Tumor volume regression during preoperative chemoradiotherapy for rectal cancer: a prospective observational study with weekly MRI

Begin, Robbe Van den; Kleijnen, J.J.E.; Engels, Benedikt; Philippens, M.E.P.; Asselen, Bram van; Raaymakers, B W; Reerink, O.; Ridder, Mark De; Intven, Martijn

doi:10.1080/0284186x.2017.1400689

Cited by 34 publications

(38 citation statements)

References 26 publications

(24 reference statements)

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“…Similar conclusions were reached also by van den Begin et al, through the use of serial diagnostic MRI [ 22 ].…”

Section: Discussionsupporting

confidence: 87%

“…Cusumano et al recently described a radiomics-based predictive model able to identify patients achieving pCR through the use of staging magnetic resonance (MR) images, while other authors investigated the possibility to identify such patients analysing the tumour volume on one or more MR scans acquired throughout the radiotherapy treatment [ 20 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

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Delta radiomics for rectal cancer response prediction with hybrid 0.35 T magnetic resonance-guided radiotherapy (MRgRT): a hypothesis-generating study for an innovative personalized medicine approach

et al. 2018

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The aim of this study was to evaluate the variation of radiomics features, defined as “delta radiomics”, in patients undergoing neoadjuvant radiochemotherapy (RCT) for rectal cancer treated with hybrid magnetic resonance (MR)-guided radiotherapy (MRgRT). The delta radiomics features were then correlated with clinical complete response (cCR) outcome, to investigate their predictive power. A total of 16 patients were enrolled, and 5 patients (31%) showed cCR at restaging examinations. T 2*/ T 1 MR images acquired with a hybrid 0.35 T MRgRT unit were considered for this analysis. An imaging acquisition protocol of 6 MR scans per patient was performed: the first MR was acquired at first simulation ( t 0) and the remaining ones at fractions 5, 10, 15, 20 and 25. Radiomics features were extracted from the gross tumour volume (GTV), and each feature was correlated with the corresponding delivered dose. The variations of each feature during treatment were quantified, and the ratio between the values calculated at different dose levels and the one extracted at t 0 was calculated too. The Wilcoxon–Mann–Whitney test was performed to identify the features whose variation can be predictive of cCR, assessed with a MR acquired 6 weeks after RCT and digital examination. The most predictive feature ratios in cCR prediction were the L_least and glnu ones, calculated at the second week of treatment (22 Gy) with a p value = 0.001. Delta radiomics approach showed promising results and the quantitative analysis of images throughout MRgRT treatment can successfully predict cCR offering an innovative personalized medicine approach to rectal cancer treatment.

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“…Similar conclusions were reached also by van den Begin et al, through the use of serial diagnostic MRI [ 22 ].…”

Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Delta radiomics for rectal cancer response prediction with hybrid 0.35 T magnetic resonance-guided radiotherapy (MRgRT): a hypothesis-generating study for an innovative personalized medicine approach

et al. 2018

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“…We observed no tumor regression on the day-to-day timescale during RT, whereas on the week-to-week timescale tumor regression during CRT was found. The latter was also shown by Van den Begin et al [18]. Also rectal volume tends to decrease after two to three weeks of CRT whereas this is not observed during one week of RT [19,20].…”

Section: Discussionsupporting

confidence: 68%

MRI-based tumor inter-fraction motion statistics for rectal cancer boost radiotherapy

