor Response on MRI Following Chemoradiotherapy of Rectal Cancer: Inter-Reader Agreement and Associated Factors in Multi-Center Clinical Practice. Korean J Radiol 2024; 25:351-362. [PMID: 38528693 PMCID: PMC10973736 DOI: 10.3348/kjr.2023.1213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To measure inter-reader agreement and identify associated factors in interpreting complete response (CR) on magnetic resonance imaging (MRI) following chemoradiotherapy (CRT) for rectal cancer. MATERIALS AND METHODS This retrospective study involved 10 readers from seven hospitals with experience of 80-10210 cases, and 149 patients who underwent surgery after CRT for rectal cancer. Using MRI-based tumor regression grading (mrTRG) and methods employed in daily practice, the readers independently assessed mrTRG, CR on T2-weighted images (T2WI) denoted as mrCRT2W, and CR on all images including diffusion-weighted images (DWI) denoted as mrCRoverall. The readers described their interpretation patterns and how they utilized DWI. Inter-reader agreement was measured using multi-rater kappa, and associated factors were analyzed using multivariable regression. Correlation between sensitivity and specificity of each reader was analyzed using Spearman coefficient. RESULTS The mrCRT2W and mrCRoverall rates varied widely among the readers, ranging 18.8%-40.3% and 18.1%-34.9%, respectively. Nine readers used DWI as a supplement sequence, which modified interpretations on T2WI in 2.7% of cases (36/1341 [149 patients × 9 readers]) and mostly (33/36) changed mrCRT2W to non-mrCRoverall. The kappa values for mrTRG, mrCRT2W, and mrCRoverall were 0.56 (95% confidence interval: 0.49, 0.62), 0.55 (0.52, 0.57), and 0.54 (0.51, 0.57), respectively. No use of rectal gel, larger initial tumor size, and higher initial cT stage exhibited significant association with a higher inter-reader agreement for assessing mrCRoverall (P ≤ 0.042). Strong negative correlations were observed between the sensitivity and specificity of individual readers (coefficient, -0.718 to -0.963; P ≤ 0.019). CONCLUSION Inter-reader agreement was moderate for assessing CR on post-CRT MRI. Readers' varying standards on MRI interpretation (i.e., threshold effect), along with the use of rectal gel, initial tumor size, and initial cT stage, were significant factors associated with inter-reader agreement.
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Affiliation(s)
- Hae Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Hyun Cho
- Department of Radiology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jong Keon Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul-Min Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Joon Seok Lim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Kyoung Moon
- Department of Radiology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Soon Nam Oh
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nieun Seo
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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John AO, Singh A, Bala D, Joel A, Georgy JT, Jesudasan MR, Mittal R, Ram TS, Reddy JR, Murthy A, Chandramohan A, Eapen A, Masih D, Ramnath N, Dobrosotskaya I, Yadav B, Chacko RT. Total Neoadjuvant Therapy (TNT) with Full Dose Concurrent Chemotherapy in Locally Advanced Rectal Adenocarcinoma Including Signet Ring and Mucinous Cancers. J Gastrointest Cancer 2024; 55:307-317. [PMID: 37479897 DOI: 10.1007/s12029-023-00941-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE Total neoadjuvant therapy (TNT) with pre-operative chemotherapy and chemoradiotherapy results in improved survival and is becoming the new standard of care in locally advanced rectal cancer (LARC). We describe our experience with TNT consisting of induction chemotherapy followed by chemoradiotherapy using full dose 5FU without oxaliplatin. METHODS Adults with biopsy-proven, newly diagnosed LARC with high-risk characteristics on pelvic MRI (T4a or T4b, extramural vascular invasion, N2, mesorectal fascia involvement, enlargement/tumor deposits on lateral lymph nodes) were included. The TNT protocol comprised of six biweekly courses of modified FOLFOX6 followed by pelvic RT with four concurrent cycles of biweekly 5-FU 2600 mg/m2 + LV 200 mg/m2 without oxaliplatin to complete 20 uninterrupted weeks of full dose 5FU. Surgery was planned 11-13 weeks after completing chemoradiotherapy. RESULTS Eighty-four LARC patients, including 26% with signet-ring cell carcinoma, with high-risk MRI characteristics were treated with the TNT protocol with a 96% completion rate. Significant (> grade 3) toxicities included neutropenia (23.8%), diarrhea (14.2%) anemia (10.7%), and two deaths. The median DFS at 2 years was 22.5 months with better survival noted for those who underwent surgery or had cCR (with NOM) compared to those who did not undergo surgery (due to progression, inadequate regression, or patient preference despite residual disease) -mDFS 27.7 months versus 11.4 months, p = < 0.0001 and mOS 29.2 months versus 15 months p = < 0.0001. CONCLUSION The hybrid TNT regimen was administered without significant dose delays or interruptions. Toxicity was manageable but with two treatment-related deaths. Ability to undergo surgery after TNT predicted for improved DFS and OS.
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Affiliation(s)
- Ajoy Oommen John
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil, Nadu-632004, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil, Nadu-632004, India.
| | - Divya Bala
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil, Nadu-632004, India
| | - Anjana Joel
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil, Nadu-632004, India
| | - Josh Thomas Georgy
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil, Nadu-632004, India
| | | | - Rohin Mittal
- Department of Colorectal Surgery, Christian Medical College, Vellore, India
| | - Thomas Samuel Ram
- Department of Radiation Oncology, Christian Medical College, Vellore, India
| | | | - Arvind Murthy
- Department of Radiation Oncology, Christian Medical College, Vellore, India
| | | | - Anu Eapen
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | - Dipti Masih
- Department of Pathology, Christian Medical College, Vellore, India
| | - Nithya Ramnath
- Division of Medical Oncology, Ann Arbor Healthcare Systems, University of Michigan, Veterans Administration, Ann Arbor, USA
| | - Irina Dobrosotskaya
- Division of Medical Oncology, Ann Arbor Healthcare Systems, University of Michigan, Veterans Administration, Ann Arbor, USA
| | - Bijesh Yadav
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Raju Titus Chacko
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil, Nadu-632004, India
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9
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Lee SF, Yip PL, Wo B, Wong NSM, Vellayappan BA, Mamon HJ, Lee FAS. Neoadjuvant short-course radiotherapy or chemoradiation plus consolidative chemotherapy followed by radical operation for locally advanced rectal cancer. Front Oncol 2024; 13:1284569. [PMID: 38322287 PMCID: PMC10844885 DOI: 10.3389/fonc.2023.1284569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/21/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Limited evidence compares short-course radiotherapy (SCRT) and long-course chemoradiotherapy (LCCRT), both of which are followed by consolidative chemotherapy before radical rectal surgery. We conducted a retrospective cohort study to assess treatment response, survival outcomes, and toxicity in patients with locally advanced rectal cancer. Materials and methods Patients (cT3-4 and/or N+) treated with SCRT or LCCRT, consolidative chemotherapy, or total mesorectal excision between 2013 and 2021 were identified. the cause-specific cumulative incidence of disease-related treatment failure, locoregional recurrence, distant metastases, and overall survival were evaluated using flexible parametric competing risk analysis and Kaplan-Meier methods, adjusted for treatment regimens and clinicopathological factors. A pathological complete response (pCR), tumor downstaging, and toxicity have been reported. Results Among the 144 patients, 115 (80%) underwent curative rectal surgery. The LCCRT and SCRT groups achieved pCR in 10 (18%) and seven (12%) patients, respectively (odds ratio, 1.68; 95% confidence interval [CI], 0.59-4.78). The adjusted cause-specific hazard ratio for disease-related treatment failure with LCCRT versus SCRT was 0.26 (95% CI, 0.08-0.87). Three-year cumulative probability of disease-related treatment failure was 10.0% and 25.6% for LCCRT and SCRT, respectively. No significant differences in T-downstaging, N-downstaging, significant pathologic downstaging (ypT0-2N0), locoregional failure, distant metastasis, or overall survival were found. Late rectal toxicity occurred in 10 (15%) LCCRT and two (3%) SCRT patients, respectively. Conclusion LCCRT with consolidative chemotherapy demonstrated improved disease-related treatment failure compared with SCRT, despite higher late rectal toxicity. Further research is needed to assess the long-term oncologic outcomes and toxicity.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Pui Lam Yip
