Evaluation Of Neoadjuvant Chemotherapy Response Research Articles

Neoadjuvant chemotherapy induces an elevation of tumour apparent diffusion coefficient values in patients with ovarian cancer

ObjectivesMultiparametric magnetic resonance imaging (mMRI) is the modality of choice in the imaging of ovarian cancer (OC). We aimed to investigate the feasibility of different types of regions of interest (ROIs) in the measurement of apparent diffusion coefficient (ADC) values of diffusion-weighted imaging in OC patients treated with neoadjuvant chemotherapy (NACT).MethodsWe retrospectively enrolled 23 consecutive patients with advanced OC who had undergone NACT and mMRI. Seventeen of them had been imaged before and after NACT. Two observers independently measured the ADC values in both ovaries and in the metastatic mass by drawing on a single slice of (1) freehand large ROIs (L-ROIs) covering the solid parts of the whole tumour and (2) three small round ROIs (S-ROIs). The side of the primary ovarian tumour was defined. We evaluated the interobserver reproducibility and statistical significance of the change in tumoural pre- and post-NACT ADC values. Each patient’s disease was defined as platinum-sensitive, semi-sensitive, or resistant. The patients were deemed either responders or non-responders.ResultsThe interobserver reproducibility of the L-ROI and S-ROI measurements ranged from good to excellent (ICC range: 0.71–0.99). The mean ADC values were significantly higher after NACT in the primary tumour (L-ROI p < 0.001, S-ROIs p < 0.01), and the increase after NACT was associated with sensitivity to platinum-based chemotherapy. The changes in the ADC values of the omental mass were associated with a response to NACT.ConclusionThe mean ADC values of the primary tumour increased significantly after NACT in the OC patients, and the amount of increase in omental mass was associated with the response to platinum-based NACT. Our study indicates that quantitative analysis of ADC values with a single slice and a whole tumour ROI placement is a reproducible method that has a potential role in the evaluation of NACT response in patients with OC.Trial registrationRetrospectively registered (institutional permission code: 5302501; date of the permission: 31.7.2020).

201 (PB-114) Poster - Evaluation of neoadjuvant chemotherapy response in breast cancer: radiological and pathological concordance

Background: MRI is the most used test for the evaluation of neoadjuvant chemotherapy (NAC) response in breast cancer. However, sometimes the pathological analysis of surgical piece revels discordance with pre-surgical radiological result. The purpose of the study was to evaluate radiological-pathological concordance of NAC response and to define which factors are associated with this coincident result.

Impact of COVID-19 On Breast Cancer Management: A Radiological Prespective from A Tertiary Centre.

The coronavirus-2019 (COVID-19) pandemic caused delaying breast cancer management, increasing time interval in chemotherapy cycles and surgery. This has implications on radiological manifestation of cancer. Further, we evaluated changes observed in mammography. This case control study was conducted from March 25th, 2020 to August 15th, 2020 at the Integrated Breast Care Centre, All India Institute of Medical Science Rishikesh (AIIMS), Rishikesh. Sonomammography was performed on follow-up patients who were on chemotherapy and were scheduled for surgery. Moreover, duration of delay from the last neoadjuvant chemotherapy (NACT) cycle was recorded. Similar data in the pre-COVID-19 period from November 4th, 2019 to March 24th, 2020 was compared with post-COVID-19 data and was analyzed by SPSS Version 23. The study included 54 patients who presented between March 25th, 2020 and August 15th, 2020. Furthermore, the delay in NACT cycles has been shown to be associated with disease progression (p = 0.045). Subgroup analysis of treatment duration with various parameters revealed significant correlation between size, appearance of ulceration, and response evaluation (p<0.05). However, no significant association was found between duration of delay and the histological subtype of lesion (p>0.05). A substantial difference was seen in the evaluation of NACT response in pre- and post-COVID-19 time, with partial response (n = 39, 58.24%) seen as the most common response in pre-COVID-19 time and progressive disease (n = 28, 51.9%) as the most common response in post-COVID-19 time (p<0.001). The coronavirus pandemic has severe impact on breast cancer management. A delay in NACT causes progression in cancer. This can be seen in ultrasound and mammogram.

