Preoperative image-guided identification of response to neoadjuvant chemoradiotherapy in esophageal cancer (PRIDE): a multicenter observational study

Borggreve, Alicia S; Mook, Stella; Verheij, Marcel; Mul, Véronique E.; Bergman, Jacques; Bartels‐Rutten, Annemarieke; Beek, Leon C. ter; Beets‐Tan, Regina G. H.; Bennink, Roelof J.; Henegouwen, Mark I. van Berge; Brosens, Lodewijk A.A.; Defize, Ingmar L.; Dieren, Jolanda M. van; Dijkstra, Hildebrand; Hillegersberg, Richard van; Hulshof, Maarten C.C.M.; Laarhoven, Hanneke W. M. van; Lam, Marnix G. E. H.; Lier, Astrid L.H.M.W. van; Muijs, Christina T.; Nagengast, WB; Nederveen, Aart J.; Noordzij, Walter; Plukker, John; Rossum, Peter S.N. van; Ruurda, Jelle P.; Sandick, Johanna W. van; Weusten, Bas L.; Voncken, Francine E.M.; Yakar, Derya; Meijer, Sybren L.

doi:10.1186/s12885-018-4892-6

Cited by 55 publications

(48 citation statements)

References 49 publications

(46 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Future comparative studies should focus on further improving response evaluation after nCRT. In this regard, the recently started Dutch multicenter PRIDE study will further investigate the findings of the DW-MRI pilot studies in a larger patient cohort and aims at developing a multimodal clinically applicable prediction model [53].…”

Section: Discussionmentioning

confidence: 99%

Optimal timing for prediction of pathologic complete response to neoadjuvant chemoradiotherapy with diffusion-weighted MRI in patients with esophageal cancer

et al. 2019

Self Cite

View full text Add to dashboard Cite

Objective This study was conducted in order to determine the optimal timing of diffusion-weighted magnetic resonance imaging (DW-MRI) for prediction of pathologic complete response (pCR) to neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer. Methods Patients with esophageal adenocarcinoma or squamous cell carcinoma who planned to undergo nCRT followed by surgery were enrolled in this prospective study. Patients underwent six DW-MRI scans: one baseline scan before the start of nCRT and weekly scans during 5 weeks of nCRT. Relative changes in mean apparent diffusion coefficient (ADC) values between the baseline scans and the scans during nCRT (ΔADC(%)) were compared between pathologic complete responders (pCR) and non-pCR (tumor regression grades 2-5). The discriminative ability of ΔADC(%) was determined based on the c-statistic. Results A total of 24 patients with 142 DW-MRI scans were included. pCR was observed in seven patients (29%). ΔADC(%) from baseline to week 2 was significantly higher in patients with pCR versus non-pCR (median [IQR], 36% [30%, 41%] for pCR versus 16% [14%, 29%] for non-pCR, p = 0.004). The ΔADC(%) of the second week in combination with histology resulted in the highest c-statistic for the prediction of pCR versus non-pCR (0.87). The c-statistic of this model increased to 0.97 after additional exclusion of patients with a small tumor volume (< 7 mL, n = 3) and tumor histology of the resection specimen other than adenocarcinoma or squamous cell carcinoma (n = 1). Conclusion The relative change in tumor ADC (ΔADC(%)) during the first 2 weeks of nCRT is the most predictive for pathologic complete response to nCRT in esophageal cancer patients. Key Points • DW-MRI during the second week of neoadjuvant chemoradiotherapy is most predictive for pathologic complete response in esophageal cancer. • A model including ΔADC week 2 was able to discriminate between pathologic complete responders and non-pathologic complete responders in 87%. • Improvements in future MRI studies for esophageal cancer may be obtained by incorporating motion management techniques.

show abstract

Section: Discussionmentioning

confidence: 99%

Optimal timing for prediction of pathologic complete response to neoadjuvant chemoradiotherapy with diffusion-weighted MRI in patients with esophageal cancer

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…To overcome the limitations of the present study and further increase specificity without decreasing sensitivity for the preoperative detection of residual tumour in oesophageal cancer, larger studies are needed. The multicentre observational PRIDE (Preoperative Image‐guided Identification of Response to Neoadjuvant Chemoradiotherapy in Esophageal Cancer) study was initiated to explore the combination of multiple diagnostic modalities in assessing the response of the primary tumour and lymph nodes to chemoradiotherapy. This study aims to develop an optimal multimodal response prediction model focusing on clinical (endoscopy and EUS) and radiological (MRI and FDG‐PET/CT) assessment combined with patient‐specific parameters (such as circulating tumour DNA) for oesophageal cancer.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer

Vollenbrock

Voncken

Dieren

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

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.

show abstract

“…The current standard of care for restaging after finishing neoadjuvant CTRT is based on endoscopy with (random) bite-on-bite biopsies of the primary tumor site in the esophagus as well as an endoscopic ultrasonography (EUS) with fine-needle aspiration of suspected lymph nodes. 32 Thus, immune markers might be easily retrieved at staging or restaging endoscopy to support the ensuing decision-making process. The immune microenvironment in the healthy esophageal mucosa on the endoscopic biopsies might provide a picture of the local immune response to cancer and to CTRT, thus giving further information on cancer progression and on the recurrence risk when cancer tissue is no more available, such in case of pCR.…”

Section: Discussionmentioning

confidence: 99%

Immune surveillance activation after neoadjuvant therapy for esophageal adenocarcinoma and complete response

et al. 2020

View full text Add to dashboard Cite

After neoadjuvant chemoradiotherapy for esophageal adenocarcinoma, up to 29% of patients have a pathological complete response (pCR). What to do afterward is still under debate. The aim of this prospective study was to define which local markers of immune response might act as predictors of pCR and of recurrence after pCR. The peritumoral healthy mucosa of the surgical specimen was sampled at esophagectomy and analyzed by immunohistochemistry, flow cytometry and Real-Time PCR. One hundred and twenty-three patients received neoadjuvant therapy for esophageal adenocarcinoma and were included in the study. Significantly higher rate of natural killer (NK) cells (CD57+), intraepithelial CD8 + T lymphocytes and degranulating T-and NK-cells (CD107+) were observed in the healthy mucosa of patients with pCR. Moreover, pCR was characterized by a lower immune-check points gene expression level. T-cell activation markers mRNA levels were significantly lower in patients with pCR and recurrent disease, showing an excellent accuracy in the prediction of the postoperative recurrence. Costimulatory molecules mRNA relative levels tended to be lower in patients with pCR and recurrent disease, showing a good accuracy in the prediction of postoperative recurrence in patients with pCR. The immune profile identified in this study might further be tested in large prospective trials as marker of pCR after neoadjuvant therapy and as predictor of recurrence after pCR.

show abstract

Preoperative image-guided identification of response to neoadjuvant chemoradiotherapy in esophageal cancer (PRIDE): a multicenter observational study

Cited by 55 publications

References 49 publications

Optimal timing for prediction of pathologic complete response to neoadjuvant chemoradiotherapy with diffusion-weighted MRI in patients with esophageal cancer

Optimal timing for prediction of pathologic complete response to neoadjuvant chemoradiotherapy with diffusion-weighted MRI in patients with esophageal cancer

Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer

Immune surveillance activation after neoadjuvant therapy for esophageal adenocarcinoma and complete response

Contact Info

Product

Resources

About