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Barry Wo
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Natalie Sean-Man Wong
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Harvey J. Mamon
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Boston, MA, United States
| | - Francis Ann Shing Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, Hong Kong SAR, China
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10
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Langenfeld SJ, Davis BR, Vogel JD, Davids JS, Temple LKF, Cologne KG, Hendren S, Hunt S, Garcia Aguilar J, Feingold DL, Lightner AL, Paquette IM. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer 2023 Supplement. Dis Colon Rectum 2024; 67:18-31. [PMID: 37647138 DOI: 10.1097/dcr.0000000000003057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Sean J Langenfeld
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Bradley R Davis
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Jon D Vogel
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Larissa K F Temple
- Colorectal Surgery Division, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Kyle G Cologne
- Department of Surgery, Division of Colorectal Surgery, University of Southern California, Los Angeles, California
| | - Samantha Hendren
- Division of Colon and Rectal Surgery, Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
| | - Steven Hunt
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Julio Garcia Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel L Feingold
- Department of Surgery, Rutgers University, New Brunswick, New Jersey
| | - Amy L Lightner
- Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ian M Paquette
- Department of Surgery, Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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11
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Patra A, Lakhani A, Augustine A, Mohapatra P, Eapen A, Singh A, Masih D, Ram TS, Jesudason MR, Mittal R, Chandramohan A. Predicting Positive Radial Margin on Restaging MRI of Patients with Low Rectal Cancer: Can We Do Better? Indian J Radiol Imaging 2024; 34:85-94. [PMID: 38106864 PMCID: PMC10723970 DOI: 10.1055/s-0043-1774300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Objective The aim of this study was to characterize the tissue involving the margin and study if this information will affect margin prediction on restaging magnetic resonance imaging (MRI) in low rectal adenocarcinoma (LRC) patients treated with neoadjuvant long-course chemoradiotherapy (LCCRT). Methods In this retrospective study of nonmetastatic LRC (distal margin <5 cm from the anal verge) treated with LCCRT followed by surgery, a radiologist blinded to outcome reread the restaging MRI and documented if the radial margin was involved by tumor, fibrosis, or mucin reaction using T2 high-resolution (HR) and diffusion-weighted imaging (DWI). The diagnostic performance of tumor-involving margin on restaging MRI was assessed using surgical histopathology as a reference. Interobserver agreement between three independent radiologists was assessed in a subset. Results We included 133 patients (80 males and 53 females) with a mean (range) age of 44.7 (21-86) years and 82% of them had well or moderately differentiated adenocarcinoma. Baseline MRI showed T3 ( n = 58) or T4 ( n = 60) disease in 89% of the patients. The pathological margin was positive in 21% ( n = 28) cases. In restaging MRI, the circumferential resection margin (CRM) ≤1 mm in 75.1% ( n = 100) cases and MRI predicted tumor, fibrosis, and mucin reaction at the margin in 60, 34, and 6%, respectively, and histopathology showed tumor cells in 33, 14.7, and 16.6% of them, respectively. LRC with tumor-involving margin and bad response (MR tumor regression grade [mr-TRG] 3-5) on restaging MRI had fourfold increased risk of positive pathological circumferential resection margin (pCRM). There was moderate and fair inter-reader agreement for the tissue type involving the CRM ( κ = 0.471) and mr-TRG ( κ = 0.266), p < 0.05. The use of both distance criteria and tumor-involving margins improved the diagnostic accuracy for margin prediction from 39 to 66% on restaging MRI. Conclusions Margin prediction on restaging MRI can be improved by characterizing the tissue type involving the margin in low rectal cancer patients. The inter-reader agreement was moderate for determining the tissue type.
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Affiliation(s)
- Anurima Patra
- Department of Radiology, Christian Medical College, Vellore, India
| | - Aisha Lakhani
- Department of Radiology, Christian Medical College, Vellore, India
| | - Antony Augustine
- Department of Radiology, Christian Medical College, Vellore, India
| | | | - Anu Eapen
- Department of Radiology, Christian Medical College, Vellore, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | - Dipti Masih
- Department of Pathology, Christian Medical College, Vellore, India
| | - Thomas S. Ram
- Department of Radiation Oncology, Christian Medical College, Vellore, India
| | - Mark R. Jesudason
- Department of Colorectal Surgery, Christian Medical College, Vellore, India
| | - Rohin Mittal
- Department of Colorectal Surgery, Christian Medical College, Vellore, India
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12
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Horvat N, Miranda J, Kinochita F, de Carvalho TL, Torri GB, Lopes TJP, Nomura CH. Restaging magnetic resonance imaging of the rectum after neoadjuvant therapy: a practical guide. Radiol Bras 2024; 57:e20240004. [PMID: 39050261 PMCID: PMC11268099 DOI: 10.1590/0100-3984.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/26/2024] [Accepted: 04/18/2024] [Indexed: 07/27/2024] Open
Abstract
Colorectal cancer is the third most common cancer and the second leading cause of cancer-related death. Rectal cancer accounts for approximately one-third of new colorectal cancer cases, with adenocarcinoma as the predominant subtype. Despite an overall decline in colorectal cancer incidence and mortality, due to advancements in screening, early diagnosis, and treatment options, there is a concerning increase in incidence rates among young patients. Recent significant advances in managing locally advanced rectal cancer, such as the establishment of different surgical approaches, neoadjuvant treatment using different protocols for high-risk cases, and the adoption of organ-preservation strategies, have increased the importance of the role played by radiologists in locoregional assessment on magnetic resonance imaging at baseline, at restaging, and during active surveillance of patients with rectal cancer. In this article, we review the role of restaging rectal magnetic resonance imaging after neoadjuvant therapy, providing radiologists with a practical, step-by-step guide for assessing treatment response.
