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Custers PA, Beets GL, Bach SP, Blomqvist LK, Figueiredo N, Gollub MJ, Martling A, Melenhorst J, Ortega CD, Perez RO, Smith JJ, Lambregts DMJ, Beets-Tan RGH, Maas M. An International Expert-Based Consensus on the Definition of a Clinical Near-Complete Response After Neoadjuvant (Chemo)radiotherapy for Rectal Cancer. Dis Colon Rectum 2024; 67:782-795. [PMID: 38701503 DOI: 10.1097/dcr.0000000000003209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
BACKGROUND A variety of definitions for a clinical near-complete response after neoadjuvant (chemo) radiotherapy for rectal cancer are currently used. This variety leads to inconsistency in clinical practice, long-term outcome, and trial enrollment. OBJECTIVE The aim of this study was to reach expert-based consensus on the definition of a clinical near-complete response after (chemo) radiotherapy. DESIGN A modified Delphi process, including a systematic review, 3 surveys, and 2 meetings, was performed with an international expert panel consisting of 7 surgeons and 4 radiologists. The surveys consisted of individual features, statements, and feature combinations (endoscopy, T2-weighted MRI, and diffusion-weighted MRI). SETTING The modified Delphi process was performed in an online setting; all 3 surveys were completed online by the expert panel, and both meetings were hosted online. MAIN OUTCOME MEASURES The main outcome was to reach consensus (80% or more agreement). RESULTS The expert panel reached consensus on a 3-tier categorization of the near-complete response category based on the likelihood of the response to evolve into a clinical complete response after a longer waiting interval. The panelists agreed that a near-complete response is a temporary entity only to be used in the first 6 months after (chemo)radiotherapy. Furthermore, consensus was reached that the lymph node status should be considered when deciding on a near-complete response and that biopsies are not always needed when a near-complete response is found. No consensus was reached on whether primary staging characteristics have to be taken into account when deciding on a near-complete response. LIMITATIONS This 3-tier subcategorization is expert-based; therefore, there is no supporting evidence for this subcategorization. Also, it is unclear whether this subcategorization can be generalized into clinical practice. CONCLUSIONS Consensus was reached on the use of a 3-tier categorization of a near-complete response, which can be helpful in daily practice as guidance for treatment and to inform patients with a near-complete response on the likelihood of successful organ preservation. See Video Abstract. UN CONSENSO INTERNACIONAL BASADO EN EXPERTOS ACERCA DE LA DEFINICIN DE UNA RESPUESTA CLNICA CASI COMPLETA DESPUS DE QUIMIORADIOTERAPIA NEOADYUVANTE CONTRA EL CNCER DE RECTO ANTECEDENTES:Actualmente, se utilizan una variedad de definiciones para una respuesta clínica casi completa después de quimioradioterapia neoadyuvante contra el cáncer de recto. Esta variedad resulta en inconsistencia en la práctica clínica, los resultados a largo plazo y la inscripción en ensayos.OBJETIVO:El objetivo de este estudio fue llegar a un consenso de expertos sobre la definición de una respuesta clínica casi completa después de quimioradioterapia.DISEÑO:Se realizó un proceso Delphi modificado que incluyó una revisión sistemática, 3 encuestas y 2 reuniones con un panel internacional de expertos compuesto por siete cirujanos y 4 radiólogos. Las encuestas consistieron en características individuales, declaraciones y combinaciones de características (endoscopía, T2W-MRI y DWI).AJUSTE:El proceso Delphi modificado se realizó en un entorno en línea; el panel de expertos completó las tres encuestas en línea y ambas reuniones se realizaron en línea.PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue llegar a un consenso (≥80% de acuerdo).RESULTADOS:El panel de expertos llegó a un consenso sobre una categorización de tres niveles de la categoría de respuesta casi completa basada en la probabilidad de que la respuesta evolucione hacia una respuesta clínica completa después de un intervalo de espera más largo. Los panelistas coincidieron en que una respuesta casi completa es una entidad temporal que sólo debe utilizarse en los primeros 6 meses después de la quimioradioterapia. Además, se llegó a un consenso en que se debe considerar el estado de los nódulos linfáticos al decidir sobre una respuesta casi completa y que no siempre se necesitan biopsias cuando se encuentra una respuesta casi completa. No se llegó a un consenso sobre si se deben tener en cuenta las características primarias de estadificación al decidir una respuesta casi completa.LIMITACIONES:Esta subcategorización de 3 niveles está basada en expertos; por lo tanto, no hay evidencia que respalde esta subcategorización. Además, no está claro si esta subcategorización puede generalizarse a la práctica clínica.CONCLUSIONES:Se alcanzó consenso sobre el uso de una categorización de 3 niveles de una respuesta casi completa que puede ser útil en la práctica diaria como guía para el tratamiento y para informar a los pacientes con una respuesta casi completa sobre la probabilidad de una preservación exitosa del órgano. (Traducción - Dr. Aurian Garcia Gonzalez).
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Affiliation(s)
- Petra A Custers
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- GROW School for Oncology and Developmental Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- GROW School for Oncology and Developmental Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Simon P Bach
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Lennart K Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Nuno Figueiredo
- Department of Surgery, Hospital Lusiadas Lisboa, Lisbon, Portugal
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York
| | - Anna Martling
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Pelvic Cancer, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - Jarno Melenhorst
- GROW School for Oncology and Developmental Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Cinthia D Ortega
- Department of Radiology, University of São Paulo School of Medicine, São Paulo, Brazil
- Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo O Perez
- Division of Colorectal Surgery, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - J Joshua Smith
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York
| | - Doenja M J Lambregts
- GROW School for Oncology and Developmental Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- GROW School for Oncology and Developmental Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Monique Maas
- GROW School for Oncology and Developmental Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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Hazen SMJA, Sluckin TC, Horsthuis K, Lambregts DMJ, Beets-Tan RGH, Hompes R, Buffart TE, Marijnen CAM, Tanis PJ, Kusters M. Impact of the new rectal cancer definition on multimodality treatment and interhospital variability: Results from a nationwide cross-sectional study. Colorectal Dis 2024. [PMID: 38682286 DOI: 10.1111/codi.17002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/27/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
AIM This study aimed to determine the consequences of the new definition of rectal cancer for decision-making in multidisciplinary team meetings (MDT). The new definition of rectal cancer, the lower border of the tumour is located below the sigmoid take-off (STO), was implemented in the Dutch guideline in 2019 after an international Delphi consensus meeting to reduce interhospital variations. METHOD All patients with rectal cancer according to the local MDT, who underwent resection in 2016 in the Netherlands were eligible for this nationwide collaborative cross-sectional study. MRI-images were rereviewed, and the tumours were classified as above or on/below the STO. RESULTS This study registered 3107 of the eligible 3178 patients (98%), of which 2784 patients had an evaluable MRI. In 314 patients, the tumour was located above the STO (11%), with interhospital variation between 0% and 36%. Based on TN-stage, 175 reclassified patients with colon cancer (6%) would have received different treatment (e.g., omitting neoadjuvant radiotherapy, candidate for adjuvant chemotherapy). Tumour location above the STO was independently associated with lower risk of 4-year locoregional recurrence (HR 0.529; p = 0.030) and higher 4-year overall survival (HR 0.732; p = 0.037) compared to location under the STO. CONCLUSION By using the STO, 11% of the prior MDT-based diagnosis of rectal cancer were redefined as sigmoid cancer, with potential implications for multimodality treatment and prognostic value. Given the substantial interhospital variation in proportion of redefined cancers, the use of the STO will contribute to standardisation and comparability of outcomes in both daily practice and trial settings.
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Affiliation(s)
- Sanne-Marije J A Hazen
- Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Tania C Sluckin
- Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Karin Horsthuis
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Radiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Regina G H Beets-Tan
- Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Roel Hompes
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Tineke E Buffart
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Medical Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Corrie A M Marijnen
- Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter J Tanis
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Miranda Kusters
- Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
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Lahaye MJ, Lambregts DMJ, Aalbers AGJ, Snaebjornsson P, Beets-Tan RGH, Kok NFM. Imaging in the era of risk-adapted treatment in Colon cancer. Br J Radiol 2024:tqae061. [PMID: 38648743 DOI: 10.1093/bjr/tqae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/14/2024] [Accepted: 03/14/2024] [Indexed: 04/25/2024] Open
Abstract
The treatment landscape for patients with colon cancer is continuously evolving. Risk-adapted treatment strategies, including neoadjuvant chemotherapy and immunotherapy, are slowly finding their way into clinical practice and guidelines. Radiologists are pivotal in guiding clinicians toward the most optimal treatment for each colon cancer patient. This review provides an overview of recent and upcoming advances in the diagnostic management of colon cancer and the radiologist's role in the multidisciplinary approach to treating colon cancer.
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Affiliation(s)
- Max J Lahaye
- The Netherlands Cancer Institute, Department of Radiology, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Doenja M J Lambregts
- The Netherlands Cancer Institute, Department of Radiology, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arend G J Aalbers
- The Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands
| | - Petur Snaebjornsson
- The Netherlands Cancer Institute, Department of Pathology, Amsterdam, The Netherlands
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - R G H Beets-Tan
- The Netherlands Cancer Institute, Department of Radiology, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niels F M Kok
- The Netherlands Cancer Institute, Department of Surgery, Amsterdam, The Netherlands
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Rijsemus CJV, Kok NFM, Aalbers AGJ, Grotenhuis BA, Berardi E, Snaebjornsson P, Lambregts DMJ, Beets-Tan RGH, Lahaye MJ. Investigating locations of recurrences with MRI after CRS-HIPEC for colorectal peritoneal metastases. Eur J Radiol 2024; 175:111478. [PMID: 38677041 DOI: 10.1016/j.ejrad.2024.111478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 03/13/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Patients with colorectal peritoneal metastases (PM) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are at high risk of recurrent disease. Understanding where and why recurrences occur is the first step in finding solutions to reduce recurrence rates. Although diffusion-weighted (DW) MRI is not routinely used in the follow-up of CRC patients, it has a clear advantage over CT in detecting the location and spread of (recurrent) PM. This study aimed to identify common locations of recurrence in CRC patients after CRS-HIPEC with MRI. METHOD This was a single-centre retrospective study of patients with recurrent PM after CRS-HIPEC performed between January 2016 and August 2020. Patients were eligible for inclusion if they had both an MRI preoperatively (MRI1) and at the time of recurrent disease (MRI2). Two abdominal radiologists reviewed in consensus and categorized recurrences according to their location on MRI2 and in correlation with previous disease location on prior imaging (MRI1) and the surgical report of the CRS-HIPEC. RESULTS Thirty patients were included, with a median surgical PCI of 7 (range 3-21) at the time of primary CRS-HIPEC. In total, 68 recurrent metastases were detected on MRI2, of which 14 were extra-peritoneal. Of the remaining 54 PM, 42 (78%) occurred where the peritoneum was damaged due to earlier resections or other surgical procedures (e.g. inserted surgical abdominal drains). Most recurrent metastases were found in the mesentery, lower abdomen/pelvis and abdominal wall (87%). CONCLUSIONS Most recurrent PMs appeared in the mesentery, lower abdomen/pelvis and abdominal wall, especially where the peritoneum was previously damaged.
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Affiliation(s)
- C J V Rijsemus
- Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121 1066CX, Amsterdam, the Netherlands; Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121 1066CX, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology - University of Maastricht, Maastricht, the Netherlands.
| | - N F M Kok
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121 1066CX, Amsterdam, the Netherlands
| | - A G J Aalbers
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121 1066CX, Amsterdam, the Netherlands
| | - B A Grotenhuis
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121 1066CX, Amsterdam, the Netherlands
| | - E Berardi
- Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121 1066CX, Amsterdam, the Netherlands
| | - P Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121 1066CX, Amsterdam, the Netherlands; Department of Pathology, Faculty of Medicine - University of Iceland, Reykjavik, Iceland
| | - D M J Lambregts
- Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121 1066CX, Amsterdam, the Netherlands
| | - R G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121 1066CX, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology - University of Maastricht, Maastricht, the Netherlands
| | - M J Lahaye
- Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121 1066CX, Amsterdam, the Netherlands
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van der Reijd DJ, Chupetlovska K, van Dijk E, Westerink B, Monraats MA, Van Griethuysen JJM, Lambregts DMJ, Tissier R, Beets-Tan RGH, Benson S, Maas M. Multi-sequence MRI radiomics of colorectal liver metastases: Which features are reproducible across readers? Eur J Radiol 2024; 172:111346. [PMID: 38309217 DOI: 10.1016/j.ejrad.2024.111346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE To assess the inter-reader reproducibility of radiomics features on multiple MRI sequences after segmentations of colorectal liver metastases (CRLM). METHOD 30 CRLM (in 23 patients) were manually delineated by three readers on MRI before the start of chemotherapy on the contrast enhanced T1-weighted images (CE-T1W) in the portal venous phase, T2-weighted images (T2W) and b800 diffusion weighted images (DWI). DWI delineations were copied to the ADC-maps. 107 radiomics features were extracted per sequence. The intraclass correlation coefficient (ICC) was calculated per feature. Features were considered reproducible if ICC > 0.9. RESULTS 90% of CE-T1W features were reproducible with a median ICC of 0.98 (range 0.76-1.00). 81% of DWI features were robust with median ICC = 0.97 (range 0.38-1.00). The T2W features had a median ICC of 0.96 (range 0.55-0.99) and were reproducible in 80%. ADC showed the lowest number of reproducible features with 58% and median ICC = 0.91 (range 0.38-0.99) When considering the lower bound of the ICC 95% confidence intervals, 58%, 66%, 54% and 29% reached 0.9 for the CE-T1W, DWI, T2W and ADC features, respectively. The feature class with the best reproducibility differed per sequence. CONCLUSIONS The majority of MRI radiomics features from CE-T1W, T2W, DWI and ADC in colorectal liver metastases were robust for segmentation variability between readers. The CE-T1W yielded slightly better reproducibility results compared to DWI and T2W. The ADC features seem more susceptible to reader differences compared to the other three sequences.
