Abstract
Introduction. Our interest was to monitor treatment response using ADC value to predict response of rectal tumour to preoperative radiochemotherapy. Materials and Methods. Twenty-two patients were treated with long course of radiochemotherapy, followed by surgery. Patients were examined by diffusion-weighted imaging MRI at three-time points (prior, during, and after radiochemotherapy) and were classified as responders and nonresponders. Results. A statistical significant correlation was found between preradiochemotherapy ADC values and during treatment ADC values, in responders (F = 21.50, P value <0.05). An increase in ADC value during treatment was predictive of at least a partial response. Discussion. Response of tumour to neoadjuvant therapy cannot be easily evaluated, and such capability might be of great importance in clinical practice, because the number of irradiated and operated patients may be superior to the number of who will really benefit from this multimodal treatment. A reliable prediction of the final clinical TN stage would allow radiotherapist to adapt multidisciplinary approach to a less invasive management, sparing surgical procedure in responder patients or even allowing an early surgery in nonresponders, which would significantly reduce radiochemotherapy related toxicity. Conclusion. Early evaluation of response during neoadjuvant radiochemotherapy treatment shows great promise to predict tumour response.
Highlights
Our interest was to monitor treatment response using apparent diffusion coefficient (ADC) value to predict response of rectal tumour to preoperative radiochemotherapy
Response of tumour to neoadjuvant therapy cannot be evaluated, and such capability might be of great importance in clinical practice, because the number of irradiated and operated patients may be superior to the number of who will really benefit from this multimodal treatment
DW-magnetic resonance imaging (MRI) depends on the microscopic Brownian motion of water; the difference in water motion is quantified by the apparent diffusion coefficient (ADC), and it is inversely correlated to the tissue cellularity and the integrity of cell membranes
Summary
Our interest was to monitor treatment response using ADC value to predict response of rectal tumour to preoperative radiochemotherapy. Response of tumour to neoadjuvant therapy cannot be evaluated, and such capability might be of great importance in clinical practice, because the number of irradiated and operated patients may be superior to the number of who will really benefit from this multimodal treatment. A reliable prediction of the final clinical TN stage would allow radiotherapist to adapt multidisciplinary approach to a less invasive management, sparing surgical procedure in responder patients or even allowing an early surgery in nonresponders, which would significantly reduce radiochemotherapy related toxicity. Preoperative radiochemotherapy (RT-CHT) is standard treatment for patients with locally advanced rectal cancer, due to less acute toxicity, greater tumour response, and higher rates of sphincter preservation when compared with adjuvant therapy [2]. Diffusionweighted magnetic resonance (DW-MRI) as an imaging biomarker has the potentiality for early evaluation of the response to RT-CHT treatment in a large section of cancer types, including head and neck tumours, pancreatic tumours, cervical tumours, and rectal cancer [4]
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