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Affiliation(s)
- Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY, USA
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
São Paulo, SP, Brazil
| | - João Miranda
- Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY, USA
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
São Paulo, SP, Brazil
| | - Fernanda Kinochita
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
São Paulo, SP, Brazil
| | - Tiago Lins de Carvalho
- Department of Radiology, Brigham and Women’s Hospital, Harvard
Medical School, Boston, MA, USA
| | - Giovanni Brondani Torri
- Department of Radiology and Diagnostic Imaging, Universidade
Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | | | - Cesar Higa Nomura
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
São Paulo, SP, Brazil
- Department of Radiology, Hospital Sírio-Libanês,
São Paulo, SP, Brazil
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13
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Chen H, Li X, Pan X, Qiang Y, Qi XS. Feature selection based on unsupervised clustering evaluation for predicting neoadjuvant chemoradiation response for patients with locally advanced rectal cancer. Phys Med Biol 2023; 68:235012. [PMID: 37972413 DOI: 10.1088/1361-6560/ad0d46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/16/2023] [Indexed: 11/19/2023]
Abstract
Accurate response prediction allows for personalized cancer treatment of locally advanced rectal cancer (LARC) with neoadjuvant chemoradiation. In this work, we designed a convolutional neural network (CNN) feature extractor with switchable 3D and 2D convolutional kernels to extract deep learning features for response prediction. Compared with radiomics features, convolutional kernels may adaptively extract local or global image features from multi-modal MR sequences without the need of feature predefinition. We then developed an unsupervised clustering based evaluation method to improve the feature selection operation in the feature space formed by the combination of CNN features and radiomics features. While normal process of feature selection generally includes the operations of classifier training and classification execution, the process needs to be repeated many times after new feature combinations were found to evaluate the model performance, which incurs a significant time cost. To address this issue, we proposed a cost effective process to use a constructed unsupervised clustering analysis indicator to replace the classifier training process by indirectly evaluating the quality of new found feature combinations in feature selection process. We evaluated the proposed method using 43 LARC patients underwent neoadjuvant chemoradiation. Our prediction model achieved accuracy, area-under-curve (AUC), sensitivity and specificity of 0.852, 0.871, 0.868, and 0.735 respectively. Compared with traditional radiomics methods, the prediction models (AUC = 0.846) based on deep learning-based feature sets are significantly better than traditional radiomics methods (AUC = 0.714). The experiments also showed following findings: (1) the features with higher predictive power are mainly from high-order abstract features extracted by CNN on ADC images and T2 images; (2) both ADC_Radiomics and ADC_CNN features are more advantageous for predicting treatment responses than the radiomics and CNN features extracted from T2 images; (3) 3D CNN features are more effective than 2D CNN features in the treatment response prediction. The proposed unsupervised clustering indicator is feasible with low computational cost, which facilitates the discovery of valuable solutions by highlighting the correlation and complementarity between different types of features.
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Affiliation(s)
- Hao Chen
- School of Computer Science and Technology, Xi'an University of Posts and Telecommunications, xi'an 710121, People's Republic of China
- Shaanxi Key Laboratory of Network Data Analysis and Intelligent Processing, Xi'an University of Posts and Telecommunications, Xi'an, 710121, People's Republic of China
| | - Xing Li
- School of Computer Science and Technology, Xi'an University of Posts and Telecommunications, xi'an 710121, People's Republic of China
| | - Xiaoying Pan
- School of Computer Science and Technology, Xi'an University of Posts and Telecommunications, xi'an 710121, People's Republic of China
- Shaanxi Key Laboratory of Network Data Analysis and Intelligent Processing, Xi'an University of Posts and Telecommunications, Xi'an, 710121, People's Republic of China
| | - Yongqian Qiang
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, People's Republic of China
| | - X Sharon Qi
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, 90095, United States of America
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14
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Jankovic A, Kovac JD, Dakovic M, Mitrovic M, Saponjski D, Milicevic O, Djuric-Stefanovic A, Barisic G. MRI Tumor Regression Grade Combined with T2-Weighted Volumetry May Predict Histopathological Response in Locally Advanced Rectal Cancer following Neoadjuvant Chemoradiotherapy-A New Scoring System Proposal. Diagnostics (Basel) 2023; 13:3226. [PMID: 37892047 PMCID: PMC10606015 DOI: 10.3390/diagnostics13203226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Modern studies focus on the discovery of innovative methods to improve the value of post-treatment magnetic resonance imaging (MRI) in the prediction of pathological responses to preoperative neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC). The aim of this study was to assess the potential benefits of combining magnetic resonance tumor regression grade (mrTRG) with T2-weighted volumetry in the prediction of pathological responses to nCRT in LARC. This was a cohort study conducted on patients with histopathologically confirmed LARC in a period from 2020 to 2022. After histopathological verification, all patients underwent initial MRI studies, while the follow-up MRI was performed after nCRT. Tumor characteristics, MRI estimated tumor regression grade (mrTRG) and tumor volumetry were evaluated both initially and at follow-up. All patients were classified into responders and non-responders according to pathological tumor regression grade (pTRG) and mrTRG. A total of 71 patients, mostly male (66.2%) were included in the study. The median tumor volume reduction rate was significantly higher in nCRT-responders compared to non-responders (79.9% vs. 63.3%) (p = 0.003). Based on ROC analysis, optimal cut-off value for tumor volume reduction rate was determined with an area under the curve (AUC) value of 0.724 (p = 0.003). Using the tumor volume reduction rate ≥75% with the addition of response to nCRT according to mrTRG, a new scoring system for prediction of pTRG to preoperative nCRT in LARC was developed. Diagnostic performance of prediction score was tested and the sensitivity, PPV, specificity, and NPV were 81.8%, 56.3%, 71.4%, and 89.7%, respectively. The combination of mrTRG and T2-weighted volumetry increases the MRI-based prediction of pTRG to preoperative nCRT in LARC. The proposed scoring system could aid in distinguishing responders to nCRT, as these patients could benefit from organ-preserving treatment and a "watch and wait" strategy.
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Affiliation(s)
- Aleksandra Jankovic
- Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (J.D.K.); (M.M.); (D.S.); (A.D.-S.)
- Faculty of Medicine, University of Belgrade, Dr. Subotica No. 8, 11000 Belgrade, Serbia; (O.M.); (G.B.)
| | - Jelena Djokic Kovac
- Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (J.D.K.); (M.M.); (D.S.); (A.D.-S.)
- Faculty of Medicine, University of Belgrade, Dr. Subotica No. 8, 11000 Belgrade, Serbia; (O.M.); (G.B.)
| | - Marko Dakovic
- Faculty of Physical Chemistry, University of Belgrade, 11000 Belgrade, Serbia;
| | - Milica Mitrovic
- Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (J.D.K.); (M.M.); (D.S.); (A.D.-S.)
- Faculty of Medicine, University of Belgrade, Dr. Subotica No. 8, 11000 Belgrade, Serbia; (O.M.); (G.B.)
| | - Dusan Saponjski
- Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (J.D.K.); (M.M.); (D.S.); (A.D.-S.)
- Faculty of Medicine, University of Belgrade, Dr. Subotica No. 8, 11000 Belgrade, Serbia; (O.M.); (G.B.)
| | - Ognjen Milicevic
- Faculty of Medicine, University of Belgrade, Dr. Subotica No. 8, 11000 Belgrade, Serbia; (O.M.); (G.B.)
| | - Aleksandra Djuric-Stefanovic
- Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (J.D.K.); (M.M.); (D.S.); (A.D.-S.)