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Affiliation(s)
- Denise J van der Reijd
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - Kalina Chupetlovska
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands
| | - Eleanor van Dijk
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands
| | - Bram Westerink
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands
| | - Melanie A Monraats
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands
| | - Joost J M Van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - Renaud Tissier
- Biostatistics Center, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, DK 5203 Odense, Denmark
| | - Sean Benson
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands; Department of Cardiology, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
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El Khababi N, Beets-Tan RGH, Tissier R, Lahaye MJ, Maas M, Curvo-Semedo L, Dresen RC, van Griethuysen JJM, Nougaret S, Beets GL, van Triest B, Taylor SA, Lambregts DMJ. Outcomes and potential impact of a virtual hands-on training program on MRI staging confidence and performance in rectal cancer. Eur Radiol 2024; 34:1746-1754. [PMID: 37646807 PMCID: PMC10873460 DOI: 10.1007/s00330-023-10167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To explore the potential impact of a dedicated virtual training course on MRI staging confidence and performance in rectal cancer. METHODS Forty-two radiologists completed a stepwise virtual training course on rectal cancer MRI staging composed of a pre-course (baseline) test with 7 test cases (5 staging, 2 restaging), a 1-day online workshop, 1 month of individual case readings (n = 70 cases with online feedback), a live online feedback session supervised by two expert faculty members, and a post-course test. The ESGAR structured reporting templates for (re)staging were used throughout the course. Results of the pre-course and post-course test were compared in terms of group interobserver agreement (Krippendorf's alpha), staging confidence (perceived staging difficulty), and diagnostic accuracy (using an expert reference standard). RESULTS Though results were largely not statistically significant, the majority of staging variables showed a mild increase in diagnostic accuracy after the course, ranging between + 2% and + 17%. A similar trend was observed for IOA which improved for nearly all variables when comparing the pre- and post-course. There was a significant decrease in the perceived difficulty level (p = 0.03), indicating an improved diagnostic confidence after completion of the course. CONCLUSIONS Though exploratory in nature, our study results suggest that use of a dedicated virtual training course and web platform has potential to enhance staging performance, confidence, and interobserver agreement to assess rectal cancer on MRI virtual training and could thus be a good alternative (or addition) to in-person training. CLINICAL RELEVANCE STATEMENT Rectal cancer MRI reporting quality is highly dependent on radiologists' expertise, stressing the need for dedicated training/teaching. This study shows promising results for a virtual web-based training program, which could be a good alternative (or addition) to in-person training. KEY POINTS • Rectal cancer MRI reporting quality is highly dependent on radiologists' expertise, stressing the need for dedicated training and teaching. • Using a dedicated virtual training course and web-based platform, encouraging first results were achieved to improve staging accuracy, diagnostic confidence, and interobserver agreement. • These exploratory results suggest that virtual training could thus be a good alternative (or addition) to in-person training.
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Affiliation(s)
- Najim El Khababi
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Renaud Tissier
- Biostatistics Unit, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Luís Curvo-Semedo
- Department of Radiology, Centro Hospitalar E Universitario de Coimbra EPE, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Raphaëla C Dresen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Joost J M van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- Department of Radiology, UMC Utrecht, Utrecht, The Netherlands
| | - Stephanie Nougaret
- Medical Imaging Department, Montpellier Cancer Institute, Montpellier Cancer Research Institute (U1194), University of Montpellier, Montpellier, France
| | - Geerard L Beets
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stuart A Taylor
- Department of Radiology, University College London Hospitals Biomedical Research Centre, London, UK
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands.
- GROW School for oncology and reproduction, University of Maastricht, Maastricht, The Netherlands.
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Willemse JRJ, Lahaye MJ, Kok NFM, Grotenhuis BA, Aalbers AGJ, Beets GL, Rijsemus C, Maas M, van Golen LW, Beets-Tan RGH, Lambregts DMJ. Whole-body MRI with diffusion-weighted imaging as an adjunct to 18 F-fluorodeoxyglucose positron emission tomography and CT in patients with suspected recurrent colorectal cancer. Colorectal Dis 2024; 26:290-299. [PMID: 38145899 DOI: 10.1111/codi.16840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023]
Abstract
AIM The aim was to explore how findings of whole-body MRI including diffusion-weighted imaging (DW-MRI) compared to the routine diagnostic workup with CT and/or 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in patients with suspected recurrent colorectal cancer (CRC). METHOD This was an exploratory retrospective analysis of 55 patients with a clinical suspicion of recurrent CRC who underwent DW-MRI following CT and/or FDG-PET/CT. Two readers in consensus interpreted all clinical imaging reports and converted each described lesion into a confidence score (1 = definitely benign to 5 = definitely malignant). DW-MRI findings were compared to the most recent previous CT or PET/CT. Any discrepant or additional DW-MRI findings were documented and compared with histology and/or clinical follow-up (if available). RESULTS Whole-body MRI including diffusion-weighted imaging (DW-MRI) resulted in discrepant/additional findings in 26/55 (47%) cases; 23/37 (62%) compared to previous CT and 3/18 (17%) compared to previous PET/CT. These included 10 cases where DW-MRI converted previously inconclusive CT (n = 8) or PET/CT (n = 2) findings into a conclusive diagnosis, one where it contradicted a previous CT diagnosis of recurrence, five where DW-MRI diagnosed recurrent disease not previously reported on CT and 10 cases where DW-MRI detected additional lesions compared to CT (n = 9) or PET/CT (n = 1). Eighty-eight per cent of cases with discrepant/additional findings concerned patients with recurrent/metachronous peritoneal metastases. In total, DW-MRI resulted in 42 discrepant/additional lesions; the DW-MRI diagnosis was correct in 76% of these lesions and incorrect (false positive) in 7%. In the remaining 17%, no standard of reference was available. CONCLUSIONS This explorative study suggests that DW-MRI may be of added value to patients with a clinical suspicion for recurrent CRC, in particular to identify patients with peritoneal metastases. DW-MRI mainly has potential as a 'problem-solver' in patients with inconclusive or negative findings on previous imaging (in particular CT) and to detect additional disease sites in patients already diagnosed with recurrent disease.
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Affiliation(s)
- Jeroen R J Willemse
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Max J Lahaye
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Niels F M Kok
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Brechtje A Grotenhuis
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arend G J Aalbers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte Rijsemus
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Larissa W van Golen
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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8
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Cai L, Lambregts DMJ, Beets GL, Mass M, Pooch EHP, Guérendel C, Beets-Tan RGH, Benson S. An automated deep learning pipeline for EMVI classification and response prediction of rectal cancer using baseline MRI: a multi-centre study. NPJ Precis Oncol 2024; 8:17. [PMID: 38253770 PMCID: PMC10803303 DOI: 10.1038/s41698-024-00516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
The classification of extramural vascular invasion status using baseline magnetic resonance imaging in rectal cancer has gained significant attention as it is an important prognostic marker. Also, the accurate prediction of patients achieving complete response with primary staging MRI assists clinicians in determining subsequent treatment plans. Most studies utilised radiomics-based methods, requiring manually annotated segmentation and handcrafted features, which tend to generalise poorly. We retrospectively collected 509 patients from 9 centres, and proposed a fully automated pipeline for EMVI status classification and CR prediction with diffusion weighted imaging and T2-weighted imaging. We applied nnUNet, a self-configuring deep learning model, for tumour segmentation and employed learned multiple-level image features to train classification models, named MLNet. This ensures a more comprehensive representation of the tumour features, in terms of both fine-grained detail and global context. On external validation, MLNet, yielding similar AUCs as internal validation, outperformed 3D ResNet10, a deep neural network with ten layers designed for analysing spatiotemporal data, in both CR and EMVI tasks. For CR prediction, MLNet showed better results than the current state-of-the-art model using imaging and clinical features in the same external cohort. Our study demonstrated that incorporating multi-level image representations learned by a deep learning based tumour segmentation model on primary MRI improves the results of EMVI classification and CR prediction with good generalisation to external data. We observed variations in the contributions of individual feature maps to different classification tasks. This pipeline has the potential to be applied in clinical settings, particularly for EMVI classification.
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Affiliation(s)
- Lishan Cai
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Monique Mass
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
| | - Eduardo H P Pooch
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
| | - Corentin Guérendel
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, 66202 AZ, Maastricht, The Netherlands
| | - Sean Benson
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Hazen SJA, Sluckin TC, Horsthuis K, Lambregts DMJ, Beets-Tan RGH, Tanis PJ, Kusters M. An updated evaluation of the implementation of the sigmoid take-off landmark 1 year after the official introduction in the Netherlands. Tech Coloproctol 2023; 27:1243-1250. [PMID: 37184772 PMCID: PMC10638143 DOI: 10.1007/s10151-023-02803-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE The definition of rectal cancer based on the sigmoid take-off (STO) was incorporated into the Dutch guideline in 2019, and became mandatory in the national audit from December 2020. This study aimed to evaluate the use of the STO in clinical practice and the added value of online training, stratified for the period before (group A, historical cohort) and after (group B, current cohort) incorporation into the national audit. METHODS Participants, including radiologists, surgeons, surgical and radiological residents, interns, PhD students, and physician assistants, were asked to complete an online training program, consisting of questionnaires, 20 MRI cases, and a training document. Outcomes were agreement with the expert reference, inter-rater variability, and accuracy before and after the training. RESULTS Group A consisted of 86 participants and group B consisted of 114 participants. Familiarity with the STO was higher in group B (76% vs 88%, p = 0.027). Its use in multidisciplinary meetings was not significantly higher (50% vs 67%, p = 0.237). Agreement with the expert reference was similar for both groups before (79% vs 80%, p = 0.423) and after the training (87% vs 87%, p = 0.848). Training resulted in significant improvement for both groups in classifying tumors located around the STO (group A, 69-79%; group B, 67-79%, p < 0.001). CONCLUSIONS The results of this study show that after the inclusion of the STO in the mandatory Dutch national audit, the STO was consequently used in only 67% of the represented hospitals. Online training has the potential to improve implementation and unambiguous assessment.
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Affiliation(s)
- S J A Hazen
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - T C Sluckin
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - K Horsthuis
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Radiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - D M J Lambregts
- Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R G H Beets-Tan
- Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - P J Tanis
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Erasmus Medical Center, Surgical Oncology and Gastrointestinal Surgery, Rotterdam, The Netherlands
| | - M Kusters
- Department of Surgery, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands.
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.
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10
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Schurink NW, van Kranen SR, van Griethuysen JJM, Roberti S, Snaebjornsson P, Bakers FCH, de Bie SH, Bosma GPT, Cappendijk VC, Geenen RWF, Neijenhuis PA, Peterson GM, Veeken CJ, Vliegen RFA, Peters FP, Bogveradze N, El Khababi N, Lahaye MJ, Maas M, Beets GL, Beets-Tan RGH, Lambregts DMJ. Development and multicenter validation of a multiparametric imaging model to predict treatment response in rectal cancer. Eur Radiol 2023; 33:8889-8898. [PMID: 37452176 PMCID: PMC10667134 DOI: 10.1007/s00330-023-09920-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To develop and validate a multiparametric model to predict neoadjuvant treatment response in rectal cancer at baseline using a heterogeneous multicenter MRI dataset. METHODS Baseline staging MRIs (T2W (T2-weighted)-MRI, diffusion-weighted imaging (DWI) / apparent diffusion coefficient (ADC)) of 509 patients (9 centres) treated with neoadjuvant chemoradiotherapy (CRT) were collected. Response was defined as (1) complete versus incomplete response, or (2) good (Mandard tumor regression grade (TRG) 1-2) versus poor response (TRG3-5). Prediction models were developed using combinations of the following variable groups: (1) Non-imaging: age/sex/tumor-location/tumor-morphology/CRT-surgery interval (2) Basic staging: cT-stage/cN-stage/mesorectal fascia involvement, derived from (2a) original staging reports, or (2b) expert re-evaluation (3) Advanced staging: variables from 2b combined with cTN-substaging/invasion depth/extramural vascular invasion/tumor length (4) Quantitative imaging: tumour volume + first-order histogram features (from T2W-MRI and DWI/ADC) Models were developed with data from 6 centers (n = 412) using logistic regression with the Least Absolute Shrinkage and Selector Operator (LASSO) feature selection, internally validated using repeated (n = 100) random hold-out validation, and externally validated using data from 3 centers (n = 97). RESULTS After external validation, the best model (including non-imaging and advanced staging variables) achieved an area under the curve of 0.60 (95%CI=0.48-0.72) to predict complete response and 0.65 (95%CI=0.53-0.76) to predict a good response. Quantitative variables did not improve model performance. Basic staging variables consistently achieved lower performance compared to advanced staging variables. CONCLUSIONS Overall model performance was moderate. Best results were obtained using advanced staging variables, highlighting the importance of good-quality staging according to current guidelines. Quantitative imaging features had no added value (in this heterogeneous dataset). CLINICAL RELEVANCE STATEMENT Predicting tumour response at baseline could aid in tailoring neoadjuvant therapies for rectal cancer. This study shows that image-based prediction models are promising, though are negatively affected by variations in staging quality and MRI acquisition, urging the need for harmonization. KEY POINTS This multicenter study combining clinical information and features derived from MRI rendered disappointing performance to predict response to neoadjuvant treatment in rectal cancer. Best results were obtained with the combination of clinical baseline information and state-of-the-art image-based staging variables, highlighting the importance of good quality staging according to current guidelines and staging templates. No added value was found for quantitative imaging features in this multicenter retrospective study. This is likely related to acquisition variations, which is a major problem for feature reproducibility and thus model generalizability.
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Affiliation(s)
- Niels W Schurink
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Simon R van Kranen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joost J M van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Sander Roberti
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frans C H Bakers
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Shira H de Bie
- Department of Radiology, Deventer Ziekenhuis, Schalkhaar, The Netherlands
| | - Gerlof P T Bosma
- Department of Interventional Radiology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Vincent C Cappendijk
- Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Remy W F Geenen
- Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands
| | | | | | - Cornelis J Veeken
- Department of Radiology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Roy F A Vliegen
- Department of Radiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Femke P Peters
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nino Bogveradze
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
- Department of Radiology, Acad. F. Todua Medical Center, Research Institute of Clinical Medicine, Tbilisi, Georgia
| | - Najim El Khababi
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Geerard L Beets
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
- Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands.
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van der Reijd DJ, Guerendel C, Staal FCR, Busard MP, De Oliveira Taveira M, Klompenhouwer EG, Kuhlmann KFD, Moelker A, Verhoef C, Starmans MPA, Lambregts DMJ, Beets-Tan RGH, Benson S, Maas M. Independent validation of CT radiomics models in colorectal liver metastases: predicting local tumour progression after ablation. Eur Radiol 2023:10.1007/s00330-023-10417-5. [PMID: 37987835 DOI: 10.1007/s00330-023-10417-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/07/2023] [Accepted: 09/10/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES Independent internal and external validation of three previously published CT-based radiomics models to predict local tumor progression (LTP) after thermal ablation of colorectal liver metastases (CRLM). MATERIALS AND METHODS Patients with CRLM treated with thermal ablation were collected from two institutions to collect a new independent internal and external validation cohort. Ablation zones (AZ) were delineated on portal venous phase CT 2-8 weeks post-ablation. Radiomics features were extracted from the AZ and a 10 mm peri-ablational rim (PAR) of liver parenchyma around the AZ. Three previously published prediction models (clinical, radiomics, combined) were tested without retraining. LTP was defined as new tumor foci appearing next to the AZ up to 24 months post-ablation. RESULTS The internal cohort included 39 patients with 68 CRLM and the external cohort 52 patients with 78 CRLM. 34/146 CRLM developed LTP after a median follow-up of 24 months (range 5-139). The median time to LTP was 8 months (range 2-22). The combined clinical-radiomics model yielded a c-statistic of 0.47 (95%CI 0.30-0.64) in the internal cohort and 0.50 (95%CI 0.38-0.62) in the external cohort, compared to 0.78 (95%CI 0.65-0.87) in the previously published original cohort. The radiomics model yielded c-statistics of 0.46 (95%CI 0.29-0.63) and 0.39 (95%CI 0.28-0.52), and the clinical model 0.51 (95%CI 0.34-0.68) and 0.51 (95%CI 0.39-0.63) in the internal and external cohort, respectively. CONCLUSION The previously published results for prediction of LTP after thermal ablation of CRLM using clinical and radiomics models were not reproducible in independent internal and external validation. CLINICAL RELEVANCE STATEMENT Local tumour progression after thermal ablation of CRLM cannot yet be predicted with the use of CT radiomics of the ablation zone and peri-ablational rim. These results underline the importance of validation of radiomics results to test for reproducibility in independent cohorts. KEY POINTS • Previous research suggests CT radiomics models have the potential to predict local tumour progression after thermal ablation in colorectal liver metastases, but independent validation is lacking. • In internal and external validation, the previously published models were not able to predict local tumour progression after ablation. • Radiomics prediction models should be investigated in independent validation cohorts to check for reproducibility.