A Delta-radiomics model for preoperative evaluation of Neoadjuvant chemotherapy response in high-grade osteosarcoma

BackgroundThe difficulty of assessment of neoadjuvant chemotherapeutic response preoperatively may hinder personalized-medicine strategies that depend on the results from pathological examination.MethodsA total of 191 patients with high-grade osteosarcoma (HOS) were enrolled retrospectively from November 2013 to November 2017 and received neoadjuvant chemotherapy (NCT). A cutoff time of November 2016 was used to divide the training set and validation set. All patients underwent diagnostic CTs before and after chemotherapy. By quantifying the tumor regions on the CT images before and after NCT, 540 delta-radiomic features were calculated. The interclass correlation coefficients for segmentations of inter/intra-observers and feature pair-wise correlation coefficients (Pearson) were used for robust feature selection. A delta-radiomics signature was constructed using the lasso algorithm based on the training set. Radiomics signatures built from single-phase CT were constructed for comparison purpose. A radiomics nomogram was then developed from the multivariate logistic regression model by combining independent clinical factors and the delta-radiomics signature. The prediction performance was assessed using area under the ROC curve (AUC), calibration curves and decision curve analysis (DCA).ResultsThe delta-radiomics signature showed higher AUC than single-CT based radiomics signatures in both training and validation cohorts. The delta-radiomics signature, consisting of 8 selected features, showed significant differences between the pathologic good response (pGR) (necrosis fraction ≥90%) group and the non-pGR (necrosis fraction < 90%) group (P < 0.0001, in both training and validation sets). The delta-radiomics nomogram, which consisted of the delta-radiomics signature and new pulmonary metastasis during chemotherapy showed good calibration and great discrimination capacity with AUC 0.871 (95% CI, 0.804 to 0.923) in the training cohort, and 0.843 (95% CI, 0.718 to 0.927) in the validation cohort. The DCA confirmed the clinical utility of the radiomics model.ConclusionThe delta-radiomics nomogram incorporating the radiomics signature and clinical factors in this study could be used for individualized pathologic response evaluation after chemotherapy preoperatively and help tailor appropriate chemotherapy and further treatment plans.

18F-FDG-PET/CT based total metabolic tumor volume change during neoadjuvant chemotherapy predicts outcome in advanced epithelial ovarian cancer.

To evaluate the predictive potential of total metabolic tumor volume (MTV) reduction during neoadjuvant chemotherapy (NACT) with 18F-FDG-PET/CT in an advanced FIGO stage III/IV epithelial ovarian cancer (EOC) patient cohort. Twenty-nine primarily inoperable EOC patients underwent 18F-FDG-PET/CT before and after NACT. The pre- and post-NACT total MTV, in addition to the percentage MTV reduction during NACT, were compared with primary therapy outcome and progression-free survival (PFS). ROC-analysis determined an optimal threshold for MTV reduction identifying patients with progressive or stable disease (PD/SD) at the end of primary therapy. A multivariate analysis with residual tumor (0/>0), FIGO stage (III/IV) and MTV reduction compared to PFS was performed. The association between MTV reduction and overall survival (OS) was evaluated. The median pre- and post-NACT total MTV were 352cm3 (range 150 to 1322cm3) and 51cm3 (range 0 to 417cm3), respectively. The median MTV reduction during NACT was 89% (range 24% to 100%). Post-NACT MTV and MTV reduction associated with primary therapy outcome (MTV post-NACT p = 0.007, MTV reduction p = 0.001) and PFS (MTV post-NACT p = 0.005, MTV reduction p = 0.005). MTV reduction <85% identified the PD/SD patients (sensitivity 70%, specificity 78%, AUC 0.79). In a multivariate analysis, MTV reduction (p = 0.002) and FIGO stage (p = 0.003) were statistically significant variables associated with PFS. MTV reduction during NACT corresponded to OS (p = 0.05). 18F-FDG-PET/CT is helpful in NACT response evaluation. Patients with total MTV reduction <85% during NACT might be candidates for second-line chemotherapy and clinical trials, instead of interval debulking surgery.