et al. 2018

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Background: In patients diagnosed with rectal cancer, dose escalation is currently being investigated in a large number of studies. Since there is little known on gross tumor volume (GTV) inter-fraction motion for rectal cancer, a wide variety in margins is used. Purpose of this study is to quantify GTV inter-fraction motion statistics on different timescales and to give estimates of planning target volume (PTV) margins. Material and methods: Thirty-two patients, diagnosed with rectal cancer, were included. To investigate motion from week-to-week, 16 patients underwent a pretreatment and five weekly MRIs, prior to a radiotherapy (RT) fraction of the chemoradiotherapy treatment. To investigate motion from day-to-day, the remaining 16 patients underwent five daily MRIs before each fraction in one week of RT. GTV was delineated on all scans according to guidelines. Scans were aligned on bony anatomy with the first MRI. For both datasets separately, GTV inter-fraction motion was determined based on center-of-gravity displacement. Therefrom, systematic and random errors were determined in left/right (LR), anterior/posterior and cranial/caudal (CC) direction. PTV margin estimates were calculated and evaluated on GTV coverage. Results: Systematic and random errors were found in the range of 2.3-4.8 mm and 1.5-3.3 mm from week-to-week, and 1.8-4.5 mm and 1.8-4.0 mm from day-to-day, respectively. On both timescales, similar motion patterns were found; the most motion was observed in CC whilst the least motion was observed in LR. On the week-to-week data more systematic and less random motion was observed compared to the day-to-day data. Overall, only slight differences in margin estimates were found. Derived PTV margin estimates were found to give adequate GTV coverage.

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“…The detailed description of daily volumetric changes in this study aims to serve as a template to design further trials to confirm the role of MRI as a means for early response assessment in order to devise response-specific adaptive treatment strategies. Tumor volume decreases during RCT offer the option to adapt treatment volumes for a better sparing of the surrounding tissues-at-risk with a potential impact on acute and late radiogenic toxicities as well as perioperative morbidity [15]. There is an increasing interest in tailoring neoadjuvant treatments more closely to the extent of tumor regression during RCT based on MRI examinations [32].…”

Section: Discussionmentioning

confidence: 99%

Exploring MR regression patterns in rectal cancer during neoadjuvant radiochemotherapy with daily T2- and diffusion-weighted MRI

et al. 2020

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Background: To date, only limited magnetic resonance imaging (MRI) data are available concerning tumor regression during neoadjuvant radiochemotherapy (RCT) of rectal cancer patients, which is a prerequisite for adaptive radiotherapy (RT) concepts. This exploratory study prospectively evaluated daily fractional MRI during neoadjuvant treatment to analyze the predictive value of MR biomarkers for treatment response. Methods: Locally advanced rectal cancer patients were examined with daily MRI during neoadjuvant RCT. Contouring of the tumor volume was performed for each MRI scan by using T2-and diffusion-weighted-imaging (DWI)-sequences. The daily apparent-diffusion coefficient (ADC) was calculated. Volumetric and functional tumor changes during RCT were analyzed and correlated with the pathological response after surgical resection. Results: In total, 171 MRI scans of eight patients were analyzed regarding anatomical and functional dynamics during RCT. Pathological complete response (pCR) could be achieved in four patients, and four patients had a pathological partial response (pPR) following neoadjuvant treatment. T2-and DWI-based volumetry proved to be statistically significant in terms of therapeutic response, and volumetric thresholds at week two and week four during RCT were defined for the prediction of pCR. In contrast, the average tumor ADC values widely overlapped between both response groups during RCT and appeared inadequate to predict treatment response in our patient cohort. Conclusion: This prospective exploratory study supports the hypothesis that MRI may be able to predict pCR of rectal cancers early during neoadjuvant RCT. Our data therefore provide a useful template to tailor future MRguided adaptive treatment concepts.

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Tumor volume regression during preoperative chemoradiotherapy for rectal cancer: a prospective observational study with weekly MRI

Cited by 34 publications

References 26 publications

Delta radiomics for rectal cancer response prediction with hybrid 0.35 T magnetic resonance-guided radiotherapy (MRgRT): a hypothesis-generating study for an innovative personalized medicine approach

Delta radiomics for rectal cancer response prediction with hybrid 0.35 T magnetic resonance-guided radiotherapy (MRgRT): a hypothesis-generating study for an innovative personalized medicine approach

MRI-based tumor inter-fraction motion statistics for rectal cancer boost radiotherapy

Exploring MR regression patterns in rectal cancer during neoadjuvant radiochemotherapy with daily T2- and diffusion-weighted MRI

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