Treatment response of colorectal cancer liver metastases to neoadjuvant or conversion therapy: a prospective multicentre follow-up study using MRI, diffusion-weighted imaging and 1H-MR spectroscopy compared with histology (subgroup in the RAXO trial)

Abstract

Background: Colorectal cancer liver metastases respond to chemotherapy and targeted agents not only by shrinking, but also by morphologic and metabolic changes. The aim of this study was to evaluate the value of advanced magnetic resonance imaging (MRI) methods in predicting treatment response and survival. Patients and methods: We investigated contrast-enhanced MRI, apparent diffusion coefficient (ADC) in diffusionweighted imaging and 1 H-magnetic resonance spectroscopy ( 1 H-MRS) in detecting early morphologic and metabolic changes in borderline or resectable liver metastases, as a response to first-line neoadjuvant or conversion therapy in a prospective substudy of the RAXO trial (NCT01531621, EudraCT2011-003158-24). MRI findings were compared with histology of resected liver metastases and KaplaneMeier estimates of overall survival (OS). Results: In 2012-2018, 52 patients at four Finnish university hospitals were recruited. Forty-seven patients received neoadjuvant or conversion chemotherapy and 40 liver resections were carried out. Low ADC values (below median) of the representative liver metastases, at baseline and after systemic therapy, were associated with partial response according to RECIST criteria, but not with morphologic MRI changes or histology. Decreasing ADC values following systemic therapy were associated with improved OS compared to unchanged or increasing ADC, both in the liver resected subgroup (5-year OS rate 100% and 34%, respectively, P ¼ 0.022) and systemic therapy subgroup (5-year OS rate 62% and 23%, P ¼ 0.049). 1 H-MRS revealed steatohepatosis induced by systemic therapy. Conclusions: Low ADC values at baseline or during systemic therapy were associated with treatment response by RECIST but not with histology, morphologic or detectable metabolic changes. A decreasing ADC during systemic therapy is associated with improved OS both in all patients receiving systemic therapy and in the resected subgroup.

Morphometric analysis of fatty liver with the treatment of ginseng root extract

“…This is a morphometric analysis of hepatocytes, and gross morphological changes were observed like other researchers for measuring histological changes. The reticule was used as it has used by Utela in 2021 26 . Fatty droplets were more clearly visible in slides stained by Sudan Black.…”

Treatment Assessment of pNET and NELM after Everolimus by Quantitative MRI Parameters

“…Another influencing factor could be related to the immunological effects, as everolimus is known to increase the rate of regulatory T-cells [ 34 ]. Additionally, increased fibrosis due to replacement of viable tumor cells by collagen was hypothesized as a cause for decreasing ADC values in responding hepatic metastases indicated by improved OS [ 35 ].…”