Early change of MR diffusion weighted imaging parameters of breast cancer after neoadjuvant chemotherapy and the relationship of the change with therapy response

Objective To investigate the early change of MR DWI parameters of breast cancer after neoadjuvant chemotherapy (NAC) and assess the relationship between the changes of the NAC response. Methods Patients with local advanced breast cancer diagnosed by biopsy were enrolled in the prospective study. They received DWI examination before NAC and then received DWI examination at 24 h after the first cycle of NAC. The pathological results of breast cancers were recorded after NAC finished. 14 patients (15 lesions) were enrolled in this study.The minimum ADC values of breast cancer before NAC and after the first cycle of NAC were recorded, and their change rates were calculated. Two weeks after NAC,all cases were divided into clinical complete response (cCR) and non-clinical complete response group according to clinical NAC response evaluation. Then lesions were divided into pathological complete response (pCR) and non-pathological complete response group according to pathological NAC response evaluation. Using the Paired samples t test,we analysed the change of ADC values 24 h after the first cycle of NAC. The ADC values and change rates were compared between cCR and non-cCR group using Mann-Whitney U test. The ADC values and change rates were also compared between pCR and non-pCR group using Mann-Whitney U test. Results The 15 cases were all invasive ductal carcinoma patients. According to clinical NAC response evaluation, 5 cases were cCR and 10 cases were non-cCR. According to pathological NAC response evaluation, 6 cases were pCR and 9 cases were non-pCR. Before NAC, the minimum ADC value of breast cancer was(0.78±0.15)×10-3 mm2/s. After the first cycle of NAC, the minimum ADC value of breast cancer was(0.91±0.16)×10-3 mm2/s. The minimum ADC value of breast cancer significantly increased 24 h after the first cycle of NAC (t=-2.954,P=0.010). But ADC value and its change rate were not significantly different between cCR and non-cCR groups, also between pCR and non-pCR groups (P>0.05). Conclusion Significant change in the minimum ADC value of breast cancer could be observed 24 h after the first cycle of NAC, but the change do not relate to clinical and pathological NAC response in this study. Key words: Breast neoplasms; Magnetic resonance imaging; Treatment outcome

Neoadjuvant chemotherapy response evaluation in breast cancer based on mammogram registration and tumor segmentation

The standard approach for assessing the response of breast tumors to neoadjuvant chemotherapy is to monitor gross changes in tumor size as measured by physical exam and/or conventional imaging such as mammography. However, the deformable nature of the breast and variation in the imaging procedure, make it difficult to match the shape of breasts between serials of temporal mammograms, particularly when the tumor is shrinking due to the treatment. In this paper we propose a method for assessing residual tumor size following neoadjuvant chemotherapy by analyzing changes between pre-treatment and post-treatment mammograms. Our method consists of three steps: (1) pre-treatment and post-treatment mammograms were first registered in order to circumvent the problem of patient repositioning and breast deformation. (2) Tumors at corresponding locations were segmented using region growing segmentation, (3) and based on changes in tumor sizes the response rate is quantified. The proposed method has been tested on 6 breast cancer patients undergoing neoadjuvant chemotherapy, and the experimental results demonstrate that our approach may improve the ability of mammography to evaluate breast tumor response.

Tumor-to-background ratio to predict response to chemotherapy of osteosarcoma better than standard uptake values.

According to the current treatment protocol of the Cooperative Osteosarcoma Study, it is mandatory to determine the histological response to neoadjuvant chemotherapy treatment before surgical removal of the tumor, particularly if a limb salvage procedure is planned. The aim of this systematic, retrospective study was to evaluate the ability of 2-((18) F) fluoro-2-deoxy-D-glucose positron-emission tomography/computed tomography to predict chemotherapy response of osteosarcoma and to identify a simple promising method for noninvasive evaluation of neoadjuvant chemotherapy response in osteosarcoma. The PubMed database was searched to identify and analyze relevant published reports. In particular, correlations between tumor-to-background ratio (TBR), standard uptake value (SUV) and histological response to chemotherapy were assessed. It was found that good responses are achieved in patients with TBR after chemotherapy (TBR2)/TBR before chemotherapy (TBR1) < 0.470 (positive predictive value [PPV] = 92.31%, negative predictive value [NPV] = 82.76%, sensitivity [S] = 87.80%, specificity [SP] = 88.89%), whereas poor responses occur in patients with SUV after chemotherapy/before chemotherapy (SUV2/SUV1) > 0.396 (PPV = 73.68%, NPV = 73.33%, S = 63.64%, SP = 81.48%). Changes in TBR are better predictors of chemotherapy response than SUV in osteosarcoma patients. Therefore, we believe that choice of surgical strategy is optimally based on changes in TBR.

