Investigation of volumetric apparent diffusion coefficient histogram analysis for assessing complete response and clinical outcomes following pre-operative chemoradiation treatment for rectal carcinoma
- 316 Downloads
To investigate the relationship of pre-treatment volumetric apparent diffusion coefficient (ADC) histogram parameters with post-operative histopathologic treatment response and clinical outcomes following pre-operative chemoradiation treatment (CRT) in rectal cancer.
Materials and methods
In a Health Insurance Portability and Accountability Act compliant retrospective study, 78 rectal cancer patients treated with pre-operative CRT and rectal MRI were included. MR imaging analysis was performed using OncoTREAT (software tool). Multiple volumetric ADC histogram parameters (voxel distribution across ADC ranges, kurtosis, and skewness) were assessed. Correlation was made to post-operative pathological complete response, clinical, or radiological evidence of disease progression using the Mann–Whitney test.
Post CRT, 8 patients showed pathologic complete response and 13 patients showed distant disease progression. Pre-treatment mean ADC was 1.2 × 10−3 mm2/s (range 0.3–1.99 × 10−3 mm2/s). Mean kurtosis measured was 0.56 (range −1 to 6; SD 1.36). Mean skewness was 0.3 (range −1 to 2; SD 0.69). Skewness had significant correlation (p value = 0.006) with disease progression. The mean rectal tumor volume was 24cc (range 1cc–134cc). Pre-treatment MRI tumor volume showed significant correlation (p value = 0.013) with pathologic complete response. Mean ADC and percentage voxels distribution against ADC ranges had no significant correlation with treatment response or disease outcomes.
Volumetric ADC histogram analysis of pre-CRT rectal cancer MRI appears promising for prediction of post-CRT complete response and disease progression.
KeywordsRectal carcinoma Diffusion-weighted MRI Apparent diffusion coefficient (ADC) Chemoradiation treatment (CRT)
Robert Grimm, Siemens Healthcare GmbH, Application Predevelopment, Erlangen, Germany for providing the MR imaging analysis software, OncoTreat.
Compliance with ethical standards
No funding was received for this study.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Statement of informed consent was not applicable since the manuscript does not contain any patient data.
- 2.American Cancer Society, “Cancer Facts & Figures,” Cancer Facts Fig. 2014., vol. Atlanta, G, 2014.Google Scholar
- 6.Peeters KCMJ, van de Velde CJH, Leer JWH, et al. (2005) Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J Clin Oncol 23(25):6199–6206CrossRefGoogle Scholar
- 11.Wong R, Berry S, Spithoff K, Simunovic M, Chan K, Agboola O, Dingle B (2011) Preoperative or postoperative therapy for the management of patients with stage II or III rectal cancer preoperative or postoperative therapy for the management of patients with stage II or III rectal cancer: guideline recommendations. Cancer Care Ontario 2–4.Google Scholar
- 14.Al-Sukhni E, Milot L, Fruitman M, et al. (2012) Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol 19(7):2212–2223CrossRefGoogle Scholar
- 22.Sobin LH, Gospodarowicz MK (2009) TNM Classification of Malignant Tumors, 7th edn. New York: Wiley-BlackwellGoogle Scholar
- 23.Bonekamp S, Kiraly AP, Gulsun MA, Jolepalem P, Kamel IR (2010) First experiences with a novel software prototype for assessment of treatment response of liver tumors to transarterial chemoembolization. Magnatom Flash (Seimens) 33(10)Google Scholar
- 27.Coeffi D, Collins DJ, Messiou C, et al. (2011) Metastatic ovarian and primary peritoneal cancer : assessing chemotherapy response with diffusion-weighted MR imaging—value of histogram analysis of apparent diffusion coefficients. Genitourin Imaging. doi: 10.1148/radiol.11110577 CrossRefGoogle Scholar
- 36.Cho SH, Kim GC, Jang YJ, et al. (2014) Locally advanced rectal cancer: post-chemoradiotherapy ADC histogram analysis for predicting a complete response. Acta RadiolGoogle Scholar