Locally Advanced Rectal Cancer: Added Value of Diffusion-weighted MR Imaging in the Evaluation of Tumor Response to Neoadjuvant Chemo- and Radiation Therapy

Kim, Seung Ho; Lee, Jeong Min; Hong, Sung Hwan; Kim, Gi Hyeon; Lee, Jae Young; Han, Joon Koo; Choi, Byung Ihn

doi:10.1148/radiol.2532090027

Cited by 323 publications

(264 citation statements)

References 39 publications

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“…It is believed that the presence of microscopic residual tumor cell nests in fibrotic areas or in the mucinous subset is the main reason for indiscrimination of CR from near CR by DW-MRI (15). In our study, this hypothesis was supported by the determination that there was no relationship between post-CRT ADC values and SI changes with pRS in rectal tumors.…”

Section: Z=462)supporting

confidence: 67%

“…They stated that the mean ADC of the pCR group was significantly higher than that of the non-pCR group (1.62×10 -3 vs. 1.04×10 -3 mm 2 /s, respectively; P < 0.0001); however, an overlap of ADC values was observed in the two groups (15). In the current study, ADC measurements were taken from the normal rectal wall and rectal tumors.…”

Section: Z=462)mentioning

confidence: 58%

“…Kim et al (15) showed that adding DW-MRI to conventional MRI yields better diagnostic accuracy than the use of conventional MRI alone in the evaluation of CR to neoadjuvant CRT in patients with locally advanced rectal cancer. They stated that the mean ADC of the pCR group was significantly higher than that of the non-pCR group (1.62×10 -3 vs. 1.04×10 -3 mm 2 /s, respectively; P < 0.0001); however, an overlap of ADC values was observed in the two groups (15).…”

Section: Z=462)mentioning

confidence: 99%

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Can diffusion-weighted MRI determine complete responders after neoadjuvant chemoradiation for locally advanced rectal cancer?

Engin

Sharifov²,

Güral³

et al. 2012

Diagn Interv Radiol

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N eoadjuvant chemoradiotheraphy (CRT) improves tumor downstaging, pathological complete response (pCR), and local control (1, 2). pCR rates of 13%-30% have been reported in phase II and phase III trials following 5-fluorouracil-based preoperative CRT (3, 4). Currently, management of patients with clinical complete response (cCR) remains controversial (5-8).A recent meta-analysis including 218 phase I/II or retrospective studies and 28 phase III trials of adjuvant CRT reported that T3 rectal cancer is associated with high local recurrence rates after nonsurgical treatment (9). In addition, similiar results were recently shown from a study using a "wait-and-see" policy after CRT (10).Accurate imaging methods are needed to evaluate CRT responses, and post-CRT magnetic resonance imaging (MRI) is frequently used for this purpose. However, the method has low accuracy in predicting the pathological stage of the tumor and can often overstage T1 and T2 tumors due to the limited capability of MRI to differentiate viable tumor, residual fibrotic nontumoral tissue, and a desmoplastic reaction. Understaging of irradiated rectal cancer can affect treatment planning, including the surgical strategy, and thus affects the tumor recurrence rate and prognosis (11).Diffusion-weighted (DW)-MRI is a functional imaging technique that yields qualitative and quantitative information and provides unique insights regarding tumor cellularity, integrity of cell membranes, and microcirculation.

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Section: Z=462)supporting

confidence: 67%

Section: Z=462)mentioning

confidence: 58%

Section: Z=462)mentioning

confidence: 99%

See 1 more Smart Citation

Can diffusion-weighted MRI determine complete responders after neoadjuvant chemoradiation for locally advanced rectal cancer?

Engin

Sharifov²,

Güral³

et al. 2012

Diagn Interv Radiol

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“…Differences between previous reported results and our findings are likely associated with differences in the study design (3,6,(14)(15)(16)(17)(18).…”

Section: Discussioncontrasting

confidence: 99%

“…The apparent diffusion coefficient (ADC) calculated from DW-MRI measurements may be used to quantify and express these properties. The majority of the studies have demonstrated that the pretreatment ADC is negatively correlated with response to treatment (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). It appears that necrotic areas with high pretreatment ADC values may be less sensitive to CRT.…”

Section: Introductionmentioning

confidence: 99%

Diffusion-weighted magnetic resonance imaging for prediction of tumor response to neoadjuvant chemoradiotherapy using irinotecan plus S-1 for rectal cancer

Doi

Beppu

Kato

et al. 2015

Molecular and Clinical Oncology

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Abstract. The purpose of this study was to investigate the clinical value of diffusion-weighted (DW) magnetic resonance imaging (MRI) as a predictor of tumor response in patients receiving neoadjuvant chemoradiotherapy (NA-CRT) for rectal cancer (RC) through measurement of the apparent diffusion coefficient (ADC) value in each tumor. Neoadjuvant radiotherapy with a total dose of 45 Gy in 25 fractions was performed in all 16 patients with RC, combined with irinotecan and S-1. MRI was performed before and after NA-CRT. Multiple factors were assessed to predict the pathological response to NA-CRT. The pathological response rate was determined in 9 patients (56.3%). Statistical analyses indicated that the ADC value prior to NA-CRT was significantly lower in patients with a better response to NA-CRT (P= 0.023). A cut-off value of 0.750x10 -3 mm 2 /sec obtained by a receiver operating characteristic curve analysis indicated a sensitivity of 77.8% and specificity of 85.7% for pathological responders to NA-CRT. In addition, the patients with lower ADC values exhibited a greater pathological response to NA-CRT (P= 0.041). In conclusion, the ADC value of MRI of RC patients treated with NA-CRT followed by surgery may provide valuable information to predict the response to NA-CRT.

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The Role of the Multidisciplinary Team in the Management of Locally Advanced and Recurrent Rectal Cancer

Schaap

Rutten

Burger

2021

Surgical Management of Advanced Pelvic Cancer

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Locally Advanced Rectal Cancer: Added Value of Diffusion-weighted MR Imaging in the Evaluation of Tumor Response to Neoadjuvant Chemo- and Radiation Therapy

Abstract: Adding DW MR imaging to conventional MR imaging yields better diagnostic accuracy than use of conventional MR imaging alone in the evaluation of CR to neoadjuvant CRT in patients with locally advanced rectal cancer.

Cited by 323 publications

References 39 publications

Can diffusion-weighted MRI determine complete responders after neoadjuvant chemoradiation for locally advanced rectal cancer?

Can diffusion-weighted MRI determine complete responders after neoadjuvant chemoradiation for locally advanced rectal cancer?

Diffusion-weighted magnetic resonance imaging for prediction of tumor response to neoadjuvant chemoradiotherapy using irinotecan plus S-1 for rectal cancer

The Role of the Multidisciplinary Team in the Management of Locally Advanced and Recurrent Rectal Cancer

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