Locally Advanced Rectal Carcinoma Treated with Preoperative Chemotherapy and Radiation Therapy: Preliminary Analysis of Diffusion-weighted MR Imaging for Early Detection of Tumor Histopathologic Downstaging

被引:246
作者
Sun, Ying-Shi [1 ]
Zhang, Xiao-Peng [1 ]
Tang, Lei [1 ]
Ji, Jia-Fu [2 ]
Gu, Jin
Cai, Yong [3 ]
Zhang, Xiao-Yan [1 ]
机构
[1] Peking Univ, Key Lab Carcinogenesis & Translat Res, Beijing Canc Hosp & Inst, Minist Educ,Dept Radiol,Sch Oncol, Beijing 100142, Peoples R China
[2] Peking Univ, Sch Oncol, Beijing Canc Hosp & Inst, Dept Surg, Beijing 100142, Peoples R China
[3] Peking Univ, Sch Oncol, Beijing Canc Hosp & Inst, Dept Radiotherapy, Beijing 100142, Peoples R China
关键词
EARLY SURROGATE MARKER; IN-VIVO; PREDICTING RESPONSE; THYMIDINE KINASE; BREAST-CANCER; CELL-DENSITY; BRAIN-TUMORS; CHEMORADIATION; RADIOTHERAPY; SURVIVAL;
D O I
10.1148/radiol.2541082230
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Purpose: To determine whether changes in apparent diffusion coefficients (ADCs) of rectal carcinoma obtained 1 week after the beginning of chemotherapy and radiation therapy (CRT) correlate with tumor histopathologic downstaging after preoperative CRT. Materials and Methods: This prospective study was approved by an institutional review board; informed consent was obtained from all patients. Thirty-seven patients (mean age, 54.7 years; 13 women, 24 men) with primary rectal carcinoma who were undergoing preoperative CRT were recruited for the study. Diffusion-weighted (DW) magnetic resonance (MR) imaging was performed with a 1.5-T MR imager in all patients before therapy, at the end of the 1st and 2nd week of therapy, and before surgery. Tumor ADCs were calculated. Linear mixed-effects modeling was applied to analyze change in ADCs and volumes following treatment. Results: Patients were assigned to the tumor downstaged group (n = 17) or the tumor nondownstaged group (n = 20) on the basis of histopathologic examination results following surgery. Before CRT, the mean tumor ADC in the downstaged group was lower than that in the nondownstaged group (1.07 x 10(-3) mm(2)/sec +/- 0.13 [standard deviation] vs 1.19 x 10(-3) mm(2)/sec +/- 0.15, F = 6.91, P=.013). At the end of the 1st week of CRT, the mean tumor ADC increased significantly from 1.07 x 10(-3)mm(2)/sec +/- 0.13 to 1.32 x 10(-3) mm(2)/sec +/- 0.16 (F = 37.63, P<.001) in the downstaged group, but there was no significant ADC increase in the nondownstaged group (F = 1.18, P=.291). The mean percentage of tumor ADC change in the downstaged group was significantly higher than that in the nondownstaged group at each time point (F = 18.39, P<.001). Conclusion: Early increase of mean tumor ADC and low pretherapy mean ADC in rectal carcinoma correlate with good response to CRT. DW MR imaging is a promising noninvasive technique for helping predict and monitor early therapeutic response in patients with rectal carcinoma who are undergoing CRT. (C) RSNA, 2009
引用
收藏
页码:170 / 178
页数:9
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