MRI and FDG-PET for assessment of response to neoadjuvant chemotherapy in locally advanced rectal cancer

Toshisada Aiba, Keisuke Uehara, Takashi Nihashi, Toyonori Tsuzuki, Hiroshi Yatsuya, Yuichiro Yoshioka, Katsuhiko Kato, Masato Nagino

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13 Citations (Scopus)

Abstract

Background: The purpose of this study was to assess the value of magnetic resonance imaging (MRI) and additional 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for tumor response to neoadjuvant chemotherapy (NAC) in patients with locally advanced rectal cancer (LARC). Methods: Data on 40 patients with LARC, who were treated with NAC and underwent MRI and FDG-PET/CT before and after NAC, were analyzed retrospectively. Surgery was performed at a median of 6 weeks after NAC and the images were compared with the histological findings. The tumor regression grade 3/4 was classified as a responder. Results: Sixteen patients were pathological responders. Receiver operating characteristic (ROC) analysis revealed that MRI total volume after NAC (MRI-TV2) and ΔMRI-TV had the highest performance to assess responders (area under the ROC curve [AUC] 0.849 and AUC 0.853, respectively). The reduction rate of the maximum standardized uptake value (ΔSUVmax) was also an informative factor (AUC 0.719). There seems no added value of adding FDG-PET/CT to MRI-TV2 and ΔMRI-TV in assessment of NAC responders judging from changes in AUC (AUC of ΔSUVmax and MRI-TV2 was 0.844, and AUC of ΔSUVmax and ΔMRI-TV was 0.846). Conclusions: MRI-TV2 and ΔMRI-TV were the most accurate factors to assess pathological response to NAC. Although ΔSUVmax by itself was also informative, the addition of FDG-PET/CT to MRI did not improve performance. Patients with LARC who were treated by induction chemotherapy should receive an MRI examination before and after NAC to assess treatment response. A more than 70 % volume reduction shown by MRI volumetry may justify the omission of subsequent radiotherapy.

Original languageEnglish
Pages (from-to)1801-1808
Number of pages8
JournalAnnals of Surgical Oncology
Volume21
Issue number6
DOIs
Publication statusPublished - 01-01-2014

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Rectal Neoplasms
Magnetic Resonance Imaging
Drug Therapy
ROC Curve
Area Under Curve
Induction Chemotherapy
Fluorodeoxyglucose F18
Neoplasms
Radiotherapy

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology
  • Medicine(all)

Cite this

Aiba, Toshisada ; Uehara, Keisuke ; Nihashi, Takashi ; Tsuzuki, Toyonori ; Yatsuya, Hiroshi ; Yoshioka, Yuichiro ; Kato, Katsuhiko ; Nagino, Masato. / MRI and FDG-PET for assessment of response to neoadjuvant chemotherapy in locally advanced rectal cancer. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 6. pp. 1801-1808.
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abstract = "Background: The purpose of this study was to assess the value of magnetic resonance imaging (MRI) and additional 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for tumor response to neoadjuvant chemotherapy (NAC) in patients with locally advanced rectal cancer (LARC). Methods: Data on 40 patients with LARC, who were treated with NAC and underwent MRI and FDG-PET/CT before and after NAC, were analyzed retrospectively. Surgery was performed at a median of 6 weeks after NAC and the images were compared with the histological findings. The tumor regression grade 3/4 was classified as a responder. Results: Sixteen patients were pathological responders. Receiver operating characteristic (ROC) analysis revealed that MRI total volume after NAC (MRI-TV2) and ΔMRI-TV had the highest performance to assess responders (area under the ROC curve [AUC] 0.849 and AUC 0.853, respectively). The reduction rate of the maximum standardized uptake value (ΔSUVmax) was also an informative factor (AUC 0.719). There seems no added value of adding FDG-PET/CT to MRI-TV2 and ΔMRI-TV in assessment of NAC responders judging from changes in AUC (AUC of ΔSUVmax and MRI-TV2 was 0.844, and AUC of ΔSUVmax and ΔMRI-TV was 0.846). Conclusions: MRI-TV2 and ΔMRI-TV were the most accurate factors to assess pathological response to NAC. Although ΔSUVmax by itself was also informative, the addition of FDG-PET/CT to MRI did not improve performance. Patients with LARC who were treated by induction chemotherapy should receive an MRI examination before and after NAC to assess treatment response. A more than 70 {\%} volume reduction shown by MRI volumetry may justify the omission of subsequent radiotherapy.",
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MRI and FDG-PET for assessment of response to neoadjuvant chemotherapy in locally advanced rectal cancer. / Aiba, Toshisada; Uehara, Keisuke; Nihashi, Takashi; Tsuzuki, Toyonori; Yatsuya, Hiroshi; Yoshioka, Yuichiro; Kato, Katsuhiko; Nagino, Masato.