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Affiliation(s)
- Denise J van der Reijd
- Department of Radiology, Antoni Van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - Corentin Guerendel
- Department of Radiology, Antoni Van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - Femke C R Staal
- Department of Radiology, Antoni Van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - Milou P Busard
- Department of Radiology, Antoni Van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Mateus De Oliveira Taveira
- Department of Radiology, Antoni Van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Elisabeth G Klompenhouwer
- Department of Radiology, Antoni Van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Koert F D Kuhlmann
- Department of Surgery, Antoni Van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus MC Cancer Institute, University Hospital Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Hospital Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Martijn P A Starmans
- Department of Radiology and Nuclear Medicine, Erasmus MC Cancer Institute, University Hospital Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, Antoni Van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Antoni Van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, DK 5230, Odense M, Denmark
| | - Sean Benson
- Department of Radiology, Antoni Van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, Antoni Van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
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12
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El Khababi N, Beets-Tan RGH, Tissier R, Lahaye MJ, Maas M, Curvo-Semedo L, Dresen RC, Nougaret S, Beets GL, Lambregts DMJ. Predicting response to chemoradiotherapy in rectal cancer via visual morphologic assessment and staging on baseline MRI: a multicenter and multireader study. Abdom Radiol (NY) 2023; 48:3039-3049. [PMID: 37358604 PMCID: PMC10480283 DOI: 10.1007/s00261-023-03961-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Pre-treatment knowledge of the anticipated response of rectal tumors to neoadjuvant chemoradiotherapy (CRT) could help to further optimize the treatment. Van Griethuysen et al. proposed a visual 5-point confidence score to predict the likelihood of response on baseline MRI. Aim was to evaluate this score in a multicenter and multireader study setting and compare it to two simplified (4-point and 2-point) adaptations in terms of diagnostic performance, interobserver agreement (IOA), and reader preference. METHODS Twenty-two radiologists from 14 countries (5 MRI-experts,17 general/abdominal radiologists) retrospectively reviewed 90 baseline MRIs to estimate if patients would likely achieve a (near-)complete response (nCR); first using the 5-point score by van Griethuysen (1=highly unlikely to 5=highly likely to achieve nCR), second using a 4-point adaptation (with 1-point each for high-risk T-stage, obvious mesorectal fascia invasion, nodal involvement, and extramural vascular invasion), and third using a 2-point score (unlikely/likely to achieve nCR). Diagnostic performance was calculated using ROC curves and IOA using Krippendorf's alpha (α). RESULTS Areas under the ROC curve to predict the likelihood of a nCR were similar for the three methods (0.71-0.74). IOA was higher for the 5- and 4-point scores (α=0.55 and 0.57 versus 0.46 for the 2-point score) with best results for the MRI-experts (α=0.64-0.65). Most readers (55%) favored the 4-point score. CONCLUSIONS Visual morphologic assessment and staging methods can predict neoadjuvant treatment response with moderate-good performance. Compared to a previously published confidence-based scoring system, study readers preferred a simplified 4-point risk score based on high-risk T-stage, MRF involvement, nodal involvement, and EMVI.
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Affiliation(s)
- Najim El Khababi
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Renaud Tissier
- Biostatistics Unit, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Luís Curvo-Semedo
- Department of Radiology, Faculty of Medicine, Centro Hospitalar e Universitario de Coimbra EPE, University of Coimbra, Coimbra, Portugal
| | - Raphaëla C Dresen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Stephanie Nougaret
- Medical Imaging Department, Montpellier Cancer Institute, Montpellier Cancer Research Institute (U1194), University of Montpellier, Montpellier, France
| | - Geerard L Beets
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106 BE, Amsterdam, The Netherlands.
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands.
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13
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El Khababi N, Beets-Tan RGH, Tissier R, Lahaye MJ, Maas M, Curvo-Semedo L, Dresen RC, Nougaret S, Beets GL, Lambregts DMJ. Sense and nonsense of yT-staging on MRI after chemoradiotherapy in rectal cancer. Colorectal Dis 2023; 25:1878-1887. [PMID: 37545140 DOI: 10.1111/codi.16698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/02/2023] [Accepted: 06/08/2023] [Indexed: 08/08/2023]
Abstract
AIM The aim of this work was to investigate the value of rectal cancer T-staging on MRI after chemoradiotherapy (ymrT-staging) in relation to the degree of fibrotic transformation of the tumour bed as assessed using the pathological tumour regression grade (pTRG) of Mandard as a standard of reference. METHOD Twenty two radiologists, including five rectal MRI experts and 17 'nonexperts' (general/abdominal radiologists), evaluated the ymrT stage on the restaging MRIs of 90 rectal cancer patients after chemoradiotherapy. The ymrT stage was compared with the final ypT stage at histopathology; the percentages of correct staging (ymrT = ypT), understaging (ymrT < ypT) and overstaging (ymrT > ypT) were calculated and compared between patients with predominant tumour at histopathology (pTRG4-5) and patients with predominant fibrosis (pTRG1-3). Interobserver agreement (IOA) was computed using Krippendorff's alpha. RESULTS Average ymrT/ypT stage concordance was 48% for the experts and 43% for the nonexperts; ymrT/ypT stage concordance was significantly higher in the pTRG4-5 subgroup (58% vs. 41% for the pTRG1-3 group; p = 0.01), with the best results for the MRI experts. Overstaging was the main source of error, especially in the pTRG1-3 subgroup (average overstaging rate 38%-44% vs. 13%-55% in the pTRG4-5 subgroup). IOA was higher for the expert versus nonexpert readers (α = 0.67 vs. α = 0.39). CONCLUSIONS ymrT-staging is moderately accurate; accuracy is higher in poorly responding patients with predominant tumour but low in good responders with predominant fibrosis, resulting in significant overstaging. Radiologists should shift their focus from ymrT-staging to detecting gross residual (and progressive) disease, and identifying potential candidates for organ preservation who would benefit from further clinical and endoscopic evaluation to guide final treatment planning.
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Affiliation(s)
- Najim El Khababi
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Renaud Tissier
- Biostatistics Unit, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Luís Curvo-Semedo
- Department of Radiology, Centro Hospitalar e Universitario de Coimbra EPE, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Raphaëla C Dresen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Stephanie Nougaret
- Medical Imaging Department, Montpellier Cancer Institute, Montpellier Cancer Research Institute (U1194), University of Montpellier, Montpellier, France
| | - Geerard L Beets
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, The Netherlands
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Verschoor YL, Lambregts DMJ, van den Berg J, Grotenhuis BA, Aalbers A, Van Triest B, Beets-Tan RG, van de Belt M, Dokter S, Balduzzi S, Voest EE, Haanen JBAG, van Leerdam ME, Beets G, Chalabi M. Radiotherapy, atezolizumab, and bevacizumab in rectal cancers with the aim of organ preservation: The TARZAN study. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
158 Background: Rectal cancer is traditionally treated with total mesorectal excision (TME), with/without neoadjuvant radiotherapy (RT) and chemotherapy. This approach often leads to temporary or permanent colostomies and other long-term morbidity such as urinary and sexual dysfunction in over 60% of patients. Organ preservation is increasingly being pursued in patients with a clinical complete response (cCR) following neoadjuvant treatment, thereby aiming to avoid TME-surgery. Based on preclinical data suggesting immunomodulatory effects of RT, and the synergy of combined PD-L1/VEGF blockade in several tumor types, the TARZAN study (NCT04017455) combines these treatments aiming to increase chances of organ preservation in patients with mainly MMR proficient (pMMR) rectal cancer without the need for chemotherapy. Methods: Patients with clinical stage ≤T3ab N0-1 distal-mid rectal tumors without mesorectal fascia involvement underwent 5x5 Gy RT followed by 3 cycles of atezolizumab and bevacizumab. Response was evaluated by MRI and endoscopy. The primary endpoint was clinical complete and near-complete response (CR) rate at 12 weeks after RT. Secondary endpoints included safety, organ preservation, pathologic (near) CR in case of surgery, and relapse free survival. According to a Simon’s 2-stage design, ≥3 responders were needed in stage I (18 patients) to continue accrual into stage II. Here we report data from stage I. Results: Eighteen patients (14 male, median age 63), all with pMMR tumors, were treated. Six tumors were cN1 on MRI, 10/18 tumors were ≥4cm and for 10/18 patients abdominoperineal resection (APR) appeared necessary due to distal tumor location. At the time of response evaluation, (near-)CR was achieved in 10/18 (56%) patients according to the primary endpoint. With a median follow-up of 20 months, 9/18 (50%) patients remain without TME surgery. Of these 9 patients, 5 underwent local excision to achieve organ preservation and in 5 patients no additional intervention was needed (cCR). The remaining 9 patients underwent TME surgery (4 APR), and pathologic assessment revealed near-CR in two patients, and a pCR in one patient. Three patients developed distant recurrences, one in the organ-sparing group. Neoadjuvant treatment was well-tolerated with grade 3 study drug-related adverse events (AEs) in 1 (5%) patient. Grade 3 surgery-related AEs occurred in 5/9 (55%) patients, including 4 anastomotic leaks and 1 abscess. Conclusions: Neoadjuvant RT followed by atezolizumab and bevacizumab resulted in a promising rate of clinical (near-)CRs in 56% of patients without the need for chemotherapy, reaching the primary endpoint. Accrual is ongoing in stage II, in which an additional 20 patients will be treated. Clinical trial information: NCT04017455 .
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Affiliation(s)
- Yara L. Verschoor
- Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - José van den Berg
- Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Arend Aalbers
- Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Baukelien Van Triest
- Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Regina G.H. Beets-Tan
- Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Marieke van de Belt
- Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Simone Dokter
- Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Sara Balduzzi
- Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Emile E. Voest
- Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands
| | - John B. A. G. Haanen
- Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Geerard Beets
- Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Myriam Chalabi
- Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, Netherlands
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16
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Bogveradze N, Snaebjornsson P, Grotenhuis BA, van Triest B, Lahaye MJ, Maas M, Beets GL, Beets-Tan RGH, Lambregts DMJ. MRI anatomy of the rectum: key concepts important for rectal cancer staging and treatment planning. Insights Imaging 2023; 14:13. [PMID: 36652149 PMCID: PMC9849549 DOI: 10.1186/s13244-022-01348-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/04/2022] [Indexed: 01/19/2023] Open
Abstract
A good understanding of the MRI anatomy of the rectum and its surroundings is pivotal to ensure high-quality diagnostic evaluation and reporting of rectal cancer. With this pictorial review, we aim to provide an image-based overview of key anatomical concepts essential for treatment planning, response evaluation and post-operative assessment. These concepts include the cross-sectional anatomy of the rectal wall in relation to T-staging; differences in staging and treatment between anal and rectal cancer; landmarks used to define the upper and lower boundaries of the rectum; the anatomy of the pelvic floor and anal canal, the mesorectal fascia, peritoneum and peritoneal reflection; and guides to help discern different pelvic lymph node stations on MRI to properly stage regional and non-regional rectal lymph node metastases. Finally, this review will highlight key aspects of post-treatment anatomy, including the assessment of radiation-induced changes and the evaluation of the post-operative pelvis after different surgical resection and reconstruction techniques.
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Affiliation(s)
- Nino Bogveradze
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands ,grid.5012.60000 0001 0481 6099GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands ,Department of Radiology, American Hospital Tbilisi, Tbilisi, Georgia
| | - Petur Snaebjornsson
- grid.430814.a0000 0001 0674 1393Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Brechtje A. Grotenhuis
- grid.430814.a0000 0001 0674 1393Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Baukelien van Triest
- grid.430814.a0000 0001 0674 1393Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Max J. Lahaye
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
| | - Monique Maas
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
| | - Geerard L. Beets
- grid.5012.60000 0001 0481 6099GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands ,grid.430814.a0000 0001 0674 1393Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G. H. Beets-Tan
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands ,grid.5012.60000 0001 0481 6099GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands ,grid.10825.3e0000 0001 0728 0170Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Doenja M. J. Lambregts
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
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17
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El Khababi N, Beets-Tan RGH, Tissier R, Lahaye MJ, Maas M, Curvo-Semedo L, Dresen RC, Nougaret S, Beets GL, Lambregts DMJ. Comparison of MRI response evaluation methods in rectal cancer: a multicentre and multireader validation study. Eur Radiol 2022; 33:4367-4377. [PMID: 36576549 DOI: 10.1007/s00330-022-09342-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/30/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To compare four previously published methods for rectal tumor response evaluation after chemoradiotherapy on MRI. METHODS Twenty-two radiologists (5 rectal MRI experts, 17 general/abdominal radiologists) retrospectively reviewed the post-chemoradiotherapy MRIs of 90 patients, scanned at 10 centers (with non-standardized protocols). They applied four response methods; two based on T2W-MRI only (MRI tumor regression grade (mrTRG); split-scar sign), and two based on T2W-MRI+DWI (modified-mrTRG; DWI-patterns). Image quality was graded using a 0-6-point score (including slice thickness and in-plane resolution; sequence angulation; DWI b-values, signal-to-noise, and artefacts); scores < 4 were classified below average. Mixed model linear regression was used to calculate average sensitivity/specificity/accuracy to predict a complete response (versus residual tumor) and assess the impact of reader experience and image quality. Group interobserver agreement (IOA) was calculated using Krippendorff's alpha. Readers were asked to indicate their preferred scoring method(s). RESULTS Average sensitivity/specificity/accuracy was 57%/64%/62% (mrTRG), 36%/79%/66% (split-scar), 40%/79%/67% (modified-mrTRG), and 37%/82%/68% (DWI-patterns); mrTRG showed higher sensitivity but lower specificity and accuracy (p < 0.001) compared to the other methods. IOA was lower for the split scar method (0.18 vs. 0.39-0.43). Higher reader experience had a significant positive effect on diagnostic performance and IOA (except for the split scar sign); below-average imaging quality had a significant negative effect on diagnostic performance. DWI pattern was selected as the preferred method by 73% of readers. CONCLUSIONS Methods incorporating DWI showed the most favorable results when combining diagnostic performance, IOA, and reader preference. Reader experience and image quality clearly impacted diagnostic performance emphasizing the need for state-of-the-art imaging and dedicated radiologist training. KEY POINTS • In a multireader study comparing 4 MRI methods for rectal tumor response evaluation, those incorporating DWI showed the best results when combining diagnostic performance, IOA, and reader preference. • The most preferred method (by 73% of readers) was the "DWI patterns" approach with an accuracy of 68%, high specificity of 82%, and group IOA of 0.43. • Reader experience level and MRI quality had an evident effect on diagnostic performance and IOA.