- Faculty of Medicine, University of Belgrade, Dr. Subotica No. 8, 11000 Belgrade, Serbia; (O.M.); (G.B.)
| | - Goran Barisic
- Faculty of Medicine, University of Belgrade, Dr. Subotica No. 8, 11000 Belgrade, Serbia; (O.M.); (G.B.)
- Clinic for Digestive Surgery—First Surgical Clinic, University Clinical Center of Serbia, Koste Todorovica No. 6, 11000 Belgrade, Serbia
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15
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Hall WA, Li J, You YN, Gollub MJ, Grajo JR, Rosen M, dePrisco G, Yothers G, Dorth JA, Rahma OE, Russell MM, Gross HM, Jacobs SA, Faller BA, George S, Al baghdadi T, Haddock MG, Valicenti R, Hong TS, George TJ. Prospective Correlation of Magnetic Resonance Tumor Regression Grade With Pathologic Outcomes in Total Neoadjuvant Therapy for Rectal Adenocarcinoma. J Clin Oncol 2023; 41:4643-4651. [PMID: 37478389 PMCID: PMC10564288 DOI: 10.1200/jco.22.02525] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/01/2023] [Accepted: 05/09/2023] [Indexed: 07/23/2023] Open
Abstract
PURPOSE Total neoadjuvant therapy (TNT) is a newly established standard treatment for rectal adenocarcinoma. Current methods to communicate magnitudes of regression during TNT are subjective and imprecise. Magnetic resonance tumor regression grade (MR-TRG) is an existing, but rarely used, regression grading system. Prospective validation of MR-TRG correlation with pathologic response in patients undergoing TNT is lacking. Utility of adding diffusion-weighted imaging to MR-TRG is also unknown. METHODS We conducted a multi-institutional prospective imaging substudy within NRG-GI002 (ClinicalTrials.gov identifier: NCT02921256) examining the ability of MR-based imaging to predict pathologic complete response (pCR) and correlate MR-TRG with the pathologic neoadjuvant response score (NAR). Serial MRIs were needed from 110 patients. Three radiologists independently, then collectively, reviewed each MRI for complete response (mriCR), which was tested for positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity with pCR. MR-TRG was examined for association with the pathologic NAR score. All team members were blinded to pathologic data. RESULTS A total of 121 patients from 71 institutions met criteria: 28% were female (n = 34), 84% White (n = 101), and median age was 55 (24-78 years). Kappa scores for T- and N-stage after TNT were 0.38 and 0.88, reflecting fair agreement and near-perfect agreement, respectively. Calling an mriCR resulted in a kappa score of 0.82 after chemotherapy and 0.56 after TNT reflected near-perfect agreement and moderate agreement, respectively. MR-TRG scores were associated with pCR (P < .01) and NAR (P < .0001), PPV for pCR was 40% (95% CI, 26 to 53), and NPV was 84% (95% CI, 75 to 94). CONCLUSION MRI alone is a poor tool to distinguish pCR in rectal adenocarcinoma undergoing TNT. However, the MR-TRG score presents a now validated method, correlated with pathologic NAR, which can objectively measure regression magnitude during TNT.
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Affiliation(s)
- William A. Hall
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI
| | - Jiahe Li
- The University of Pittsburgh, Pittsburgh, PA
| | - Y. Nancy You
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Joseph R. Grajo
- University of Florida, Gainesville, FL
- University of Florida Health Cancer Center, Gainesville, FL
| | - Mark Rosen
- Imaging and Radiation Oncology Core (IROC) Group, and the University of Pennsylvania, Philadelphia, PA
| | - Greg dePrisco
- Baylor Scott and White Health Baylor University Medical Center at Dallas, Dallas, TX
| | | | - Jennifer A. Dorth
- University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | | | - Marcia M. Russell
- Department of Surgery, David Geffen School of Medicine at UCLA, and VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | | | - Bryan A. Faller
- Missouri Baptist Medical Center/Heartland NCORP, St Louis, MO
| | - Sagila George
- Stephenson Cancer Center University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Tareq Al baghdadi
- Trinity Health Ann Arbor Hospital, Michigan Cancer Research Consortium (NCORP), Ann Arbor, MI
| | | | - Richard Valicenti
- University of California Davis Comprehensive Cancer Center/UC Davis School of Med/UC Davis Health, Sacramento, CA
| | - Theodore S. Hong
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Thomas J. George
- University of Florida, Gainesville, FL
- University of Florida Health Cancer Center, Gainesville, FL
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16
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Nougaret S, Rousset P, Lambregts DMJ, Maas M, Gormly K, Lucidarme O, Brunelle S, Milot L, Arrivé L, Salut C, Pilleul F, Hordonneau C, Baudin G, Soyer P, Brun V, Laurent V, Savoye-Collet C, Petkovska I, Gerard JP, Cotte E, Rouanet P, Catalano O, Denost Q, Tan RB, Frulio N, Hoeffel C. MRI restaging of rectal cancer: The RAC (Response-Anal canal-CRM) analysis joint consensus guidelines of the GRERCAR and GRECCAR groups. Diagn Interv Imaging 2023; 104:311-322. [PMID: 36949002 DOI: 10.1016/j.diii.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/09/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To develop guidelines by international experts to standardize data acquisition, image interpretation, and reporting in rectal cancer restaging with magnetic resonance imaging (MRI). MATERIALS AND METHODS Evidence-based data and experts' opinions were combined using the RAND-UCLA Appropriateness Method to attain consensus guidelines. Experts provided recommendations for reporting template and protocol for data acquisition were collected; responses were analysed and classified as "RECOMMENDED" versus "NOT RECOMMENDED" (if ≥ 80% consensus among experts) or uncertain (if < 80% consensus among experts). RESULTS Consensus regarding patient preparation, MRI sequences, staging and reporting was attained using the RAND-UCLA Appropriateness Method. A consensus was reached for each reporting template item among the experts. Tailored MRI protocol and standardized report were proposed. CONCLUSION These consensus recommendations should be used as a guide for rectal cancer restaging with MRI.
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Affiliation(s)
- Stephanie Nougaret
- Department of Radiology IRCM, Montpellier Cancer Research Institute, 34000 Montpellier, France; INSERM, U1194, University of Montpellier, 34295, Montpellier, France.