In: Annals of Surgical Oncology, Vol. 21, No. 6, 01.01.2014, p. 1801-1808.

Research output: Contribution to journalArticle

TY - JOUR

T1 - MRI and FDG-PET for assessment of response to neoadjuvant chemotherapy in locally advanced rectal cancer

AU - Aiba, Toshisada

AU - Uehara, Keisuke

AU - Nihashi, Takashi

AU - Tsuzuki, Toyonori

AU - Yatsuya, Hiroshi

AU - Yoshioka, Yuichiro

AU - Kato, Katsuhiko

AU - Nagino, Masato

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: The purpose of this study was to assess the value of magnetic resonance imaging (MRI) and additional 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for tumor response to neoadjuvant chemotherapy (NAC) in patients with locally advanced rectal cancer (LARC). Methods: Data on 40 patients with LARC, who were treated with NAC and underwent MRI and FDG-PET/CT before and after NAC, were analyzed retrospectively. Surgery was performed at a median of 6 weeks after NAC and the images were compared with the histological findings. The tumor regression grade 3/4 was classified as a responder. Results: Sixteen patients were pathological responders. Receiver operating characteristic (ROC) analysis revealed that MRI total volume after NAC (MRI-TV2) and ΔMRI-TV had the highest performance to assess responders (area under the ROC curve [AUC] 0.849 and AUC 0.853, respectively). The reduction rate of the maximum standardized uptake value (ΔSUVmax) was also an informative factor (AUC 0.719). There seems no added value of adding FDG-PET/CT to MRI-TV2 and ΔMRI-TV in assessment of NAC responders judging from changes in AUC (AUC of ΔSUVmax and MRI-TV2 was 0.844, and AUC of ΔSUVmax and ΔMRI-TV was 0.846). Conclusions: MRI-TV2 and ΔMRI-TV were the most accurate factors to assess pathological response to NAC. Although ΔSUVmax by itself was also informative, the addition of FDG-PET/CT to MRI did not improve performance. Patients with LARC who were treated by induction chemotherapy should receive an MRI examination before and after NAC to assess treatment response. A more than 70 % volume reduction shown by MRI volumetry may justify the omission of subsequent radiotherapy.

AB - Background: The purpose of this study was to assess the value of magnetic resonance imaging (MRI) and additional 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for tumor response to neoadjuvant chemotherapy (NAC) in patients with locally advanced rectal cancer (LARC). Methods: Data on 40 patients with LARC, who were treated with NAC and underwent MRI and FDG-PET/CT before and after NAC, were analyzed retrospectively. Surgery was performed at a median of 6 weeks after NAC and the images were compared with the histological findings. The tumor regression grade 3/4 was classified as a responder. Results: Sixteen patients were pathological responders. Receiver operating characteristic (ROC) analysis revealed that MRI total volume after NAC (MRI-TV2) and ΔMRI-TV had the highest performance to assess responders (area under the ROC curve [AUC] 0.849 and AUC 0.853, respectively). The reduction rate of the maximum standardized uptake value (ΔSUVmax) was also an informative factor (AUC 0.719). There seems no added value of adding FDG-PET/CT to MRI-TV2 and ΔMRI-TV in assessment of NAC responders judging from changes in AUC (AUC of ΔSUVmax and MRI-TV2 was 0.844, and AUC of ΔSUVmax and ΔMRI-TV was 0.846). Conclusions: MRI-TV2 and ΔMRI-TV were the most accurate factors to assess pathological response to NAC. Although ΔSUVmax by itself was also informative, the addition of FDG-PET/CT to MRI did not improve performance. Patients with LARC who were treated by induction chemotherapy should receive an MRI examination before and after NAC to assess treatment response. A more than 70 % volume reduction shown by MRI volumetry may justify the omission of subsequent radiotherapy.

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