Evaluation of Neoadjuvant Chemotherapy Response with Dynamic Contrast Enhanced Breast Magnetic Resonance Imaging in Locally Advanced Invasive Breast Cancer.

The reliability of traditional methods such as physical examination, ultrasonography (US) and mammography is limited in determining the type of treatment response in patients with neoadjuvant chemotherapy (NAC) application for locally advanced breast cancer (LABC). Dynamic contrast-enhanced magnetic resonance imaging (MRI) is gaining popularity in the evaluation of NAC response. This study aimed to compare NAC response as determined by dynamic contrast-enhanced breast MRI in patients with LABC to histopathology that is the gold standard; and evaluate the compatibility of MRI, mammography and US with response types. The US, mammography and MRI findings of 38 patients who received NAC with a diagnosis of locally advanced breast cancer and surgical treatment were retrospectively analyzed and compared to histopathology results. Type of response to treatment was determined according to the "Criteria in Solid Tumors Response Evolution 1.1" by mammography, US and MRI criteria. The relationship between response types as defined by all three imaging modalities and histopathology were evaluated, and the correlation of response type as detected by MRI and pathological response and histopathological type of breast cancer was further determined. For statistical analysis, the chi-square, paired t test, correlation and kappa tests were used. There is a statistical moderate positive correlation between response type according to pathology and MRI (kappa: 0.63). There was a weak correlation between response type according to mammography or US and according to pathology (kappa: 0.2). When the distribution of treatment response by MRI is stratified according to histopathological types, partial response was higher in all histopathological types similar to the type of pathologic response. When compared with pathology MRI detected treatment response accurately in 84.2% of the patients. Dynamic contrast-enhanced breast MRI appears to be a more effective method than mammography or US in the evaluation of response to neoadjuvant chemotherapy. MRI evaluation of LABC is accepted as the appropriate radiological approach.

Evaluation of Neoadjuvant Chemotherapy Response in Women with Locally Advanced Breast Cancer Using Ultrasound Elastography

PURPOSE: Ultrasound elastography is a new imaging technique that can be used to assess tissue stiffness. The aim of this study was to investigate the potential of ultrasound elastography for monitoring treatment response of locally advanced breast cancer patients undergoing neoadjuvant therapy. METHODS: Fifteen women receiving neoadjuvant chemotherapy had the affected breast scanned before, 1, 4, and 8 weeks following therapy initiation, and then before surgery. Changes in elastographic parameters related to tissue biomechanical properties were then determined and compared to clinical and pathologic tumor response after mastectomy. RESULTS: Patients who responded to therapy demonstrated a significant decrease (P < .05) in strain ratios and strain differences 4 weeks after treatment initiation compared to non-responding patients. Mean strain ratio and mean strain difference for responders was 81 ± 3% and 1 ± 17% for static regions of interest (ROIs) and 81 ± 3% and 6 ± 18% for dynamic ROIs, respectively. In contrast, these parameters were 102±2%, 110±17%, 101±4%, and 109±30% for non-responding patients, respectively. Strain ratio using static ROIs was found to be the best predictor of treatment response, with 100% sensitivity and 100% specificity obtained 4 weeks after starting treatment. CONCLUSIONS: These results suggest that ultrasound elastography can be potentially used as an early predictor of tumor therapy response in breast cancer patients.