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Affiliation(s)
- Najim El Khababi
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106, BE, Amsterdam, The Netherlands.,GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106, BE, Amsterdam, The Netherlands.,GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Renaud Tissier
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106, BE, Amsterdam, The Netherlands.,GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106, BE, Amsterdam, The Netherlands.,GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Luís Curvo-Semedo
- Department of Radiology, Centro Hospitalar e Universitario de Coimbra EPE, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Raphaëla C Dresen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Stephanie Nougaret
- Medical Imaging Department, Montpellier Cancer Institute, Montpellier Cancer Research Institute (U1194), University of Montpellier, Montpellier, France
| | - Geerard L Beets
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands.,Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1106, BE, Amsterdam, The Netherlands. .,GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands.
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18
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Custers PA, Geubels BM, Beets GL, Lambregts DMJ, van Leerdam ME, van Triest B, Maas M. Defining near-complete response following (chemo)radiotherapy for rectal cancer: systematic review. Br J Surg 2022; 110:43-49. [PMID: 36349555 DOI: 10.1093/bjs/znac372] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/09/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND A uniform definition of a clinical near-complete response (near-CR) after neoadjuvant (chemo)radiotherapy for rectal cancer is lacking. A clear definition is necessary for uniformity in clinical practice and trial enrolment for organ-preserving treatments. This review aimed to provide an overview of the terminology, criteria, and features used in the literature to define a near-CR. METHODS A systematic review was performed based on the PRISMA statement. PubMed and Embase were searched up to May 2021 to identify the terminology, criteria, and features used to define a near-CR after (chemo)radiotherapy for rectal cancer. Studies with no clear cut-off point between a cCR and near-CR, studies using Response Evaluation Criteria In Solid Tumours, and studies including only complete responders were excluded. RESULTS A total of 1876 articles were found, of which 23 were included. Patients were managed by watchful waiting and/or additional local treatment in 11 and 17 of 23 studies respectively. Response evaluation included digital rectal examination (DRE) and/or endoscopy with MRI in 18 studies. The majority of studies used the term 'near-complete response'. In most studies, minor irregularities or a smooth induration with DRE and a small flat ulcer on endoscopy were considered to indicate a near-CR. On MRI, five studies used features (obvious downstaging with or without heterogeneous/irregular fibrosis on T2-weighted MRI or small spot of high signal on diffusion-weighted imaging), five studies used TNM criteria (ycT2), and four used magnetic resonance tumour regression grade (mrTRG) (mrTRG1-2/mrTRG2) to describe a near-CR. CONCLUSION The terminology, criteria, and features used to describe a near-CR vary substantially, which can partly be explained by the different treatment strategies patients are selected for (watchful waiting or additional local treatment). A reproducible definition of near-CR is required.
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Affiliation(s)
- Petra A Custers
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.,GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Barbara M Geubels
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.,GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.,Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.,GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.,Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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19
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Sluckin TC, Hazen SMJA, Horsthuis K, Lambregts DMJ, Beets-Tan RGH, Tanis PJ, Kusters M. Significant improvement after training in the assessment of lateral compartments and short-axis measurements of lateral lymph nodes in rectal cancer. Eur Radiol 2022; 33:483-492. [PMID: 35802179 DOI: 10.1007/s00330-022-08968-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVES In patients with rectal cancer, the size and location of lateral lymph nodes (LLNs) are correlated to increased lateral local recurrence rates. Sufficient knowledge and accuracy when measuring these features are therefore essential. The objective of this study was to evaluate the variation in measurements and anatomical classifications of LLNs before and after training. METHODS Fifty-three Dutch radiologists examined three rectal MRI scans and completed a questionnaire. Presence, location, size, and suspiciousness of LLNs were reported. This assessment was repeated after a 2-hour online training by the same radiologists with the same three cases plus three additional cases. Three expert radiologists independently evaluated these 6 cases and served as the standard of reference. RESULTS Correct identification of the anatomical location improved in case 1 (62 to 77% (p = .077)) and in case 2 (46 to 72% (p = .007)) but decreased in case 3 (92 to 74%, p = .453). Compared to the first three cases, cases 4, 5, and 6 all had a higher initial consensus of 73%, 79%, and 85%, respectively. The mean absolute deviation of the short-axis measurements in cases 1-3 were closer-though not significantly-to the expert reference value after training with reduced ranges and standard deviations. Subjective determination of malignancy had a high consensus rate between participants and experts. CONCLUSION Though finding a high consensus rate for determining malignancy of LLNs, variation in short-axis measurements and anatomical location classifications were present and improved after training. Adequate training would support the challenges involved in evaluating LLNs appropriately. KEY POINTS • Variation was present in the assessment of the anatomical location and short-axis size of lateral lymph nodes. • In certain cases, the accuracy of short-axis measurements and anatomical location, when compared to an expert reference value, improved after a training session. • Consensus before and after training on whether an LLN was subjectively considered to be suspicious for malignancy was high.
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Affiliation(s)
- Tania C Sluckin
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Sanne-Marije J A Hazen
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Karin Horsthuis
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, the Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, Maastricht, The Netherlands.,Department of Radiology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Campusvej 55, DK-5230, Odense, Denmark
| | - Pieter J Tanis
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Doctor Molewaterplein 40, Rotterdam, the Netherlands
| | - Miranda Kusters
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, the Netherlands. .,Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands. .,Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands.
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20
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Lambregts DMJ, Bogveradze N, Blomqvist LK, Fokas E, Garcia-Aguilar J, Glimelius B, Gollub MJ, Konishi T, Marijnen CAM, Nagtegaal ID, Nilsson PJ, Perez RO, Snaebjornsson P, Taylor SA, Tolan DJM, Valentini V, West NP, Wolthuis A, Lahaye MJ, Maas M, Beets GL, Beets-Tan RGH. Current controversies in TNM for the radiological staging of rectal cancer and how to deal with them: results of a global online survey and multidisciplinary expert consensus. Eur Radiol 2022; 32:4991-5003. [PMID: 35254485 PMCID: PMC9213337 DOI: 10.1007/s00330-022-08591-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/22/2021] [Accepted: 01/13/2022] [Indexed: 12/17/2022]
Abstract
Abstract
Objectives
To identify the main problem areas in the applicability of the current TNM staging system (8th ed.) for the radiological staging and reporting of rectal cancer and provide practice recommendations on how to handle them.
Methods
A global case-based online survey was conducted including 41 image-based rectal cancer cases focusing on various items included in the TNM system. Cases reaching < 80% agreement among survey respondents were identified as problem areas and discussed among an international expert panel, including 5 radiologists, 6 colorectal surgeons, 4 radiation oncologists, and 3 pathologists.
Results
Three hundred twenty-one respondents (from 32 countries) completed the survey. Sixteen problem areas were identified, related to cT staging in low-rectal cancers, definitions for cT4b and cM1a disease, definitions for mesorectal fascia (MRF) involvement, evaluation of lymph nodes versus tumor deposits, and staging of lateral lymph nodes. The expert panel recommended strategies on how to handle these, including advice on cT-stage categorization in case of involvement of different layers of the anal canal, specifications on which structures to include in the definition of cT4b disease, how to define MRF involvement by the primary tumor and other tumor-bearing structures, how to differentiate and report lymph nodes and tumor deposits on MRI, and how to anatomically localize and stage lateral lymph nodes.
Conclusions
The recommendations derived from this global survey and expert panel discussion may serve as a practice guide and support tool for radiologists (and other clinicians) involved in the staging of rectal cancer and may contribute to improved consistency in radiological staging and reporting.
Key Points
• Via a case-based online survey (incl. 321 respondents from 32 countries), we identified 16 problem areas related to the applicability of the TNM staging system for the radiological staging and reporting of rectal cancer.
• A multidisciplinary panel of experts recommended strategies on how to handle these problem areas, including advice on cT-stage categorization in case of involvement of different layers of the anal canal, specifications on which structures to include in the definition of cT4b disease, how to define mesorectal fascia involvement by the primary tumor and other tumor-bearing structures, how to differentiate and report lymph nodes and tumor deposits on MRI, and how to anatomically localize and stage lateral lymph nodes.
• These recommendations may serve as a practice guide and support tool for radiologists (and other clinicians) involved in the staging of rectal cancer and may contribute to improved consistency in radiological staging and reporting.
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Affiliation(s)
- Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands.
| | - Nino Bogveradze
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Radiology, American Hospital Tbilisi, Tbilisi, Georgia
| | - Lennart K Blomqvist
- Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Emmanouil Fokas
- Department of Radiooncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Julio Garcia-Aguilar
- Department of Surgery, Colorectal Service, Benno C. Schmidt Chair in Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tsuyoshi Konishi
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Corrie A M Marijnen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Per J Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Division of Coloproctology, Pelvic Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Rodrigo O Perez
- Hospital Alemão Oswaldo Cruz & Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Petur Snaebjornsson
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London Hospital, London, UK
| | - Damian J M Tolan
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Vincenzo Valentini
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica S. Cuore, Rome, Italy
| | - Nicholas P West
- Pathology & Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands.
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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21
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Schurink NW, van Kranen SR, Roberti S, van Griethuysen JJM, Bogveradze N, Castagnoli F, El Khababi N, Bakers FCH, de Bie SH, Bosma GPT, Cappendijk VC, Geenen RWF, Neijenhuis PA, Peterson GM, Veeken CJ, Vliegen RFA, Beets-Tan RGH, Lambregts DMJ. Sources of variation in multicenter rectal MRI data and their effect on radiomics feature reproducibility. Eur Radiol 2022; 32:1506-1516. [PMID: 34655313 PMCID: PMC8831294 DOI: 10.1007/s00330-021-08251-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To investigate sources of variation in a multicenter rectal cancer MRI dataset focusing on hardware and image acquisition, segmentation methodology, and radiomics feature extraction software. METHODS T2W and DWI/ADC MRIs from 649 rectal cancer patients were retrospectively acquired in 9 centers. Fifty-two imaging features (14 first-order/6 shape/32 higher-order) were extracted from each scan using whole-volume (expert/non-expert) and single-slice segmentations using two different software packages (PyRadiomics/CapTk). Influence of hardware, acquisition, and patient-intrinsic factors (age/gender/cTN-stage) on ADC was assessed using linear regression. Feature reproducibility was assessed between segmentation methods and software packages using the intraclass correlation coefficient. RESULTS Image features differed significantly (p < 0.001) between centers with more substantial variations in ADC compared to T2W-MRI. In total, 64.3% of the variation in mean ADC was explained by differences in hardware and acquisition, compared to 0.4% by patient-intrinsic factors. Feature reproducibility between expert and non-expert segmentations was good to excellent (median ICC 0.89-0.90). Reproducibility for single-slice versus whole-volume segmentations was substantially poorer (median ICC 0.40-0.58). Between software packages, reproducibility was good to excellent (median ICC 0.99) for most features (first-order/shape/GLCM/GLRLM) but poor for higher-order (GLSZM/NGTDM) features (median ICC 0.00-0.41). CONCLUSIONS Significant variations are present in multicenter MRI data, particularly related to differences in hardware and acquisition, which will likely negatively influence subsequent analysis if not corrected for. Segmentation variations had a minor impact when using whole volume segmentations. Between software packages, higher-order features were less reproducible and caution is warranted when implementing these in prediction models. KEY POINTS • Features derived from T2W-MRI and in particular ADC differ significantly between centers when performing multicenter data analysis. • Variations in ADC are mainly (> 60%) caused by hardware and image acquisition differences and less so (< 1%) by patient- or tumor-intrinsic variations. • Features derived using different image segmentations (expert/non-expert) were reproducible, provided that whole-volume segmentations were used. When using different feature extraction software packages with similar settings, higher-order features were less reproducible.
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Affiliation(s)
- Niels W Schurink
- Department of Radiology, The Netherlands Cancer Institute, POB 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Simon R van Kranen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sander Roberti
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joost J M van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, POB 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Nino Bogveradze
- Department of Radiology, The Netherlands Cancer Institute, POB 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
- Department of Radiology, Acad. F. Todua Medical Center, Research Institute of Clinical Medicine, Tbilisi, Georgia
| | - Francesca Castagnoli
- Department of Radiology, The Netherlands Cancer Institute, POB 90203, 1006 BE, Amsterdam, The Netherlands
| | - Najim El Khababi
- Department of Radiology, The Netherlands Cancer Institute, POB 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Frans C H Bakers
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Shira H de Bie
- Department of Radiology, Deventer Ziekenhuis, Deventer, The Netherlands
| | - Gerlof P T Bosma
- Department of Interventional Radiology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Vincent C Cappendijk
- Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Remy W F Geenen
- Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands
| | | | | | - Cornelis J Veeken
- Department of Radiology, IJsselland Hospital, Capelle Aan Den IJssel, The Netherlands
| | - Roy F A Vliegen
- Department of Radiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, POB 90203, 1006 BE, Amsterdam, The Netherlands.
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands.
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, POB 90203, 1006 BE, Amsterdam, The Netherlands.
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22
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Hazen SMJA, Sluckin TC, Horsthuis K, Lambregts DMJ, Beets-Tan RGH, Tanis PJ, Kusters M. Evaluation of the implementation of the sigmoid take-off landmark in the Netherlands. Colorectal Dis 2022; 24:292-307. [PMID: 34839573 DOI: 10.1111/codi.16005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/03/2021] [Accepted: 11/18/2021] [Indexed: 12/15/2022]
Abstract
AIM The sigmoid take-off (STO), the point on imaging where the sigmoid sweeps ventral from the sacrum, was chosen as the definition of the rectum during an international Delphi consensus meeting and has been incorporated into the Dutch guidelines since October 2019. The aim of this study was to evaluate the implementation of this landmark 1 year after the guideline implementation and to perform a quality assessment of the STO training. METHOD Dutch radiologists, surgeons, surgical residents, interns, PhD students and physician assistants were asked to complete a survey and classify 20 tumours on MRI as 'below', 'on' or 'above' the STO. Outcomes were agreement with the expert reference, inter-rater variability and accuracy before and after the training. RESULTS Eighty-six collaborators participated. Six radiologists (32%) and 11 surgeons (73%) used the STO as the standard landmark to distinguish between rectal and sigmoidal tumours during multidisciplinary meetings. Overall agreement with the expert reference improved from 53% to 70% (p < 0.001) after the training. The positive predictive value for diagnosing rectal tumours was high before and after the training (92% vs. 90%); the negative predictive value for diagnosing sigmoidal tumours improved from 39% to 63%. CONCLUSION Approximately half of the represented hospitals have implemented the new definition of rectal cancer 1 year after the implementation of the Dutch national guidelines. Overall baseline agreement with the expert reference and accuracy for the tumours around the STO was low, but improved significantly after training. These results highlight the added value of training in implementation of radiological landmarks to ensure unambiguous assessment.