| | - Pascal Rousset
- Department of Radiology, CHU Lyon-Sud, EMR 3738 CICLY, Université Claude-Bernard Lyon 1, 69495 Pierre-Benite, France
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Kirsten Gormly
- Jones Radiology, Kurralta Park, 5037, Australia; University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - Oliver Lucidarme
- Department of Radiology, Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, Sorbonne Université, 75013 Paris, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Laurent Milot
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Lionel Arrivé
- Department of Radiology, Hôpital Saint-Antoine, AP-HP, 75012 Paris, France; Sorbonne Université, 75013 Paris, France
| | - Celine Salut
- CHU de Bordeaux, Department of Radiology, Université de Bordeaux, 33000 Bordeaux, France
| | - Franck Pilleul
- Department of Radiology, Centre Léon Bérard, Lyon, France Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621, Lyon, France
| | | | - Guillaume Baudin
- Department of Radiology, Centre Antoine Lacassagne, 06100 Nice, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Vanessa Brun
- Department of Radiology, CHU Hôpital Pontchaillou, 35000 Rennes, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jean-Pierre Gerard
- Department of Radiotherapy, Centre Antoine Lacassagne, 06000 Nice, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hospices Civils de Lyon, Lyon Sud University Hospital, 69310 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Philippe Rouanet
- Department of Surgery, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France
| | - Onofrio Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Quentin Denost
- Department of Digestive Surgery, Hôpital Haut-Lévèque, Université de Bordeaux, 33000 Bordeaux, France
| | - Regina Beets Tan
- Department of Radiology, The Netherlands Cancer Institute, 1006 BE, Amsterdam, the Netherlands
| | - Nora Frulio
- CHU de Bordeaux, Department of Radiology, Université de Bordeaux, 33000 Bordeaux, France
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré & CRESTIC, URCA, 51092 Reims, France
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Horvat N, El Homsi M, Miranda J, Mazaheri Y, Gollub MJ, Paroder V. Rectal MRI Interpretation After Neoadjuvant Therapy. J Magn Reson Imaging 2023; 57:353-369. [PMID: 36073323 PMCID: PMC9851947 DOI: 10.1002/jmri.28426] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 02/01/2023] Open
Abstract
In recent years, several key advances in the management of locally advanced rectal cancer have been made, including the implementation of total mesorectal excision as the standard surgical approach; use of neoadjuvant chemoradiotherapy in selected patients with a high risk of local recurrence, and finally, adoption of organ preservation strategies, through either local excision or nonoperative management in selected patients with clinical complete response following neoadjuvant chemoradiotherapy. This review aims to shed light on the role of rectal MRI in the assessment of treatment response after neoadjuvant therapy, which is especially important given the growing feasibility of nonoperative management. First, an overview of current neoadjuvant therapies and response assessment based on digital rectal examination, endoscopy, and MRI will be provided. Second, the use of a high-quality restaging rectal MRI protocol will be presented. Third, a step-by-step approach to assessing treatment response on restaging rectal MRI following neoadjuvant treatment will be outlined, acknowledging challenges faced by radiologists during MRI interpretation. Finally, research related to response assessment will be discussed. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joao Miranda
- Department of Radiology, University of Sao Paulo, Sao Paulo, Brazil
| | - Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J. Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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18
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Chandramohan A, Patra A, Eapen A, John R, Simon B, Masih D, Jesudason MR, Mittal R. MDT stage migration in MRI of significant rectal polyps and early rectal cancers. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2760-2769. [PMID: 35674786 DOI: 10.1007/s00261-022-03570-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To audit the diagnostic accuracy of MRI for staging early and polyp rectal cancers with the purpose of identifying scope for service improvement. METHODS This is an IRB approved retrospective study of patients who underwent staging MRI for rectal growths followed by upfront TME type surgery or local excision without neoadjuvant therapy between 2018 and 2021. MR-T-stage was compared with surgical histopathology. The degree of stage migration in the multidisciplinary team meetings (MDT) was assessed and training needs were identified. RESULTS 53 patients (32 males) with a mean (SD) age of 56.7 (13.6) years with 54 rectal lesions and underwent trans-anal excision (n = 18) or upfront surgery (n = 35) were included. Pathology showed < / = pT1 stage in n = 18 and > / = pT2 stage in n = 36. Radio-pathological concordance rate was 38.9% and 74.1%, respectively, for primary reports and MDT reads, respectively, and during MDT, the rates improved by 44.5% and 30.5% for < / = pT1 and > / = pT2 stages ,respectively. The overall T-stage migration rate at MDT was 44.6% (25/54) and the migration rate was higher (61.1%) for < / = pT1 stage lesions. The best sensitivity, specificity, PPV, NPV and accuracy of MRI for T-staging was 83.3%, 91.6%, 83.3%, 91.6% and 88.8%, respectively. CONCLUSION Radio-pathological correlation for MRI T-stage is excellent for MDT reads by experienced radiologists. MDT reads lead to significant down-staging of T-stage in polyp and early rectal cancer thereby improving radio-path correlation.
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Affiliation(s)
| | - Anurima Patra
- Department of Radiology, Christian Medical College, Vellore, 632004, India
| | - Anu Eapen
- Department of Radiology, Christian Medical College, Vellore, 632004, India
| | - Reetu John
- Department of Radiology, Christian Medical College, Vellore, 632004, India
| | - Betty Simon
- Department of Radiology, Christian Medical College, Vellore, 632004, India
| | - Dipti Masih
- Department of Pathology, Christian Medical College, Vellore, 632004, India
| | | | - Rohin Mittal
- Department of Colorectal Surgery, Christian Medical College, Vellore, 632004, India
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19
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Xiao Y, Li J, Zhong J, Chen D, Shi J, Jin H. Diagnostic Performance of Diffusion-Weighted Imaging for Colorectal Cancer Detection: An Updated Systematic Review and Meta-Analysis. Front Oncol 2022; 12:656095. [PMID: 35814462 PMCID: PMC9260027 DOI: 10.3389/fonc.2022.656095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Magnetic resonance imaging (MRI), which uses strong magnetic fields and radio waves (radiofrequency energy) to make images, is one of the best imaging methods for soft tissues and can clearly display unique anatomical structures. Diffusion-weighted imaging (DWI) has been developed for identifying various malignant tumors. Aim To investigate the diagnostic value of DWI-MRI quantitative analysis in colorectal cancer detection. Methods The PubMed, Cochrane Library, and Embase databases were searched from inception to May 29, 2020. Studies published in English that used DWI-MRI for diagnosing colorectal cancer were included. Case reports, letters, reviews, and studies conducted in non-humans or in-vitro experiments were excluded. The pooled diagnostic odds ratio (DOR) and hierarchical summary receiver operating characteristic (HSROC) curves were computed for DWI, and the area under the curve (AUC) and associated standard error (SE) and 95% confidence intervals (CIs) were also used. Results In total, 15 studies with 1,655 participants were finally included in this meta-analysis. There were four prospective studies and 11 retrospective studies. Eight studies focused on rectal cancer, six on colorectal cancer, and one on colonic cancer. The performance of DWI-MRI for diagnosing colorectal cancer was accurate, with pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 0.88 (95% CI = 0.85–0.91), 0.92 (95% CI = 0.91–0.94), 30.36 (95% CI = 11.05–83.43), and 0.44 (95% CI = 0.30–0.64), respectively. The DOR and HSROC curves were 121 (95% CI = 56–261) and 0.92 (λ: 4.79), respectively. Conclusion DWI showed high diagnostic accuracy for colorectal cancer detection. Further studies with large sample sizes and prospective design are needed to confirm these results.
