Abstract
Background Concurrent chemoradiotherapy (CCRT) is the main treatment for esophageal cancer, but the response to treatment varies from individual to individual. MR imaging methods, such as diffusion-weighted (DW) MRI and the use of dynamic contrast-enhanced (DCE) MRI, have the potential to provide additional biomarkers that could evaluate the effect of CCRT in patients with esophageal carcinoma. Materials and Methods Fifty-six patients with esophageal carcinoma, verified by histopathology, underwent MRI examination before and at midtreatment (4th week, radiotherapy 30–40 Gy) using the Siemens 3.0 T MR System. Parameter maps of apparent diffusion coefficient (ADC), and DCE maps of volume transfer constant (Krans), rate contrast (kep), and extracellular fluid space (ve), were computed using a Siemens Company Multimodality Workplace (MMWP) model. Comparison of histogram parameters and their diagnostic performance was determined using the Mann–Whitney U test and receiver operating characteristic (ROC) analysis. Results 56 patient MRI scans were available for analysis at baseline and at the third week, respectively. Pretreatment Krans, pretreatment kep, pretreatment ADC (P < 0.05), and during-treatment Krans (P < 0.05) and ΔKrans and ΔADC (P < 0.05) were significantly different after CCRT. Based on the binary logistic model, the ROC analysis demonstrated that the combined predictors demonstrated a high diagnostic performance with an AUC of 0.939. The sensitivity and specificity were 98.6% and 73.8%, respectively. Conclusion The combination of DCE and DWI can be used as an early biomarker in the prediction of the effect of CCRT three weeks after treatment in esophageal carcinoma.
Highlights
Concurrent chemoradiotherapy (CCRT) is the main treatment for esophageal cancer, but the response to treatment varies from individual to individual
Aim In this context, with relatively few reports on the application of dynamic contrast-enhanced (DCE), this project is aimed at analyzing the efficacy of combining this modality with diffusion-weighted imaging (DWI) in evaluating CCRT for esophageal carcinoma
According to the CT scan within one week at the end of radiotherapy, 14 patients (25%) were classified into the complete response (CR) group, whereas 42 cases were assigned to the non-CR group (SD+PR+progressive disease (PD) with 5, 37, and 0 cases, respectively) (85.0%)
Summary
Concurrent chemoradiotherapy (CCRT) is the main treatment for esophageal cancer, but the response to treatment varies from individual to individual. MR imaging methods, such as diffusion-weighted (DW) MRI and the use of dynamic contrast-enhanced (DCE) MRI, have the potential to provide additional biomarkers that could evaluate the effect of CCRT in patients with esophageal carcinoma. The combination of DCE and DWI can be used as an early biomarker in the prediction of the effect of CCRT three weeks after treatment in esophageal carcinoma. DCE has shown to be effective for tumor diagnosis, tumor grading, tumor response evaluation, and recurrence prediction, for several cancer types such as breast cancer [3,4,5], liver cancer [6, 7], rectal cancer [8, 9], pancreatic cancer [10], nasopharyngeal carcinoma [11, 12], and prostate cancer [13, 14]
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