Early evaluation of neoadjuvant chemotherapy response using FDG-PET/CT predicts survival prognosis in patients with head and neck squamous cell carcinoma

The purpose of this study was to investigate the possibility of early survival prediction after completion of one cycle of neoadjuvant chemotherapy (NAC) by positron emission tomography (PET)/computed tomography (CT) with (18)F-fluorodeoxyglucose (FDG). Fifty-seven patients with advanced head and neck squamous cell carcinoma (HNSCC) underwent FDG-PET/CT scans twice, before and after one cycle of NAC. We calculated the maximal standardized uptake value (SUV(max)) for a primary tumor and/or metastatic lymph nodes and defined %decrease as the %difference in SUV(max) between the two scans divided by that of the initial scan. Patients were classified as responders by PET (%decrease ≥55.5% or post-NAC SUV(max) ≤3.5) and by RECIST (≥30% decrease in size). The local control (LC) rate and the disease-specific survival (DSS) rate were assessed between the responders and non-responders. Multivariate analysis was also performed using the Cox proportional hazards model. In univariate analysis, the PET finding of a primary site was a significant risk factor for LC and DSS rates at 2 years after completion of NAC (P = 0.03 and 0.02, respectively), but there was no difference between responders and non-responders by the RECIST criteria. In a multivariate regression analysis, the PET finding in the primary site and the definitive therapy choice were independent prognostic factors in LC, while the PET finding in the primary site was the only independent prognostic factor in DSS. Our preliminary data indicate that the PET finding in the primary lesion after one cycle of NAC was an independent prognostic factor in LC and DSS in patients with HNSCC.

Role of PET/CT in Staging and Evaluation of Treatment Response After 3 Cycles of Chemotherapy in Locally Advanced Retinoblastoma: A Prospective Study

The present study prospectively evaluated the role of (18)F-FDG PET/CT for staging, neoadjuvant chemotherapy response evaluation, and final outcome assessment in International Retinoblastoma Staging System (IRSS) stage III retinoblastoma. Twenty-five consecutive IRSS stage III patients, with a median age of 3 y, were prospectively enrolled after ethics approval. All patients received neoadjuvant chemotherapy followed by enucleation, radiotherapy, and adjuvant chemotherapy. PET/CT was performed at baseline (PET/CT-1) and after 3 cycles of neoadjuvant chemotherapy (PET/CT-2). All 25 patients underwent PET/CT-1, and 21 of 25 patients underwent PET/CT-2. PET/CT-1 was compared with routine staging, and response on PET/CT-2 was assessed by criteria from the European Organization for Research and Treatment of Cancer response. Event-free survival (EFS) and overall survival (OS) were calculated using Kaplan-Meier survival analysis, and differences between the groups were compared using log-rank test. A P value of 0.05 or less was considered significant. Increased (18)F-FDG uptake was noted in primary extraocular tumor in all patients, except 5 with bilateral retinoblastoma (one eye with advanced and the other eye with intraocular disease) in whom the intraocular tumor did not show (18)F-FDG uptake. Five of 22 IRSS stage IIIA patients with clinically negative cervical lymph node involvement were found to have uptake in cervical lymph nodes on PET/CT-1, and 2 of 3 IRSS stage IIIB patients with pathologically confirmed cervical lymph node involvement did not show any uptake in the involved lymph nodes. No significant difference in EFS and OS was seen between IRSS stage IIIA and IIIB patients using routine staging or PET/CT staging (P ≥ 0.05); however, there was a trend toward better OS in patients with IRSS stage IIIB disease on PET/CT (P = 0.065). There was no significant discordance between routine staging and PET/CT staging (P = 0.256). The 8 patients with optic nerve uptake had lower EFS (P = 0.0001) and OS (P = 0.0009) than did 17 patients without optic nerve uptake on PET/CT-1. The 17 patients with complete response or partial response had better EFS (P = 0.042) and OS (P = 0.026) than did the 4 patients with progressive disease on PET/CT-2. Optic nerve uptake at baseline on PET/CT and response after neoadjuvant chemotherapy according to criteria from the European Organization for Research and Treatment of Cancer are strong predictors of EFS and OS in IRSS stage III retinoblastoma.