Oesophageal squamous cell carcinoma: histogram-derived ADC parameters are not predictive of tumour response to chemoradiotherapy

Maiko Kozumi,Keiichi Jingu,Takaya Yamamoto,Rei Umezawa,Kei Takase,Yojiro Ishikawa,Noriyoshi Takahashi,Haruo Matsushita,Tomonori Matsuura,Hideki Ota

doi:10.1007/s00330-018-5439-6

Abstract

ObjectivesTo evaluate correlations between tumour response to definitive chemoradiotherapy (CRT) in oesophageal squamous cell carcinoma (SCC) and histogram-derived apparent diffusion coefficient (ADC) parameters on diffusion-weighted MR images.MethodsForty patients with clinical T3–4 oesophageal SCC underwent concurrent CRT. MR examination at 3 T was performed 1–3 days prior to CRT. Readout-segmented echo-planar diffusion imaging was used to acquire ADC maps. Pre- and post-treatment CT examinations were performed. Histogram parameters (mean, 10th, 25th, 50th, 75th, 90th percentiles, skewness and kurtosis) of the ADC values were compared with post-treatment disease status based on RECIST and the tumour regression ratio.ResultsNone of the ADC parameters showed significant correlation with post-treatment status (range of Spearman’s ρ values − 0.19 to 0.14, range of p values 0.22–0.47) or tumour regression ratio (range of Spearman’s ρ values − 0.045 to 0.18, range of p values 0.26–0.96). Neither progression-free survival (PFS) (p = 0.17) nor overall survival (OS) (p = 0.15) was significantly different between the two groups corresponding to the lower (< median) and upper arms (≥ median) of the mean ADC values.ConclusionsHistogram-derived pretreatment ADC parameters were not predictive imaging biomarkers for tumour response to CRT in patients with oesophageal SCC.Key Points• Apparent diffusion coefficient (ADC) values are derived from diffusion-weighted MR imaging.• High-resolution diffusion-weighted images are generated by readout-segmented echo-planar diffusion imaging.• Readout-segmented echo-planar diffusion-weighted imaging enabled evaluation of ADC parameters.• Pretreatment ADC parameters do not predict chemoradiotherapy response in patients with oesophageal carcinoma.

Highlights

Chemoradiotherapy (CRT) is one of the standard treatment methods for patients with locally advanced oesophageal squamous cell carcinoma (SCC)
Apparent diffusion coefficient (ADC) values are derived from diffusion-weighted MR imaging
Mean histogram parameters of ADC values in patients with CR or PR versus those with SD and in those with CR versus those with PR or SD are shown in Fig. 2 and Table 2

Summary

Introduction

Chemoradiotherapy (CRT) is one of the standard treatment methods for patients with locally advanced oesophageal squamous cell carcinoma (SCC). If the lack of response to definitive CRT can be predicted before treatment in patients with locally advanced oesophageal SCC, CRT can be discontinued and salvage surgery can be scheduled. Previous studies indicated its potential for predicting treatment response before and during treatment [8,9,10]. Most previous studies only assessed median or mean ADC values, a few indicated its potential for predicting treatment response using 1.5 T scanners [8, 9]. The study by van Rossum et al [9] included patients with oesophageal adenocarcinoma and oesophageal SCC; this pathologically heterogeneous cohort may have influenced the baseline ADC values and treatment response to CRT. ADC histogram analysis is being increasingly applied for examination of the heterogeneity of diffusion in the tumour region based on pixel distribution [11]

Objectives

Methods

Results