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Affiliation(s)
- Yunfei Xiao
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Li
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiamei Zhong
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dequan Chen
- Department of Radiology, People’s Hospital of Chongqing Hechuan, Chongqing, China
| | - Jianbo Shi
- Department of Radiology, The Seventh People’s Hospital of Chongqing, Chongqing, China
| | - Hongrui Jin
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Hongrui Jin,
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20
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Voogt EL, Nordkamp S, van Zoggel DM, Daniëls-Gooszen AW, Nieuwenhuijzen GA, Bloemen JG, Creemers GJ, Cnossen JS, van Lijnschoten G, Burger JW, Rutten HJ, Nederend J. MRI tumour regression grade in locally recurrent rectal cancer. BJS Open 2022; 6:zrac033. [PMID: 35552373 PMCID: PMC9097816 DOI: 10.1093/bjsopen/zrac033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/03/2022] [Accepted: 02/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study aimed to investigate the agreement between magnetic resonance tumour regression grade (mrTRG) and pathological regression grade (pTRG) in patients with locally recurrent rectal cancer (LRRC). Also, the reproducibility of mrTRG was investigated. METHODS All patients with LRRC who underwent a resection between 2010 and 2018 after treatment with induction chemotherapy and neoadjuvant chemo(re)irradiation in whom a restaging MRI was available were retrospectively selected. All MRI scans were reassessed by two independent radiologists using the mrTRG, and the pTRG was reassessed by an independent pathologist. The interobserver agreement between the radiologists as well as between the radiologists and the pathologist was assessed with the weighted kappa test. A subanalysis was performed to evaluate the influence of the interval between imaging and surgery. RESULTS Out of 313 patients with LRRC treated during the study interval, 124 patients were selected. Interobserver agreement between the radiologists was fair (k = 0.28) using a two-tier grading system (mrTRG 1-2 versus mrTRG 3-5). For the lead radiologist, agreement with pTRG was moderate (k = 0.52; 95 per cent c.i. 0.36 to 0.68) when comparing good (mrTRG 1-2 and Mandard 1-2) and intermediate/poor responders (mrTRG 3-5 and Mandard 3-5), and the agreement was fair between the other abdominal radiologist and pTRG (k = 0.39; 95 per cent c.i. 0.22 to 0.56). A shorter interval (less than 7 weeks) between MRI and surgery resulted in an improved agreement (k = 0.69), compared with an interval more than 7 weeks (k = 0.340). For the lead radiologist, the positive predictive value for predicting good responders was 95 per cent (95 per cent c.i. 71 per cent to 99 per cent), whereas this was 56 per cent (95 per cent c.i. 44 per cent to 66 per cent) for the other radiologist. CONCLUSION This study showed that, in LRRC, the reproducibility of mrTRG among radiologists is limited and the agreement of mrTRG with pTRG is low. However, a shorter interval between MRI and surgery seems to improve this agreement and, if assessed by a dedicated radiologist, mrTRG could predict good responders.
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Affiliation(s)
- Eva L.K. Voogt
- Department of Surgery, Catherina Hospital, Eindhoven, the Netherlands
| | - Stefi Nordkamp
- Department of Surgery, Catherina Hospital, Eindhoven, the Netherlands
| | | | | | | | | | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Jeltsje S. Cnossen
- Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands
| | - Gesina van Lijnschoten
- Department of Pathology, PAMM Laboratory for Pathology and Medical Microbiology, Eindhoven, the Netherlands
| | | | - Harm J.T. Rutten
- Department of Surgery, Catherina Hospital, Eindhoven, the Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
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21
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Chandramohan A, Mittal R, Dsouza R, Yezzaji H, Eapen A, Simon B, John R, Singh A, Ram TS, Jesudason MR, Masih D, Karuppusami R. Prognostic significance of MR identified EMVI, tumour deposits, mesorectal nodes and pelvic side wall disease in locally advanced rectal cancer. Colorectal Dis 2022; 24:428-438. [PMID: 34954863 DOI: 10.1111/codi.16032] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/03/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023]
Abstract
AIM To study the prognostic significance of MRI identified tumour deposits (TD), extramural vascular invasion (EMVI), lymph node metastases (LNM) and pelvic sidewall (PSW) disease in rectal cancer. METHODS This IRB approved study was conducted on patients with stage IIA-IIIC rectal adenocarcinoma treated with neoadjuvant long course chemoradiotherapy (LCCRT) and total mesorectal excision (TME) type of surgery between 2012-2018. A radiologist blinded to outcome reviewed staging and restaging magnetic resonance imaging (MRI) for TD, EMVI, LNM and PSW. The agreement between four radiologists was studied and we obtained outcome data from a prospectively maintained database. The prognostic significance of imaging findings was assessed. RESULTS A total of 297 (186 males) patients with a mean age of 47.3 (SD14.4) years were included in the study. The majority had T3 (n = 206) or T4 (n = 59) stage disease. The mean duration of follow-up was 49.3 ± 25 months (6.6-101 months). 5-year overall (OS) and disease-free survival (DFS) was 84% and 74%, respectively. Staging and restaging MRI had EMVI in 49.5% and 31.3%; TD in 47.5% and 31.6%; LNM in 61.1% and 38.1% and PSW in 11.4% and 6.1%. OS was adversely affected by EMVI, TD and PSW with the adjusted HR (aHR) of 3.32, 3.31, 3.27 for staging MRI and 2.99, 3.1, 2.81 for restaging MRI, respectively, p < 0.05. DFS was affected by EMVI (aHR = 1.85, 2.33) and TD (aHR = 1.83, 2.19), p < 0.05. Persistence of these findings after LCCRT led to worst outcome. Intra- and interobserver agreement for EMVI, TD and LN was 0.789, 0.734, 0.406 and 0.449, 0.354, 0.376, respectively, p < 0.001. CONCLUSIONS MRI identified that TD, EMVI and PSW disease are independent poor prognostic indicators in rectal cancer patients. Interobserver agreement for these findings was moderate to fair.
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Affiliation(s)
| | - Rohin Mittal
- Department of Colorectal Surgery, Christian Medical College, Vellore, India
| | - Romina Dsouza
- Department of Radiology, Christian Medical College, Vellore, India
| | - Harish Yezzaji
- Department of Colorectal Surgery, Christian Medical College, Vellore, India
| | - Anu Eapen
- Department of Radiology, Christian Medical College, Vellore, India
| | - Betty Simon
- Department of Radiology, Christian Medical College, Vellore, India
| | - Reetu John
- Department of Radiology, Christian Medical College, Vellore, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | - Thomas S Ram
- Department of Radiation Oncology, Christian Medical College, Vellore, India
| | - Mark R Jesudason
- Department of Colorectal Surgery, Christian Medical College, Vellore, India
| | - Dipti Masih
- Department of Pathology, Christian Medical College, Vellore, India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, India
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22
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Munk NE, Bondeven P, Pedersen BG. Diagnostic performance of MRI and endoscopy for assessing complete response in rectal cancer after neoadjuvant chemoradiotherapy: a systematic review of the literature. Acta Radiol 2021; 64:20-31. [PMID: 34928715 DOI: 10.1177/02841851211065925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The diagnostic performance of magnetic resonance imaging (MRI) modalities and/or endoscopy for assessing complete response in rectal cancer after neoadjuvant chemoradiotherapy (nCRT) is unclear. PURPOSE To summarize existing evidence on the diagnostic performance of diffusion-weighted MRI, perfusion-weighted MRI, T2-weighted MR tumor regression grade, and/or endoscopy for assessing complete tumor response after nCRT. MATERIAL AND METHODS MEDLINE and Embase databases were searched. The PRISMA guidelines were followed. Sensitivity, specificity, negative predictive, and positive predictive values were retrieved from included studies. RESULTS In total, 81 studies were eligible for inclusion. Evidence suggests that combined use of MRI and endoscopy tends to improve the diagnostic performance compared to single imaging modality. The positive predictive value of a complete response varies substantially between studies. There is considerable heterogeneity between studies. CONCLUSION Combined re-staging tends to improve diagnostic performance compared to single imaging modality, but the vast majority of studies fail to offer true clinical value due to the study heterogeneity.