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Affiliation(s)
- Sanne-Marije J A Hazen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tania C Sluckin
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karin Horsthuis
- Department of Radiology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Miranda Kusters
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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23
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Rijsemus CJV, Kok NFM, Aalbers AGJ, Buffart TE, Fijneman RJA, Snaebjornsson P, Engbersen M, Lambregts DMJ, Beets-Tan RGH, Lahaye MJ. Diagnostic performance of MRI for staging peritoneal metastases in patients with colorectal cancer after neoadjuvant chemotherapy. Eur J Radiol 2022; 149:110225. [DOI: 10.1016/j.ejrad.2022.110225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/31/2022] [Accepted: 02/16/2022] [Indexed: 11/03/2022]
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24
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Bogveradze N, El Khababi N, Schurink NW, van Griethuysen JJM, de Bie S, Bosma G, Cappendijk VC, Geenen RWF, Neijenhuis P, Peterson G, Veeken CJ, Vliegen RFA, Maas M, Lahaye MJ, Beets GL, Beets-Tan RGH, Lambregts DMJ. Evolutions in rectal cancer MRI staging and risk stratification in The Netherlands. Abdom Radiol (NY) 2022; 47:38-47. [PMID: 34605966 PMCID: PMC8776669 DOI: 10.1007/s00261-021-03281-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022]
Abstract
Purpose To analyze how the MRI reporting of rectal cancer has evolved (following guideline updates) in The Netherlands. Methods Retrospective analysis of 712 patients (2011–2018) from 8 teaching hospitals in The Netherlands with available original radiological staging reports that were re-evaluated by a dedicated MR expert using updated guideline criteria. Original reports were classified as “free-text,” “semi-structured,” or “template” and completeness of reporting was documented. Patients were categorized as low versus high risk, first based on the original reports (high risk = cT3-4, cN+, and/or cMRF+) and then based on the expert re-evaluations (high risk = cT3cd-4, cN+, MRF+, and/or EMVI+). Evolutions over time were studied by splitting the inclusion period in 3 equal time periods. Results A significant increase in template reporting was observed (from 1.6 to 17.6–29.6%; p < 0.001), along with a significant increase in the reporting of cT-substage, number of N+ and extramesorectal nodes, MRF invasion and tumor-MRF distance, EMVI, anal sphincter involvement, and tumor morphology and circumference. Expert re-evaluation changed the risk classification from high to low risk in 18.0% of cases and from low to high risk in 1.7% (total 19.7%). In the majority (17.9%) of these cases, the changed risk classification was likely (at least in part) related to use of updated guideline criteria, which mainly led to a reduction in high-risk cT-stage and nodal downstaging. Conclusion Updated concepts of risk stratification have increasingly been adopted, accompanied by an increase in template reporting and improved completeness of reporting. Use of updated guideline criteria resulted in considerable downstaging (of mainly high-risk cT-stage and nodal stage). Graphic abstract ![]()
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Affiliation(s)
- Nino Bogveradze
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
- Department of Radiology, Acad. F. Todua Medical Center, Research Institute of Clinical Medicine, Tbilisi, Georgia
| | - Najim El Khababi
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Niels W Schurink
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Joost J M van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Shira de Bie
- Department of Radiology, Deventer Ziekenhuis, Deventer, The Netherlands
| | - Gerlof Bosma
- Department of Radiology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Vincent C Cappendijk
- Department of Radiology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Remy W F Geenen
- Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Peter Neijenhuis
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Gerald Peterson
- Department of Radiology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Cornelis J Veeken
- Department of Radiology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Roy F A Vliegen
- Department of Radiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Geerard L Beets
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology & Developmental Biology, University of Maastricht, Maastricht, The Netherlands
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands.
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25
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Bogveradze N, Lambregts DMJ, El Khababi N, Dresen RC, Maas M, Kusters M, Tanis PJ, Beets-Tan RGH. The sigmoid take-off as a landmark to distinguish rectal from sigmoid tumours on MRI: Reproducibility, pitfalls and potential impact on treatment stratification. Eur J Surg Oncol 2021; 48:237-244. [PMID: 34583878 DOI: 10.1016/j.ejso.2021.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The sigmoid take-off (STO) was recently introduced as a preferred landmark, agreed upon by expert consensus recommendation, to discern rectal from sigmoid cancer on imaging. Aim of this study was to assess the reproducibility of the STO, explore its potential treatment impact and identify its main interpretation pitfalls. METHODS Eleven international radiologists (with varying expertise) retrospectively assessed n = 155 patients with previously clinically staged upper rectal/rectosigmoid tumours and re-classified them using the STO as completely below (rectum), straddling the STO (rectosigmoid) or completely above (sigmoid), after which scores were dichotomized as rectum (below/straddling STO) and sigmoid (above STO), being the clinically most relevant distinction. A random subset of n = 48 was assessed likewise by 6 colorectal surgeons. . RESULTS Interobserver agreement (IOA) for the 3-category score ranged from κ0.19-0.82 (radiologists) and κ0.32-0.72 (surgeons), with highest scores for the most experienced radiologists (κ0.69-0.76). Of the 155 cases, 44 (28%) were re-classified by ≥ 80% of radiologists as sigmoid cancers; 36 of these originally received neoadjuvant treatment which in retrospect might have been omitted if the STO had been applied. Main interpretation pitfalls were related to anatomical variations, borderline cases near the STO and angulation of axial imaging planes. CONCLUSIONS Good agreement was reached for experienced radiologists. Despite considerable variation among less-expert readers, use of the STO could have changed treatment in ±1/4 of patients in our cohort. Identified interpretation pitfalls may serve as a basis for teaching and to further optimize MR protocols.
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Affiliation(s)
- Nino Bogveradze
- Dept. of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology & Developmental Biology - University of Maastricht, Maastricht, the Netherlands; Dept. of Radiology, Acad. F. Todua Medical Center, Research Institute of Clinical Medicine, Tbilisi, Georgia
| | - Doenja M J Lambregts
- Dept. of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Najim El Khababi
- Dept. of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology & Developmental Biology - University of Maastricht, Maastricht, the Netherlands
| | | | - Monique Maas
- Dept. of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Miranda Kusters
- Dept. of Surgery, Amsterdam University Medical Centres, Cancer Centre Amsterdam, the Netherlands
| | - Pieter J Tanis
- Dept. of Surgery, Amsterdam University Medical Centres, Cancer Centre Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- Dept. of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology & Developmental Biology - University of Maastricht, Maastricht, the Netherlands
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Min LA, Castagnoli F, Vogel WV, Vellenga JP, van Griethuysen JJM, Lahaye MJ, Maas M, Beets Tan RGH, Lambregts DMJ. A decade of multi-modality PET and MR imaging in abdominal oncology. Br J Radiol 2021; 94:20201351. [PMID: 34387508 PMCID: PMC9328040 DOI: 10.1259/bjr.20201351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate trends observed in a decade of published research on multimodality PET(/CT)+MR imaging in abdominal oncology, and to explore how these trends are reflected by the use of multimodality imaging performed at our institution. METHODS First, we performed a literature search (2009-2018) including all papers published on the multimodality combination of PET(/CT) and MRI in abdominal oncology. Retrieved papers were categorized according to a structured labelling system, including study design and outcome, cancer and lesion type under investigation and PET-tracer type. Results were analysed using descriptive statistics and evolutions over time were plotted graphically. Second, we performed a descriptive analysis of the numbers of MRI, PET/CT and multimodality PET/CT+MRI combinations (performed within a ≤14 days interval) performed during a similar time span at our institution. RESULTS Published research papers involving multimodality PET(/CT)+MRI combinations showed an impressive increase in numbers, both for retrospective combinations of PET/CT and MRI, as well as hybrid PET/MRI. Main areas of research included new PET-tracers, visual PET(/CT)+MRI assessment for staging, and (semi-)quantitative analysis of PET-parameters compared to or combined with MRI-parameters as predictive biomarkers. In line with literature, we also observed a vast increase in numbers of multimodality PET/CT+MRI imaging in our institutional data. CONCLUSIONS The tremendous increase in published literature on multimodality imaging, reflected by our institutional data, shows the continuously growing interest in comprehensive multivariable imaging evaluations to guide oncological practice. ADVANCES IN KNOWLEDGE The role of multimodality imaging in oncology is rapidly evolving. This paper summarizes the main applications and recent developments in multimodality imaging, with a specific focus on the combination of PET+MRI in abdominal oncology.
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Affiliation(s)
- Lisa A Min
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | | | - Wouter V Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jisk P Vellenga
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joost J M van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands.,Faculty or Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Nowee ME, van Pelt VWJ, Walraven I, Simões R, Liskamp CP, Lambregts DMJ, Heijmink S, Schaake E, van der Heide UA, Janssen TM. The impact of image acquisition time on registration, delineation and image quality for magnetic resonance guided radiotherapy of prostate cancer patients. Phys Imaging Radiat Oncol 2021; 19:85-89. [PMID: 34355071 PMCID: PMC8325094 DOI: 10.1016/j.phro.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/03/2021] [Accepted: 07/01/2021] [Indexed: 12/22/2022]
Abstract
Background and Purpose Magnetic resonance (MR) guided radiotherapy utilizes MR images for (online) plan adaptation and image guidance. The aim of this study was to investigate the impact of variation in MR acquisition time and scan resolution on image quality, interobserver variation in contouring and interobserver variation in registration. Materials and Methods Nine patients with prostate cancer were included. Four T2-weighted 3D turbo spin echo (T2w 3D TSE) sequences were acquired with different acquisition times and resolutions. Two radiologists assessed image quality, conspicuity of the capsule, peripheral zone and central gland architecture and motion artefacts on a 5 point scale. Images were delineated by two radiation oncologists and interobserver variation was assessed by the 95% Hausdorff distance. Seven observers registered the MR images on the planning CT. Registrations were compared on systematic offset and interobserver variation. Results Acquisition times ranged between 1.3 and 6.3 min. Overall image quality and capsule definition were significantly worse for the MR sequence with an acquisition time of 1.3 min compared to the other sequences. Median 95% Hausdorff distance showed no significant differences in interobserver variation of contouring. Systematic offset and interobserver variation in registration were small (<1 mm) and of no clinical significance. Conclusions Our results can be used to effectively shorten overall fraction time for online adaptive MR guided radiotherapy by optimising the imaging sequence used for registration. From the sequences studied, a sequence of 3.1 min with anisotropic voxels of 1.2 × 1.2 × 2.4 mm3 provided the shortest acquisition time without compromising image quality.
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Affiliation(s)
- M E Nowee
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - V W J van Pelt
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - I Walraven
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R Simões
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C P Liskamp
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Heijmink
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E Schaake
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - U A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - T M Janssen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Haak HE, Beets GL, Peeters K, Nelemans PJ, Valentini V, Rödel C, Kuo L, Calvo FA, Garcia-Aguilar J, Glynne-Jones R, Pucciarelli S, Suarez J, Theodoropoulos G, Biondo S, Lambregts DMJ, Beets-Tan RGH, Maas M. Prevalence of nodal involvement in rectal cancer after chemoradiotherapy. Br J Surg 2021; 108:1251-1258. [PMID: 34240110 DOI: 10.1093/bjs/znab194] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/28/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the prevalence of ypN+ status according to ypT category in patients with locally advanced rectal cancer treated with chemoradiotherapy and total mesorectal excision, and to assess the impact of ypN+ on disease recurrence and survival by pooled analysis of individual-patient data. METHODS Individual-patient data from 10 studies of chemoradiotherapy for rectal cancer were included. Pooled rates of ypN+ disease were calculated with 95 per cent confidence interval for each ypT category. Kaplan-Meier and Cox regression analyses were undertaken to assess influence of ypN status on 5-year disease-free survival (DFS) and overall survival (OS). RESULTS Data on 1898 patients were included in the study. Median follow-up was 50 (range 0-219) months. The pooled rate of ypN+ disease was 7 per cent for ypT0, 12 per cent for ypT1, 17 per cent for ypT2, 40 per cent for ypT3, and 46 per cent for ypT4 tumours. Patients with ypN+ disease had lower 5-year DFS and OS (46.2 and 63.4 per cent respectively) than patients with ypN0 tumours (74.5 and 83.2 per cent) (P < 0.001). Cox regression analyses showed ypN+ status to be an independent predictor of recurrence and death. CONCLUSION Risk of nodal metastases (ypN+) after chemoradiotherapy increases with advancing ypT category and needs to be considered if an organ-preserving strategy is contemplated.
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Affiliation(s)
- H E Haak
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - G L Beets
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - K Peeters
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - P J Nelemans
- Department of Epidemiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - V Valentini
- Department of Radiation Oncology, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - C Rödel
- Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - L Kuo
- Department of Colorectal Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - F A Calvo
- Department of Oncology, General University Hospital Gregorio Marañón, Madrid, Spain
| | - J Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Centre, New York, USA
| | - R Glynne-Jones
- Department of Clinical Oncology, Mount Vernon Hospital, London, UK
| | - S Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padua, Padua, Italy
| | - J Suarez
- Department of Surgery, Hospital de Navarra, Pamplona, Spain
| | - G Theodoropoulos
- First Department of Propaedeutic Surgery, Athens Medical School, Hippocration General Hospital, Athens, Greece
| | - S Biondo
- Department of Surgery, Bellvitge University Hospital, Barcelona, Spain.,IDIBELL, University of Barcelona, Barcelona, Spain
| | - D M J Lambregts
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R G H Beets-Tan
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M Maas
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Haak HE, Žmuc J, Lambregts DMJ, Beets-Tan RGH, Melenhorst J, Beets GL, Maas M. The evaluation of follow-up strategies of watch-and-wait patients with a complete response after neoadjuvant therapy in rectal cancer. Colorectal Dis 2021; 23:1785-1792. [PMID: 33725387 DOI: 10.1111/codi.15636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/19/2021] [Accepted: 03/05/2021] [Indexed: 12/25/2022]
Abstract
AIM Many of the current follow-up schedules in a watch-and-wait approach include very frequent MRI and endoscopy examinations to ensure early detection of local regrowth (LR). The aim of this study was to analyse the occurrence and detection of LR in a watch-and-wait cohort and to suggest a more efficient follow-up schedule. METHOD Rectal cancer patients with a clinical complete response after neoadjuvant therapy were prospectively and retrospectively included in a multicentre watch-and-wait registry between 2004 and 2018, with the current follow-up schedule with 3-monthly endoscopy and MRI in the first year and 6 monthly thereafter. A theoretical comparison was constructed for the detection of LR in the current follow-up schedule against four other hypothetical schedules. RESULTS In all, 50/304 (16%) of patients developed a LR. The majority (98%) were detected at ≤2 years, located in the lumen (94%) and were visible on endoscopy (88%). The theoretical comparison of the different hypothetical schedules suggests that the optimal follow-up schedule should focus on the first 2 years with 3-monthly endoscopy and 3-6 monthly MRI. Longer intervals in the first 2 years will cause delays in diagnosis of LR ranging from 0 to 5 months. After 2 years, increasing the interval from 6 to 12 months did not cause important delays. CONCLUSION The optimal follow-up schedule for a watch-and-wait policy in patients with a clinical complete response after chemoradiation for rectal cancer should include frequent endoscopy and to a lesser degree MRI in the first 2 years. Longer intervals, up to 12 months, can be considered after 2 years.
