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. 2017 Jul;124(1):104-109.
doi: 10.1016/j.radonc.2017.06.013. Epub 2017 Jun 21.

Quantitative imaging outperforms molecular markers when predicting response to chemoradiotherapy for rectal cancer

Ines Joye  1 , Annelies Debucquoy  2 , Christophe M Deroose  3 , Vincent Vandecaveye  4 , Eric Van Cutsem  5 , Albert Wolthuis  6 , André D'Hoore  6 , Xavier Sagaert  7 , Mu Zhou  8 , Olivier Gevaert  8 , Karin Haustermans  9
Affiliations

Quantitative imaging outperforms molecular markers when predicting response to chemoradiotherapy for rectal cancer

Ines Joye et al. Radiother Oncol. 2017 Jul.

Abstract

Background and purpose: To explore the integration of imaging and molecular data for response prediction to chemoradiotherapy (CRT) for rectal cancer.

Material and methods: Eighty-five rectal cancer patients underwent preoperative CRT. 18F-FDG PET/CT and diffusion-weighted imaging (DWI) were acquired before (TP1) and during CRT (TP2) and prior to surgery (TP3). Inflammatory cytokines and gene expression were analysed. Tumour response was defined as ypT0-1N0. Multivariate models were built combining the obtained parameters. Final models were calculated on the data combination with the highest AUC.

Results: Twenty-two patients (26%) achieved ypT0-1N0 response. 18F-FDG PET/CT had worse predictive performance than DWI and T2-volumetry (AUC 0.61±0.04, 0.72±0.03, and 0.72±0.02, respectively). Combining all imaging parameters increased the AUC to 0.81±0.03. Adding cytokines or gene expression did not improve the AUC (AUC of 0.72±0.06 and 0.79±0.04 respectively). Final models combining 18F-FDG PET/CT, DWI, and T2-weighted volumetry at all TPs and using only TP1 and TP3, allowed ypT0-1N0 prediction with a 75% sensitivity, 94% specificity and PPV of 80%.

Conclusions: Combining 18F-FDG PET/CT, DWI, and T2-weighted MRI volumetry obtained before CRT and prior to surgery may help physicians in selecting rectal cancer patients for organ-preservation.

Keywords: Chemoradiotherapy; Imaging; Molecular markers; Rectal cancer; Response prediction.

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Conflict of interest statement

Conflict of Interest Statement

There are no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Study design
Abbreviations: 5-FU = 5-fluorouracil; Cape = capecitabine; CRT = chemoradiotherapy; TME = total mesorectal excision; TP = time point. Six patients received capecitabine (825 mg/m2 twice daily).
Figure 2
Figure 2. Models’ performance in prediction of ypT0-1N0 response
Box plots showing the performance in terms of the AUC of the multivariate linear prediction models for several combinations of imaging, clinical and molecular data at different time points. Abbreviations: AUC = area under the ROC curve; EL = ELISA; MA = microarray gene expression signatures; ROC = Receiver Operating Characteristic; TP = time point; TP12 = combination of data obtained at TP1 and TP2; TP13 = combination of data obtained at TP1 and TP3.
See this image and copyright information in PMC

References

    1. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1(8496):1479–82. - PubMed
    1. Sauer R, Liersch T, Merkel S, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30(16):1926–33. - PubMed
    1. Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 2010;11(9):835–44. - PubMed
    1. Rödel C, Martus P, Papadoupolos T, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol. 2005;23(34):8688–96. - PubMed
    1. Lezoche G, Baldarelli M, Guerrieri M, et al. A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc. 2008;22(2):352–58. - PubMed