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Affiliation(s)
| | - Peter Bondeven
- Department of Surgery, Regional Hospital Randers, Randers, Denmark
| | - Bodil Ginnerup Pedersen
- Department of Radiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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23
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Recent Advances in Functional MRI to Predict Treatment Response for Locally Advanced Rectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2021. [DOI: 10.1007/s11888-021-00470-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Liu J, Li Q, Tang L, Huang Z, Lin Q. Correlations of Mean and Mimimum Apparent Diffusion Coefficient Values With the Clinicopathological Features in Rectal Cancer. Acad Radiol 2021; 28 Suppl 1:S105-S111. [PMID: 33162315 DOI: 10.1016/j.acra.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVE The study aimed to investigate the possible correlation between mean (MeanADC) and minimum (MinADC) apparent diffusion coefficient values with the clinicopathological features and evaluate the diagnostic potential of MinADC values and MeanADC values in predicting the behavior of rectal cancer. MATERIALS AND METHODS In total, 148 pathologically verified lesions that were subjected to conventional MR imaging and diffusion weighted imaging prior to operation were included. The MeanADC values and MinADC values were calculated and their correlation with clinicopathological characteristics were investigated. RESULTS Both MeanADC values and MinADC values correlated with T classification (MeanADC: t = 2.841, p = 0.005; MinADC: t = 2.356, p = 0.020), N classification (MeanADC: t = 3.468, p = 0.001; MinADC: t = 3.072, p = 0.003), tumor histological grade (MeanADC: F = 8.175, p = 0.000; MinADC: F = 22.038, p = 0.000), perineural invasion (MeanADC: t = 2.547, p = 0.012; MinADC: t = 3.081, p = 0.002), and extramural venous invasion (MeanADC: t = 2.157, p = 0.033; MinADC: t = 2.635, p = 0.009) in rectal cancer, but no significant correlation with gender, age, and tumor location (p > 0.05). The MinADC values showed a higher diagnostic efficacy in discriminating the well or poor differentiation of rectal cancer compared to MeanADC values, with a threshold value of ≥0.929 × 10-3 mm2/s (sensitivity, 80%; specificity, 88.1%) or ≤0.752 × 10-3 mm2/s (sensitivity, 94.1%; specificity, 74%). CONCLUSION Both MeanADC values and MinADC values might be used as a quantitative parameter to evaluate the aggressiveness of rectal cancer. The MinADC values could be as the better predictor in identifying tumor differentiation compared to the MeanADC values.
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25
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Zhang J, Huang Y, Chen J, Wang X, Ma H. Potential of combination of DCE-MRI and DWI with serum CA125 and CA199 in evaluating effectiveness of neoadjuvant chemotherapy in breast cancer. World J Surg Oncol 2021; 19:284. [PMID: 34537053 PMCID: PMC8449881 DOI: 10.1186/s12957-021-02398-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/10/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To determine the potential of the combination of DCE-MRI imaging method with DWI and serum CA125 and CA199 levels in the evaluation of the efficacy of neoadjuvant chemotherapy in breast cancer patients. METHODS Sixty-five breast cancer patients who received neoadjuvant chemotherapy in our hospital from April 2016 to April 2017 were selected as research subjects. The patients received 4 courses of neoadjuvant chemotherapy. Lesions were monitored using DCE-MRI and DWI, while ELISA was used to measure the serum expression levels of the tumour markers CA125 and CA199. The patients were divided into the remission group and ineffective group based on pathological diagnosis. RESULTS There were significant differences in Kep, Ktrans, ADCmin, ADCmean, tumour volume, and serum levels of CA125 and CA199 in patients in the remission group, before and after neoadjuvant chemotherapy, and there were significant differences in post-chemotherapy values of these indexes between the remission group and the ineffective group (p < 0.01). CONCLUSION Combination of DCE-MRI diagnostic imaging with DWI can directly reflect the lesions in breast cancer patients after neoadjuvant chemotherapy. Serum levels of CA125 and CA199 levels are useful for evaluation of the impact of neoadjuvant chemotherapy on breast cancer patients, including risk of cancer cell metastasis and changes in some small lesions.
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Affiliation(s)
- Jun Zhang
- Radiological Department, Gaomi People's Hospital, Gaomi, 261500, Shandong Province, China
| | - Yongbo Huang
- CT Radiology, Gaomi People's Hospital, Gaomi, 261500, Shandong Province, China
| | - Jianghui Chen
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, 117583, Singapore
| | - Xia Wang
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, 117583, Singapore
| | - Hongyu Ma
- CT Radiology, Gaomi People's Hospital, Gaomi, 261500, Shandong Province, China.
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Xu Q, Xu Y, Sun H, Jiang T, Xie S, Ooi BY, Ding Y. MRI Evaluation of Complete Response of Locally Advanced Rectal Cancer After Neoadjuvant Therapy: Current Status and Future Trends. Cancer Manag Res 2021; 13:4317-4328. [PMID: 34103987 PMCID: PMC8179813 DOI: 10.2147/cmar.s309252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/08/2021] [Indexed: 12/29/2022] Open
Abstract
Complete tumor response can be achieved in a certain proportion of patients with locally advanced rectal cancer, who achieve maximal response to neoadjuvant therapy (NAT). For these patients, a watch-and-wait (WW) or nonsurgical strategy has been proposed and is becoming widely practiced in order to avoid unnecessary surgical complications. Therefore, a non-invasive, reliable diagnostic tool for accurately evaluating complete tumor response is needed. Magnetic resonance imaging (MRI) plays a crucial role in both primary staging and restaging tumor response to NAT in rectal cancer without relying on resected specimen. In recent years, numerous efforts have been made to research the value of MRI in predicting and evaluating complete response in rectal cancer. Current MRI evaluation is mainly based on morphological and functional images. Morphologic MRI yields high soft tissue resolution, multiplanar images, and provides detailed depictions of rectal cancer and its surrounding structures. Functional MRI may help to distinguish residual tumor from fibrosis, therefore improving the diagnostic performance of morphologic MRI in identifying complete tumor response. Both morphologic and functional MRI have several promising parameters that may help accurately evaluate and/or predict complete response of rectal cancer. However, these parameters still have limitations and the results remain inconsistent. Recent development of new techniques, such as textural analysis, radiomics analysis and deep learning, demonstrate great potential based on MRI-derived parameters. This article aimed to review and help better understand the strengths, limitations, and future trends of these MRI-derived methods in evaluating complete response in rectal cancer.