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Affiliation(s)
- Hester E Haak
- Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Jan Žmuc
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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30
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Staal FCR, Taghavi M, van der Reijd DJ, Gomez FM, Imani F, Klompenhouwer EG, Meek D, Roberti S, de Boer M, Lambregts DMJ, Beets-Tan RGH, Maas M. Predicting local tumour progression after ablation for colorectal liver metastases: CT-based radiomics of the ablation zone. Eur J Radiol 2021; 141:109773. [PMID: 34022475 DOI: 10.1016/j.ejrad.2021.109773] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/23/2021] [Accepted: 05/10/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess whether CT-based radiomics of the ablation zone (AZ) can predict local tumour progression (LTP) after thermal ablation for colorectal liver metastases (CRLM). MATERIALS AND METHODS Eighty-two patients with 127 CRLM were included. Radiomics features (with different filters) were extracted from the AZ and a 10 mm periablational rim (PAR)on portal-venous-phase CT up to 8 weeks after ablation. Multivariable stepwise Cox regression analyses were used to predict LTP based on clinical and radiomics features. Performance (concordance [c]-statistics) of the different models was compared and performance in an 'independent' dataset was approximated with bootstrapped leave-one-out-cross-validation (LOOCV). RESULTS Thirty-three lesions (26 %) developed LTP. Median follow-up was 21 months (range 6-115). The combined model, a combination of clinical and radiomics features, included chemotherapy (HR 0.50, p = 0.024), cT-stage (HR 10.13, p = 0.016), lesion size (HR 1.11, p = <0.001), AZ_Skewness (HR 1.58, p = 0.016), AZ_Uniformity (HR 0.45, p = 0.002), PAR_Mean (HR 0.52, p = 0.008), PAR_Skewness (HR 1.67, p = 0.019) and PAR_Uniformity (HR 3.35, p < 0.001) as relevant predictors for LTP. The predictive performance of the combined model (after LOOCV) yielded a c-statistic of 0.78 (95 %CI 0.65-0.87), compared to the clinical or radiomics models only (c-statistic 0.74 (95 %CI 0.58-0.84) and 0.65 (95 %CI 0.52-0.83), respectively). CONCLUSION Combining radiomics features with clinical features yielded a better performing prediction of LTP than radiomics only. CT-based radiomics of the AZ and PAR may have potential to aid in the prediction of LTP during follow-up in patients with CRLM.
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Affiliation(s)
- F C R Staal
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
| | - M Taghavi
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - D J van der Reijd
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - F M Gomez
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Radiology, Hospital Clinic de Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - F Imani
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - E G Klompenhouwer
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - D Meek
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - S Roberti
- Department of Epidemiology and Biostatistics, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - M de Boer
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - D M J Lambregts
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - R G H Beets-Tan
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - M Maas
- Department of Radiology, Antoni van Leeuwenhoek - The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
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Engbersen MP, Rijsemus CJV, Nederend J, Aalbers AGJ, de Hingh IHJT, Retel V, Lambregts DMJ, Van der Hoeven EJRJ, Boerma D, Wiezer MJ, De Vries M, Madsen EVE, Brandt-Kerkhof ARM, Van Koeverden S, De Reuver PR, Beets-Tan RGH, Kok NFM, Lahaye MJ. Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomized multicenter trial. BMC Cancer 2021; 21:464. [PMID: 33902498 PMCID: PMC8077799 DOI: 10.1186/s12885-021-08168-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/11/2021] [Indexed: 12/18/2022] Open
Abstract
Background Selecting patients with peritoneal metastases from colorectal cancer (CRCPM) who might benefit from cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is challenging. Computed tomography generally underestimates the peritoneal tumor load. Diagnostic laparoscopy is often used to determine whether patients are amenable for surgery. Magnetic resonance imaging (MRI) has shown to be accurate in predicting completeness of CRS. The aim of this study is to determine whether MRI can effectively reduce the need for surgical staging. Methods The study is designed as a multicenter randomized controlled trial (RCT) of colorectal cancer patients who are deemed eligible for CRS-HIPEC after conventional CT staging. Patients are randomly assigned to either MRI based staging (arm A) or to standard surgical staging with or without laparoscopy (arm B). In arm A, MRI assessment will determine whether patients are eligible for CRS-HIPEC. In borderline cases, an additional diagnostic laparoscopy is advised. The primary outcome is the number of unnecessary surgical procedures in both arms defined as: all surgeries in patients with definitely inoperable disease (PCI > 24) or explorative surgeries in patients with limited disease (PCI < 15). Secondary outcomes include correlations between surgical findings and MRI findings, cost-effectiveness, and quality of life (QOL) analysis. Conclusion This randomized trial determines whether MRI can effectively replace surgical staging in patients with CRCPM considered for CRS-HIPEC. Trial registration Registered in the clinical trials registry of U.S. National Library of Medicine under NCT04231175.
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Affiliation(s)
- M P Engbersen
- Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - C J V Rijsemus
- Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - J Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - A G J Aalbers
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - V Retel
- Department of Psychosocial research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department Health Technology and Services Research (HTSR), University of Twente, Drienerlolaan 5, Enschede, The Netherlands
| | - D M J Lambregts
- Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - E J R J Van der Hoeven
- Department of Radiology, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands
| | - D Boerma
- Department of Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands
| | - M J Wiezer
- Department of Surgery, St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands
| | - M De Vries
- Department of Radiology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - E V E Madsen
- Department of Surgery, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - A R M Brandt-Kerkhof
- Department of Surgery, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - S Van Koeverden
- Department of Radiology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - P R De Reuver
- Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - R G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N F M Kok
- Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - M J Lahaye
- Department of Radiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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Taghavi M, Trebeschi S, Simões R, Meek DB, Beckers RCJ, Lambregts DMJ, Verhoef C, Houwers JB, van der Heide UA, Beets-Tan RGH, Maas M. Machine learning-based analysis of CT radiomics model for prediction of colorectal metachronous liver metastases. Abdom Radiol (NY) 2021; 46:249-256. [PMID: 32583138 DOI: 10.1007/s00261-020-02624-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Early identification of patients at risk of developing colorectal liver metastases can help personalizing treatment and improve oncological outcome. The aim of this study was to investigate in patients with colorectal cancer (CRC) whether a machine learning-based radiomics model can predict the occurrence of metachronous metastases. METHODS In this multicentre study, the primary staging portal venous phase CT of 91 CRC patients were retrospectively analysed. Two groups were assessed: patients without liver metastases at primary staging, or during follow-up of ≥ 24 months (n = 67) and patients without liver metastases at primary staging but developed metachronous liver metastases < 24 months after primary staging (n = 24). After liver parenchyma segmentation, 1767 radiomics features were extracted for each patient. Three predictive models were constructed based on (1) radiomics features, (2) clinical features and (3) a combination of clinical and radiomics features. Stability of features across hospitals was assessed by the Kruskal-Wallis test and inter-correlated features were removed if their correlation coefficient was higher than 0.9. Bayesian-optimized random forest with wrapper feature selection was used for prediction models. RESULTS The three predictive models that included radiomics features, clinical features and a combination of radiomics with clinical features resulted in an AUC in the validation cohort of 86% (95%CI 85-87%), 71% (95%CI 69-72%) and 86% (95% CI 85-87%), respectively. CONCLUSION A machine learning-based radiomics analysis of routine clinical CT imaging at primary staging can provide valuable biomarkers to identify patients at high risk for developing colorectal liver metastases.
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Staal FCR, van der Reijd DJ, Taghavi M, Lambregts DMJ, Beets-Tan RGH, Maas M. Radiomics for the Prediction of Treatment Outcome and Survival in Patients With Colorectal Cancer: A Systematic Review. Clin Colorectal Cancer 2020; 20:52-71. [PMID: 33349519 DOI: 10.1016/j.clcc.2020.11.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 09/03/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Prediction of outcome in patients with colorectal cancer (CRC) is challenging as a result of lack of a robust biomarker and heterogeneity between and within tumors. The aim of this review was to assess the current possibilities and limitations of radiomics (on computed tomography [CT], magnetic resonance imaging [MRI], and positron emission tomography [PET]) for the prediction of treatment outcome and long-term outcome in CRC. Medline/PubMed was searched up to August 2020 for studies that used radiomics for the prediction of response to treatment and survival in patients with CRC (based on pretreatment imaging). The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool and Radiomics Quality Score (RQS) were used for quality assessment. A total of 76 studies met the inclusion criteria and were included for further analysis. Radiomics analyses were performed on MRI in 41 studies, on CT in 30 studies, and on 18F-FDG-PET/CT in 10 studies. Heterogeneous results were reported regarding radiomics methods and included features. High-quality studies (n = 13), consisting mainly of MRI-based radiomics to predict response in rectal cancer, were able to predict response with good performance. Radiomics literature in CRC is highly heterogeneous, but it nonetheless holds promise for the prediction of outcome. The most evidence is available for MRI-based radiomics in rectal cancer. Future radiomics research in CRC should focus on independent validation of existing models rather than on developing new models.
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Affiliation(s)
- Femke C R Staal
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Denise J van der Reijd
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marjaneh Taghavi
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Monique Maas
- Department of Radiology, Antoni van Leeuwenhoek, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Trebeschi S, Drago SG, Birkbak NJ, Kurilova I, Cǎlin AM, Delli Pizzi A, Lalezari F, Lambregts DMJ, Rohaan MW, Parmar C, Rozeman EA, Hartemink KJ, Swanton C, Haanen JBAG, Blank CU, Smit EF, Beets-Tan RGH, Aerts HJWL. Predicting response to cancer immunotherapy using noninvasive radiomic biomarkers. Ann Oncol 2020; 30:998-1004. [PMID: 30895304 PMCID: PMC6594459 DOI: 10.1093/annonc/mdz108] [Citation(s) in RCA: 305] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Immunotherapy is regarded as one of the major breakthroughs in cancer treatment. Despite its success, only a subset of patients responds-urging the quest for predictive biomarkers. We hypothesize that artificial intelligence (AI) algorithms can automatically quantify radiographic characteristics that are related to and may therefore act as noninvasive radiomic biomarkers for immunotherapy response. PATIENTS AND METHODS In this study, we analyzed 1055 primary and metastatic lesions from 203 patients with advanced melanoma and non-small-cell lung cancer (NSCLC) undergoing anti-PD1 therapy. We carried out an AI-based characterization of each lesion on the pretreatment contrast-enhanced CT imaging data to develop and validate a noninvasive machine learning biomarker capable of distinguishing between immunotherapy responding and nonresponding. To define the biological basis of the radiographic biomarker, we carried out gene set enrichment analysis in an independent dataset of 262 NSCLC patients. RESULTS The biomarker reached significant performance on NSCLC lesions (up to 0.83 AUC, P < 0.001) and borderline significant for melanoma lymph nodes (0.64 AUC, P = 0.05). Combining these lesion-wide predictions on a patient level, immunotherapy response could be predicted with an AUC of up to 0.76 for both cancer types (P < 0.001), resulting in a 1-year survival difference of 24% (P = 0.02). We found highly significant associations with pathways involved in mitosis, indicating a relationship between increased proliferative potential and preferential response to immunotherapy. CONCLUSIONS These results indicate that radiographic characteristics of lesions on standard-of-care imaging may function as noninvasive biomarkers for response to immunotherapy, and may show utility for improved patient stratification in both neoadjuvant and palliative settings.
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Affiliation(s)
- S Trebeschi
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands; Departments of Radiation Oncology; Radiology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - S G Drago
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; Department of Radiology, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy
| | - N J Birkbak
- The Francis Crick Institute, London; University College London, London, UK; Department of Molecular Medicine, Aarhus University, Aarhus, Denmark
| | - I Kurilova
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands
| | - A M Cǎlin
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; Affidea Romania, Cluj-Napoca, Romania
| | - A Delli Pizzi
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; ITAB Institute for Advanced Biomedical Technologies, University G. d'Annunzio, Chieti, Italy
| | - F Lalezari
- Department of Radiology, Netherlands Cancer Institute, Amsterdam
| | - D M J Lambregts
- Department of Radiology, Netherlands Cancer Institute, Amsterdam
| | | | - C Parmar
- Departments of Radiation Oncology; Radiology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | | | - C Swanton
- The Francis Crick Institute, London; University College London, London, UK
| | | | | | - E F Smit
- Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands
| | - H J W L Aerts
- Department of Radiology, Netherlands Cancer Institute, Amsterdam; Departments of Radiation Oncology; Radiology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
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Min LA, Vacher YJL, Dewit L, Donker M, Sofia C, van Triest B, Bos P, van Griethuysen JJW, Maas M, Beets-Tan RGH, Lambregts DMJ. Gross tumour volume delineation in anal cancer on T2-weighted and diffusion-weighted MRI - Reproducibility between radiologists and radiation oncologists and impact of reader experience level and DWI image quality. Radiother Oncol 2020; 150:81-88. [PMID: 32540336 DOI: 10.1016/j.radonc.2020.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/06/2020] [Accepted: 06/07/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess how gross tumour volume (GTV) delineation in anal cancer is affected by interobserver variations between radiologists and radiation oncologists, expertise level, and use of T2-weighted MRI (T2W-MRI) vs. diffusion-weighted imaging (DWI), and to explore effects of DWI quality. METHODS AND MATERIALS We retrospectively analyzed the MRIs (T2W-MRI and b800-DWI) of 25 anal cancer patients. Four readers (Senior and Junior Radiologist; Senior and Junior Radiation Oncologist) independently delineated GTVs, first on T2W-MRI only and then on DWI (with reference to T2W-MRI). Maximum Tumour Diameter (MTD) was calculated from each GTV. Mean GTVs/MTDs were compared between readers and between T2W-MRI vs. DWI. Interobserver agreement was calculated as Intraclass Correlation Coefficient (ICC), Dice Similarity Coefficient (DSC) and Hausdorff Distance (HD). DWI image quality was assessed using a 5-point artefact scale. RESULTS Interobserver agreement between radiologists vs. radiation oncologists and between junior vs. senior readers was good-excellent, with similar agreement for T2W-MRI and DWI (e.g. ICCs 0.72-0.94 for T2W-MRI and 0.68-0.89 for DWI). There was a trend towards smaller GTVs on DWI, but only for the radiologists (P = 0.03-0.07). Moderate-severe DWI-artefacts were observed in 11/25 (44%) cases. Agreement tended to be lower in these cases. CONCLUSION Overall interobserver agreement for anal cancer GTV delineation on MRI is good for both radiologists and radiation oncologists, regardless of experience level. Use of DWI did not improve agreement. DWI artefacts affecting GTV delineation occurred in almost half of the patients, which may severely limit the use of DWI for radiotherapy planning if no steps are undertaken to avoid them.
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Affiliation(s)
- Lisa A Min
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology - University of Maastricht, Maastricht, The Netherlands.
| | - Younan J L Vacher
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Luc Dewit
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mila Donker
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paula Bos
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology - University of Maastricht, Maastricht, The Netherlands; Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joost J W van Griethuysen
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology - University of Maastricht, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology - University of Maastricht, Maastricht, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Kok END, Eppenga R, Kuhlmann KFD, Groen HC, van Veen R, van Dieren JM, de Wijkerslooth TR, van Leerdam M, Lambregts DMJ, Heerink WJ, Hoetjes NJ, Ivashchenko O, Beets GL, Aalbers AGJ, Nijkamp J, Ruers TJM. Accurate surgical navigation with real-time tumor tracking in cancer surgery. NPJ Precis Oncol 2020; 4:8. [PMID: 32285009 PMCID: PMC7142120 DOI: 10.1038/s41698-020-0115-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
In the past decades, image-guided surgery has evolved rapidly. In procedures with a relatively fixed target area, like neurosurgery and orthopedics, this has led to improved patient outcomes. In cancer surgery, intraoperative guidance could be of great benefit to secure radical resection margins since residual disease is associated with local recurrence and poor survival. However, most tumor lesions are mobile with a constantly changing position. Here, we present an innovative technique for real-time tumor tracking in cancer surgery. In this study, we evaluated the feasibility of real-time tumor tracking during rectal cancer surgery. The application of real-time tumor tracking using an intraoperative navigation system is feasible and safe with a high median target registration accuracy of 3 mm. This technique allows oncological surgeons to obtain real-time accurate information on tumor location, as well as critical anatomical information. This study demonstrates that real-time tumor tracking is feasible and could potentially decrease positive resection margins and improve patient outcome.
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Affiliation(s)
- Esther N D Kok
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Roeland Eppenga
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Koert F D Kuhlmann
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Harald C Groen
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ruben van Veen
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jolanda M van Dieren
- 2Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas R de Wijkerslooth
- 2Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique van Leerdam
- 2Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Doenja M J Lambregts
- 3Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wouter J Heerink
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nikie J Hoetjes
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Oleksandra Ivashchenko
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Geerard L Beets
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arend G J Aalbers
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jasper Nijkamp
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Theo J M Ruers
- 1Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,4Faculty TNW, Group Nanobiophysics, Twente University, Enschede, 7522 NB The Netherlands
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Engbersen MP, Aalbers AGJ, Van't Sant-Jansen I, Velsing JDR, Lambregts DMJ, Beets-Tan RGH, Kok NFM, Lahaye MJ. Extent of Peritoneal Metastases on Preoperative DW-MRI is Predictive of Disease-Free and Overall Survival for CRS/HIPEC Candidates with Colorectal Cancer. Ann Surg Oncol 2020; 27:3516-3524. [PMID: 32239338 DOI: 10.1245/s10434-020-08416-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether the extent of peritoneal metastases (PMs) on preoperative diffusion-weighted magnetic resonance imaging (DW-MRI) can be used as a biomarker of disease-free and overall survival in patients with colorectal cancer who are considered for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). METHODS For this retrospective cohort study, patients with PMs considered for CRS/HIPEC who underwent DW-MRI for preoperative staging in 2016-2017 were included. The DW-MRI protocol consisted of diffusion-weighted, T2-weighted, and pre- and post-gadolinium T1-weighted imaging of the chest, abdomen, and pelvis. DW-MRI images were evaluated by two independent readers to determine the extent of PMs represented by the Peritoneal Cancer Index (MRI-PCI), as well as extraperitoneal metastases. Cox regression and Kaplan-Meier analysis was performed to determine the prognostic value of DW-MRI for overall and disease-free survival. RESULTS Seventy-eight patients were included. CRS/HIPEC was planned for 53 patients and completed in 50 patients (60.5%). Median follow-up after DW-MRI was 23 months (interquartile range 13-24). The MRI-PCI of both readers showed prognostic value for overall survival, independently of whether R1 resection was achieved (hazard ratio [HR] 1.06-1.08; p < 0.05). For the patients who received successful CRS/HIPEC, the MRI-PCI also showed independent prognostic value for disease-free survival for both readers (HR 1.09-1.10; p < 0.05). CONCLUSION The extent of PMs on preoperative DW-MRI is an independent predictor of overall and disease-free survival and should therefore be considered as a non-invasive prognostic biomarker.
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Affiliation(s)
- Maurits P Engbersen
- Department of Radiology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arend G J Aalbers
- Department of Surgery, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Iris Van't Sant-Jansen
- Department of Radiology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeroen D R Velsing
- Department of Radiology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Niels F M Kok
- Department of Surgery, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Max J Lahaye
- Department of Radiology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Haak HE, Maas M, Lahaye MJ, Boellaard TN, Delli Pizzi A, Mihl C, van der Zee D, Fabris C, van der Sande ME, Melenhorst J, Beets-Tan RGH, Beets GL, Lambregts DMJ. Selection of Patients for Organ Preservation After Chemoradiotherapy: MRI Identifies Poor Responders Who Can Go Straight to Surgery. Ann Surg Oncol 2020; 27:2732-2739. [PMID: 32172333 DOI: 10.1245/s10434-020-08334-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate whether magnetic resonance imaging (MRI) can accurately identify poor responders after chemoradiotherapy (CRT) who will need to go straight to surgery, and to evaluate whether results are reproducible among radiologists with different levels of expertise. METHODS Seven independent readers with different levels of expertise retrospectively evaluated the restaging MRIs (T2-weighted + diffusion-weighted imaging [T2W + DWI]) of 62 patients and categorized them as (1) poor responders - highly suspicious of tumor; (2) intermediate responders - tumor most likely; and (3) good - potential (near) complete responders. The reference standard was histopathology after surgery (or long-term follow-up in the case of a watch-and-wait program). RESULTS Fourteen patients were complete responders and 48 had residual tumor. The median percentage of patients categorized by the seven readers as 'poor', 'intermediate', and 'good' responders was 21% (range 11-37%), 50% (range 23-58%), and 29% (range 23-42%), respectively. The vast majority of poor responders had histopathologically confirmed residual tumor (73% ypT3-4), with a low rate (0-5%) of 'missed complete responders'. Of the 14 confirmed complete responders, a median percentage of 71% were categorized in the MR-good response group and 29% were categorized in the MR-intermediate response group. CONCLUSIONS Radiologists of varying experience levels should be able to use MRI to identify the ± 20% subgroup of poor responders who will definitely require surgical resection after CRT. This may facilitate more selective use of endoscopy, particularly in general settings or in centers with limited access to endoscopy.
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Affiliation(s)
- Hester E Haak
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Max J Lahaye
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Andrea Delli Pizzi
- ITAB Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University, Chieti, Italy
| | - Casper Mihl
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Cristina Fabris
- Department of Radiology, Policlinico G.B. Rossi, University of Verona, Verona, Italy
| | - Marit E van der Sande
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Regina G H Beets-Tan
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
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Lambregts DMJ, Min LA, Schurink N, Beets-Tan RGH. Multiparametric Imaging for the Locoregional Follow-up of Rectal Cancer. Curr Colorectal Cancer Rep 2020. [DOI: 10.1007/s11888-020-00450-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zhang Q, van Houdt PJ, Lambregts DMJ, van Triest B, Kop MPM, Coolen BF, Strijkers GJ, van der Heide UA, Nederveen AJ. Locally advanced rectal cancer: 3D diffusion-prepared stimulated-echo turbo spin-echo versus 2D diffusion-weighted echo-planar imaging. Eur Radiol Exp 2020; 4:9. [PMID: 32030561 PMCID: PMC7005244 DOI: 10.1186/s41747-019-0138-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Diffusion-weighted imaging (DWI) has shown great value in rectal cancer imaging. However, traditional DWI with echo-planar imaging (DW-EPI) often suffers from geometrical distortions. We applied a three-dimensional diffusion-prepared stimulated-echo turbo spin-echo sequence (DPsti-TSE), allowing geometrically undistorted rectal DWI. We compared DPsti-TSE with DW-EPI for locally advanced rectal cancer DWI. Methods For 33 prior-to-treatment patients, DWI images of the rectum were acquired with DPsti-TSE and DW-EPI at 3 T using b-values of 200 and 1000 s/mm2. Two radiologists conducted a blinded scoring of the images considering nine aspects of image quality and anatomical quality. Tumour apparent diffusion coefficient (ADC) and distortions were compared quantitatively. Results DPsti-TSE scored significantly better than DW-EPI in rectum distortion (p = 0.005) and signal pileup (p = 0.001). DPsti-TSE had better tumour Dice similarity coefficient compared to DW-EPI (0.84 versus 0.80, p = 0.010). Tumour ADC values were higher for DPsti-TSE compared to DW-EPI (1.47 versus 0.86 × 10-3 mm2/s, p < 0.001). Radiologists scored DPsti-TSE significantly lower than DW-EPI on aspects of overall image quality (p = 0.001), sharpness (p < 0.001), quality of fat suppression (p < 0.001), tumour visibility (p = 0.009), tumour conspicuity (p = 0.010) and rectum wall visibility (p = 0.005). Conclusions DPsti-TSE provided geometrically less distorted rectal cancer diffusion-weighted images. However, the image quality of DW-EPI over DPsti-TSE was referred on the basis of several image quality criteria. A significant bias in tumour ADC values from DPsti-TSE was present. Further improvements of DPsti-TSE are needed until it can replace DW-EPI.
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Affiliation(s)
- Qinwei Zhang
- Amsterdam UMC, Radiology and Nuclear Medicine, University of Amsterdam, Room Z0-178, Meibergdreef 9, 1100 DD, Amsterdam, Netherlands.
| | - Petra J van Houdt
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Baukelien van Triest
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Marnix P M Kop
- Amsterdam UMC, Radiology and Nuclear Medicine, University of Amsterdam, Room Z0-178, Meibergdreef 9, 1100 DD, Amsterdam, Netherlands
| | - Bram F Coolen
- Amsterdam UMC, Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, the Netherlands
| | - Gustav J Strijkers
- Amsterdam UMC, Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, the Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Aart J Nederveen
- Amsterdam UMC, Radiology and Nuclear Medicine, University of Amsterdam, Room Z0-178, Meibergdreef 9, 1100 DD, Amsterdam, Netherlands
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Schurink NW, Min LA, Berbee M, van Elmpt W, van Griethuysen JJM, Bakers FCH, Roberti S, van Kranen SR, Lahaye MJ, Maas M, Beets GL, Beets-Tan RGH, Lambregts DMJ. Value of combined multiparametric MRI and FDG-PET/CT to identify well-responding rectal cancer patients before the start of neoadjuvant chemoradiation. Eur Radiol 2020; 30:2945-2954. [DOI: 10.1007/s00330-019-06638-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/05/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
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Haak HE, Maas M, Lambregts DMJ, Beets-Tan RGH, Beets GL. Is watch and wait a safe and effective way to treat rectal cancer in older patients? Eur J Surg Oncol 2020; 46:358-362. [PMID: 31982206 DOI: 10.1016/j.ejso.2020.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/13/2019] [Accepted: 01/03/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The aim was assess the oncological and functional outcome of the watch-and-wait (W&W) approach in older patients with a clinical (near)complete response after neoadjuvant treatment for rectal cancer. MATERIAL AND METHODS Patients were included in a W&W-approach (2004-2019) when digital rectal examination, endoscopy and MRI showed a (near)clinical complete response. Patients underwent endoscopy and MRI every 3 months during the first year, and 6-monthly thereafter. Patients aged ≥75 and ≥ 2 years of follow-up (FU) were selected. Oncological outcomes were assessed with Kaplan-Meier curves. Functional outcome was assessed with colostomy-free rate, Vaizey incontinence score, low anterior resection syndrome-score and International Prostate Syndrome Score. RESULTS 43/304 (14%) of patients in a W&W-approach met the inclusion criteria. Median FU was 37 (24-109) months. 5/43(12%) developed a local regrowth. All were treated surgically, with one patient experiencing a pelvic failure. Distant metastases occurred in 3/43 patients and 4 patients died, 3 of whom not related to rectal cancer. The 3-year local regrowth-free rate was 88%, 3-year non-regrowth disease-free survival 91%, overall survival 97% and 3-year colostomy-free rate 93%. Overall, the bowel- and urinary dysfunction scores at 3, 12 and 24 months indicated good continence, no or minor LARS and moderate urinary problems. CONCLUSION W&W for older patients with a clinical (near) complete response appears to be a safe alternative to a total mesorectal excision (TME), with a very high pelvic control rate, and few rectal cancer related deaths. Most patients can avoid major surgery and a definitive colostomy, and have a reasonable anorectal and urinary function.
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Affiliation(s)
- Hester E Haak
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology - Maastricht University, Maastricht, the Netherlands.
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
| | - Doenja M J Lambregts
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology - Maastricht University, Maastricht, the Netherlands.
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology - Maastricht University, Maastricht, the Netherlands.
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Brown PJ, Rossington H, Taylor J, Lambregts DMJ, Morris EJA, West NP, Quirke P, Tolan D. Radiologist and multidisciplinary team clinician opinions on the quality of MRI rectal cancer staging reports: how are we doing? Clin Radiol 2019; 74:637-642. [PMID: 31084973 DOI: 10.1016/j.crad.2019.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIM To evaluate the current opinion of magnetic resonance imaging (MRI) reports amongst specialist clinicians involved in colorectal cancer multidisciplinary teams (CRC MDTs). MATERIALS AND METHODS Active participants at 16 UK CRC MDTs across a population of 5.7 million were invited to complete a questionnaire, this included 22 closed and three open questions. Closed questions used ordinal (Likert) scales to judge the subjective inclusion of tumour descriptors and impressions on the clarity and consistency of the MRI report. Open (free-text) questions allowed overall feedback and suggestions. RESULTS A total of 69 participants completed the survey (21 radiologists and 48 other CRC MDT clinicians). Both groups highlighted that reports commonly omit the status of the circumferential resection margin (CRM; 83% versus 81% inclusion, other clinicians and radiologists, respectively, p>0.05), presence or absence of extra-mural venous invasion (EMVI; 67% versus 57% inclusion, p>0.05), and lymph node status (90% inclusion in both groups). Intra-radiologist agreement across MRI examinations is reported as 75% by other clinicians. Free-text comments included suggestions for template-style reports. CONCLUSION Both groups recognise a proportion of MRI reports are suboptimal with key tumour descriptors omitted. There are also concerns around the presentation style of MRI reports and inter- and intra-radiologist report variability. The widespread implementation of standardised report templates may improve completeness and clarity of MRI reports for rectal cancer and thus clinical management and outcomes in rectal cancer.