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Affiliation(s)
- Qiaoyu Xu
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yanyan Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Tao Jiang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Sheng Xie
- Department of Radiology, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Bee Yen Ooi
- Department of Radiology, Hospital Seberang Jaya, Penang, Malaysia
| | - Yi Ding
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
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Hu H, Jiang H, Wang S, Jiang H, Zhao S, Pan W. 3.0 T MRI IVIM-DWI for predicting the efficacy of neoadjuvant chemoradiation for locally advanced rectal cancer. Abdom Radiol (NY) 2021; 46:134-143. [PMID: 32462386 PMCID: PMC7864832 DOI: 10.1007/s00261-020-02594-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose The purpose of this study was to determine the diagnostic performance of intravoxel incoherent motion (IVIM) on assessing response to neoadjuvant chemoradiation (nCRT) in patients with Locally Advanced Rectal Cancer (LARC). Methods 50 patients with rectal cancer who underwent magnetic resonance (MR) imaging before and after nCRT, the values of pre-nCRT and post-nCRT IVIM-DWI parameters apparent diffusion coefficient (ADC), diffusion coefficient (D), false diffusion coefficient (D*), and perfusion fraction (f), together with the percentage changes (∆% parametric value) induced by nCRT were calculated. According to the patient's response to nCRT, the patients were divided into pathological complete response (pCR) and non-pCR groups, Good Response (GR) group and Poor Response (PR) group, and the above values were compared between different groups. Univariate and multiple logistic regression analysis were done to investigate the relation between different parameters and patient nCRT. Draw ROC curve according to sensitivity and specificity, and compare its diagnostic efficacy. Results There were no significant differences in the baseline data of 50 patients. After nCRT, the ADC and D values for LARC increased significantly (all p < 0.05). The pCR group (n = 9) had higher preD*, pref, postD*, ∆%ADC and ∆%D values than the non-pCR group (n = 41) (all p < 0.05). The GR group (n = 17) exhibited higher post D, ∆%ADC and ∆%D values than the PR group (n = 33) (all p < 0.05). From the results of Logistic regression analysis found that ∆%ADC and ∆%D were significantly correlated with patients' response to nCRT. Based on ROC analysis, ∆%D had a higher area under the curve value than ∆%ADC (p = 0.009) in discriminating the pCR from non-pCR groups. Conclusions IVIM-DWI technology may be helpful in identifying the pCR and GR patients to nCRT for LARC.
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Affiliation(s)
- Hongbo Hu
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Huijie Jiang
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
| | - Song Wang
- Department of Radiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725, South Wanping Road, Shanghai, 200032, China
| | - Hao Jiang
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Sheng Zhao
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Wenbin Pan
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
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Alvarez-Jimenez C, Antunes JT, Talasila N, Bera K, Brady JT, Gollamudi J, Marderstein E, Kalady MF, Purysko A, Willis JE, Stein S, Friedman K, Paspulati R, Delaney CP, Romero E, Madabhushi A, Viswanath SE. Radiomic Texture and Shape Descriptors of the Rectal Environment on Post-Chemoradiation T2-Weighted MRI are Associated with Pathologic Tumor Stage Regression in Rectal Cancers: A Retrospective, Multi-Institution Study. Cancers (Basel) 2020; 12:cancers12082027. [PMID: 32722082 PMCID: PMC7463898 DOI: 10.3390/cancers12082027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023] Open
Abstract
(1) Background: The relatively poor expert restaging accuracy of MRI in rectal cancer after neoadjuvant chemoradiation may be due to the difficulties in visual assessment of residual tumor on post-treatment MRI. In order to capture underlying tissue alterations and morphologic changes in rectal structures occurring due to the treatment, we hypothesized that radiomics texture and shape descriptors of the rectal environment (e.g., wall, lumen) on post-chemoradiation T2-weighted (T2w) MRI may be associated with tumor regression after neoadjuvant chemoradiation therapy (nCRT). (2) Methods: A total of 94 rectal cancer patients were retrospectively identified from three collaborating institutions, for whom a 1.5 or 3T T2w MRI was available after nCRT and prior to surgical resection. The rectal wall and the lumen were annotated by an expert radiologist on all MRIs, based on which 191 texture descriptors and 198 shape descriptors were extracted for each patient. (3) Results: Top-ranked features associated with pathologic tumor-stage regression were identified via cross-validation on a discovery set (n = 52, 1 institution) and evaluated via discriminant analysis in hold-out validation (n = 42, 2 institutions). The best performing features for distinguishing low (ypT0-2) and high (ypT3-4) pathologic tumor stages after nCRT comprised directional gradient texture expression and morphologic shape differences in the entire rectal wall and lumen. Not only were these radiomic features found to be resilient to variations in magnetic field strength and expert segmentations, a quadratic discriminant model combining them yielded consistent performance across multiple institutions (hold-out AUC of 0.73). (4) Conclusions: Radiomic texture and shape descriptors of the rectal wall from post-treatment T2w MRIs may be associated with low and high pathologic tumor stage after neoadjuvant chemoradiation therapy and generalized across variations between scanners and institutions.
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Affiliation(s)
- Charlems Alvarez-Jimenez
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (C.A.-J.); (J.T.A.); (K.B.); (K.F.); (A.M.)
- Computer Imaging and Medical Application Laboratory, Universidad Nacional de Colombia, Bogotá 111321, Colombia;
| | - Jacob T. Antunes
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (C.A.-J.); (J.T.A.); (K.B.); (K.F.); (A.M.)
| | - Nitya Talasila
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA;
| | - Kaustav Bera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (C.A.-J.); (J.T.A.); (K.B.); (K.F.); (A.M.)
| | - Justin T. Brady
- Department of General Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; (J.T.B.); (S.S.)
| | - Jayakrishna Gollamudi
- Department of Abdominal Imaging, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA;
| | - Eric Marderstein
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA;
| | - Matthew F. Kalady
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH 44106, USA; (M.F.K.); (C.P.D.)
| | - Andrei Purysko
- Section of Abdominal Imaging and Nuclear Radiology Department, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Joseph E. Willis
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA;
| | - Sharon Stein
- Department of General Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; (J.T.B.); (S.S.)
| | - Kenneth Friedman
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (C.A.-J.); (J.T.A.); (K.B.); (K.F.); (A.M.)
| | - Rajmohan Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA;
| | - Conor P. Delaney
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH 44106, USA; (M.F.K.); (C.P.D.)
| | - Eduardo Romero
- Computer Imaging and Medical Application Laboratory, Universidad Nacional de Colombia, Bogotá 111321, Colombia;
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (C.A.-J.); (J.T.A.); (K.B.); (K.F.); (A.M.)
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA;
| | - Satish E. Viswanath
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; (C.A.-J.); (J.T.A.); (K.B.); (K.F.); (A.M.)
- Correspondence:
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Canese R. Editorial for "Comparative Analysis of Amide Proton Transfer MRI and Diffusion-Weighted Imaging in Assessing p53 and Ki-67 Expression of Rectal Adenocarcinoma". J Magn Reson Imaging 2020; 52:1497-1498. [PMID: 32557898 DOI: 10.1002/jmri.27265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Rossella Canese
- MRI Unit - Core Facilities, Istituto Superiore di Sanità, Rome, Italy
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