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Affiliation(s)
- P J Brown
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - H Rossington
- Epidemiology and Biostatistics, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - J Taylor
- Epidemiology and Biostatistics, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - D M J Lambregts
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, Netherlands
| | - E J A Morris
- Epidemiology and Biostatistics, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - N P West
- Pathology, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - P Quirke
- Pathology, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - D Tolan
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
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Schurink NW, Lambregts DMJ, Beets-Tan RGH. Diffusion-weighted imaging in rectal cancer: current applications and future perspectives. Br J Radiol 2019; 92:20180655. [PMID: 30433814 DOI: 10.1259/bjr.20180655] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This review summarizes current applications and clinical utility of diffusion-weighted imaging (DWI) for rectal cancer and in addition provides a brief overview of more recent developments (including intravoxel incoherent motion imaging, diffusion kurtosis imaging, and novel postprocessing tools) that are still in more early stages of research. More than 140 papers have been published in the last decade, during which period the use of DWI have slowly moved from mainly qualitative (visual) image interpretation to increasingly advanced methods of quantitative analysis. So far, the largest body of evidence exists for assessment of tumour response to neoadjuvant treatment. In this setting, particularly the benefit of DWI for visual assessment of residual tumour in post-radiation fibrosis has been established and is now increasingly adopted in clinics. Quantitative DWI analysis (mainly the apparent diffusion coefficient) has potential, both for response prediction as well as for tumour prognostication, but protocols require standardization and results need to be prospectively confirmed on larger scale. The role of DWI for further clinical tumour and nodal staging is less well-defined, although there could be a benefit for DWI to help detect lymph nodes. Novel methods of DWI analysis and post-processing are still being developed and optimized; the clinical potential of these tools remains to be established in the upcoming years.
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Affiliation(s)
- Niels W Schurink
- 1 Radiology, Netherlands Cancer Institute , Amsterdam , The Netherlands.,2 GROW School for Oncology and Developmental Biology , Maastricht , The Netherlands
| | | | - Regina G H Beets-Tan
- 1 Radiology, Netherlands Cancer Institute , Amsterdam , The Netherlands.,2 GROW School for Oncology and Developmental Biology , Maastricht , The Netherlands
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Vollenbrock SE, Voncken FEM, van Dieren JM, Lambregts DMJ, Maas M, Meijer GJ, Goense L, Mook S, Hartemink KJ, Snaebjornsson P, Ter Beek LC, Verheij M, Aleman BMP, Beets-Tan RGH, Bartels-Rutten A. Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer. Br J Surg 2019; 106:596-605. [PMID: 30802305 PMCID: PMC6594024 DOI: 10.1002/bjs.11094] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/12/2018] [Accepted: 11/26/2018] [Indexed: 01/03/2023]
Abstract
Background Patients with a pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) for oesophageal cancer may benefit from non‐surgical management. The aim of this study was to determine the diagnostic performance of visual response assessment of the primary tumour after nCRT on T2‐weighted (T2W) and diffusion‐weighted (DW) MRI. Methods Patients with locally advanced oesophageal cancer who underwent T2W‐ and DW‐MRI (1·5 T) before and after nCRT in two hospitals, between July 2013 and September 2017, were included in this prospective study. Three radiologists evaluated T2W images retrospectively using a five‐point score for the assessment of residual tumour in a blinded manner and immediately rescored after adding DW‐MRI. Histopathology of the resection specimen was used as the reference standard; ypT0 represented a pCR. Sensitivity, specificity, area under the receiver operating characteristic (ROC) curve (AUC) and interobserver agreement were calculated. Results Twelve of 51 patients (24 per cent) had a pCR. The sensitivity and specificity of T2W‐MRI for detection of residual tumour ranged from 90 to 100 and 8 to 25 per cent respectively. Respective values for T2W + DW‐MRI were 90–97 and 42–50 per cent. AUCs for the three readers were 0·65, 0·66 and 0·68 on T2W‐MRI, and 0·71, 0·70 and 0·70 on T2W + DW‐MRI (P = 0·441, P = 0·611 and P = 0·828 for readers 1, 2 and 3 respectively). The κ value for interobserver agreement improved from 0·24–0·55 on T2W‐MRI to 0·55–0·71 with DW‐MRI. Conclusion Preoperative assessment of residual tumour on MRI after nCRT for oesophageal cancer is feasible with high sensitivity, reflecting a low chance of missing residual tumour. However, the specificity was low; this results in overstaging of complete responders as having residual tumour and, consequently, overtreatment.
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Affiliation(s)
- S E Vollenbrock
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - F E M Voncken
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - J M van Dieren
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - D M J Lambregts
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M Maas
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - G J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Goense
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - S Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K J Hartemink
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - P Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - L C Ter Beek
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M Verheij
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - B M P Aleman
- Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - R G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - A Bartels-Rutten
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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Lambregts DMJ, Boellaard TN, Beets-Tan RGH. Response evaluation after neoadjuvant treatment for rectal cancer using modern MR imaging: a pictorial review. Insights Imaging 2019; 10:15. [PMID: 30758688 PMCID: PMC6375095 DOI: 10.1186/s13244-019-0706-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/24/2018] [Indexed: 01/02/2023] Open
Abstract
In recent years, neoadjuvant chemoradiotherapy (CRT) has become the standard of care for patients with locally advanced rectal cancer. Until recently, patients routinely proceeded to surgical resection after CRT, regardless of the response. Nowadays, treatment is tailored depending on the response to chemoradiotherapy. In patients that respond very well to CRT, organ-preserving treatments such as watch-and-wait are increasingly considered as an alternative to surgery. To facilitate such personalized treatment planning, there is now an increased demand for more detailed radiological response evaluation after chemoradiation. MRI is one of the main tools used to assess response, but has difficulties in assessing response within areas of post-radiation fibrosis. Hence, MR sequences such as diffusion-weighted imaging are increasingly adopted in clinical MR protocols to improve the differentiation between tumor and fibrosis. In this pictorial review, we discuss the strengths and weaknesses of modern MR imaging, including functional imaging sequences such as diffusion-weighted MRI, for response evaluation after chemoradiation treatment and provide the main pearls and pitfalls for image interpretation.
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Affiliation(s)
- Doenja M J Lambregts
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Thierry N Boellaard
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology - Maastricht University, Maastricht, The Netherlands
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47
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Nerad E, Delli Pizzi A, Lambregts DMJ, Maas M, Wadhwani S, Bakers FCH, van den Bosch HCM, Beets-Tan RGH, Lahaye MJ. The Apparent Diffusion Coefficient (ADC) is a useful biomarker in predicting metastatic colon cancer using the ADC-value of the primary tumor. PLoS One 2019; 14:e0211830. [PMID: 30721268 PMCID: PMC6363286 DOI: 10.1371/journal.pone.0211830] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/21/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To investigate the role of the apparent diffusion coefficient (ADC) as a potential imaging biomarker to predict metastasis (lymph node metastasis and distant metastasis) in colon cancer based on the ADC-value of the primary tumor. Methods Thirty patients (21M, 9F) were included retrospectively. All patients received a 1.5T MRI of the colon including T2 and DWI sequences. ADC maps were calculated for each patient. An expert reader manually delineated all colon tumors to measure mean ADC and histogram metrics (mean, min, max, median, standard deviation (SD), skewness, kurtosis, 5th-95th percentiles) were calculated. Advanced colon cancer was defined as lymph node mestastasis (N+) or distant metastasis (M+). The student Mann Whitney U-test was used to assess the differences between the ADC means of early and advanced colon cancer. To compare the accuracy of lymph node metastasis (N+) prediction based on morpholigical criteria versus ADC-value of the primary tumor, two blinded readers, determined the lymph node metastasis (N0 vs N+) based on morphological criteria. The sensitivity and specificity in predicting lymph node metastasis was calculated for both readers and for the ADC-value of the primary tumor, with histopathology results as the gold standard. Results There was a significant difference between the mean ADC-value of advanced versus early tumors (p = 0.002). The optimal cut off value was 1179 * 10−3 mm2/s with an area under the curve (AUC) of 0.83 and a sensitivity and specificity of 81% and 86% respectively to predict advanced tumors. Histogram analyses did not add any significant additional value. The sensitivity and specificity for the prediction of lymph node metastasis based on morphological criteria were 40% and 63% for reader 1 and 30% and 88% for reader 2 respectively. The primary tumor ADC-value using 1.179 * 10−3 mm2/s as threshold had a 100% sensitivity and specificity in predicting lymph node metastasis. Conclusion The ADC-value of the primary tumor has the potential to predict advanced colon cancer, defined as lymph node metastasis or distant metastasis, with lower ADC values significantly associated with advanced tumors. Furthermore the ADC-value of the primary tumor increases the prediction accuracy of lymph node metastasis compared with morphological criteria.
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Affiliation(s)
- Elias Nerad
- University of Maastricht and GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiology, Addenbrookes Hospital Cambridge University Hospitals NHS trust, Cambridge, United Kingdom
- * E-mail:
| | - Andrea Delli Pizzi
- Institute for Advanced Biomedical Technology (ITAB), Gabriele d'Annunzio University, Chieti, Italy
| | | | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sharan Wadhwani
- Department of radiology, Queen Elizabeth Hospital, University Birmingham Hospitals NHS trust, Birmingham, United Kingdom
| | - Frans C. H. Bakers
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Regina G. H. Beets-Tan
- University of Maastricht and GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Max J. Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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van den Ende RPJ, Rigter LS, Kerkhof EM, van Persijn van Meerten EL, Rijkmans EC, Lambregts DMJ, van Triest B, van Leerdam ME, Staring M, Marijnen CAM, van der Heide UA. MRI visibility of gold fiducial markers for image-guided radiotherapy of rectal cancer. Radiother Oncol 2018; 132:93-99. [PMID: 30825976 DOI: 10.1016/j.radonc.2018.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/29/2018] [Accepted: 11/25/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE A GTV boost is suggested to result in higher complete response rates in rectal cancer patients, which is attractive for organ preservation. Fiducials may offer GTV position verification on (CB)CT, if the fiducial-GTV spatial relationship can be accurately defined on MRI. The study aim was to evaluate the MRI visibility of fiducials inserted in the rectum. MATERIALS AND METHODS We tested four fiducial types (two Visicoil types, Cook and Gold Anchor), inserted in five patients each. Four observers identified fiducial locations on two MRI exams per patient in two scenarios: without (scenario A) and with (scenario B) (CB)CT available. A fiducial was defined to be consistently identified if 3 out of 4 observers labeled that fiducial at the same position on MRI. Fiducial visibility was scored on an axial and sagittal T2-TSE sequence and a T1 3D GRE sequence. RESULTS Fiducial identification was poor in scenario A for all fiducial types. The Visicoil 0.75 and Gold Anchor were the most consistently identified fiducials in scenario B with 7 out of 9 and 8 out of 11 consistently identified fiducials in the first MRI exam and 2 out of 7 and 5 out of 10 in the second MRI exam, respectively. The consistently identified Visicoil 0.75 and Gold Anchor fiducials were best visible on the T1 3D GRE sequence. CONCLUSION The Visicoil 0.75 and Gold Anchor fiducials were the most visible fiducials on MRI as they were most consistently identified. The use of a registered (CB)CT and a T1 3D GRE MRI sequence is recommended.
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Affiliation(s)
- Roy P J van den Ende
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands.
| | - Lisanne S Rigter
- Department of Gastroenterology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen M Kerkhof
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands
| | | | - Eva C Rijkmans
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marius Staring
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands; Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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van 't Sant I, van Eden WJ, Engbersen MP, Kok NFM, Woensdregt K, Lambregts DMJ, Shanmuganathan S, Beets-Tan RGH, Aalbers AGJ, Lahaye MJ. Diffusion-weighted MRI assessment of the peritoneal cancer index before cytoreductive surgery. Br J Surg 2018; 106:491-498. [PMID: 30353920 DOI: 10.1002/bjs.10989] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/17/2018] [Accepted: 07/31/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Patients with limited peritoneal metastases from colorectal cancer may be candidates for an aggressive surgical approach including cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Selection is based on surgical inspection during laparoscopy or laparotomy. The aim of this study was to investigate whether diffusion-weighted MRI (DW-MRI) can be used to select patients for CRS-HIPEC. METHODS This was a prospective study at a tertiary referral centre. Patients with confirmed or suspected colorectal peritoneal metastases scheduled for exploratory laparotomy or laparoscopy were eligible. Two radiologists assessed the peritoneal cancer index (PCI) on CT (CT-PCI) and DW-MRI (MRI-PCI). The reference standard was PCI at surgery. Radiologists were blinded to the surgical PCI and to each other's findings. The main outcome was the accuracy of DW-MRI in predicting whether patients had resectable disease (PCI less than 21) or not. RESULTS Fifty-six patients were included in the study, of whom 49 could be evaluated. The mean(s.d.) PCI at surgery was 11·27(7·53). The mean MRI-PCI was 10·18(7·07) for reader 1 and 8·59(7·08) for reader 2. Readers 1 and 2 correctly staged 47 of 49 and 44 of 49 patients respectively (accuracy 96 and 90 per cent). Both readers detected all patients with resectable disease with a PCI below 21 at surgery (sensitivity 100 per cent). No patient was overstaged. The intraclass correlation (ICC) between readers was excellent (ICC 0·91, 95 per cent c.i. 0·77 to 0·96). MRI-PCI had a stronger correlation with surgical PCI (ICC 0·83-0·88) than did CT-PCI (ICC 0·39-0·44). CONCLUSION DW-MRI is a promising non-invasive tool to guide treatment selection in patients with peritoneal metastases from colorectal cancer.
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Affiliation(s)
- I van 't Sant
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - W J van Eden
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M P Engbersen
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - N F M Kok
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K Woensdregt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D M J Lambregts
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S Shanmuganathan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A G J Aalbers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M J Lahaye
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Manikis GC, Marias K, Lambregts DMJ, Nikiforaki K, van Heeswijk MM, Bakers FCH, Beets-Tan RGH, Papanikolaou N. Correction: Diffusion weighted imaging in patients with rectal cancer: Comparison between Gaussian and non-Gaussian models. PLoS One 2018; 13:e0196262. [PMID: 29664935 PMCID: PMC5903604 DOI: 10.1371/journal.pone.0196262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0184197.].
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