A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer
PURPOSE: In the current study we examined the ability of diffusion MRI (dMRI) to predict pathologic response in pancreatic cancer patients receiving neoadjuvant chemoradiation. METHODS: We performed a prospective pilot study of dMRI in patients with resectable pancreatic cancer. Patients underwent d...
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2014-10-01
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Series: | Translational Oncology |
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doaj-619da22ab2ca4b64a22ab6a6767a24fa2020-11-24T21:16:01ZengElsevierTranslational Oncology1936-52331944-71242014-10-017564464910.1016/j.tranon.2014.07.005A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic CancerKyle C. Cuneo0Thomas L. Chenevert1Edgar Ben-Josef2Mary U. Feng3Joel K. Greenson4Hero K. Hussain5Diane M. Simeone6Matthew J. Schipper7Michelle A. Anderson8Mark M. Zalupski9Mahmoud Al-Hawary10Craig J. Galban11Alnawaz Rehemtulla12Felix Y. Feng13Theodore S. Lawrence14Brian D. Ross15Department of Radiation Oncology, University of Michigan, Ann Arbor, MIDepartment of Radiology, University of Michigan, Ann Arbor, MIDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MIDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MIDepartment of Pathology, University of Michigan, Ann Arbor, MIDepartment of Radiology, University of Michigan, Ann Arbor, MIDepartment of Surgery, University of Michigan, Ann Arbor, MIDepartment of Statistics, University of Michigan, Ann Arbor, MIDepartment of Medicine-Gastroenterology, University of Michigan, Ann Arbor, MIDepartment of Medicine-Oncology, University of Michigan, Ann Arbor, MIDepartment of Radiology, University of Michigan, Ann Arbor, MIDepartment of Radiology, University of Michigan, Ann Arbor, MIDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MIDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MIDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MIDepartment of Radiology, University of Michigan, Ann Arbor, MIPURPOSE: In the current study we examined the ability of diffusion MRI (dMRI) to predict pathologic response in pancreatic cancer patients receiving neoadjuvant chemoradiation. METHODS: We performed a prospective pilot study of dMRI in patients with resectable pancreatic cancer. Patients underwent dMRI prior to neoadjuvant chemoradiation. Surgical specimens were graded according to the percent tumor cell destruction. Apparent diffusion coefficient (ADC) maps were used to generate whole-tumor derived ADC histogram distributions and mean ADC values. The primary objective of the study was to correlate ADC parameters with pathologic and CT response. RESULTS: Ten of the 12 patients enrolled on the study completed chemoradiation and had surgery. Three were found to be unresectable at the time of surgery and no specimen was obtained. Out of the 7 patients who underwent pancreaticoduodenectomy, 3 had a grade III histopathologic response (>90% tumor cell destruction), 2 had a grade IIB response (51% to 90% tumor cell destruction), 1 had a grade IIA response (11% to 50% tumor cell destruction), and 1 had a grade I response (>90% viable tumor). Median survival for patients with a grade III response, grade I-II response, and unresectable disease were 25.6, 18.7, and 6.1 months, respectively. There was a significant correlation between pre-treatment mean tumor ADC values and the amount of tumor cell destruction after chemoradiation with a Pearson correlation coefficient of 0.94 (P = .001). Mean pre-treatment ADC was 161 × 10−5 mm2/s (n = 3) in responding patients (>90% tumor cell destruction) compared to 125 × 10−5 mm2/s (n = 4) in non-responding patients (>10% viable tumor). CT imaging showed no significant change in tumor size in responders or non-responders. CONCLUSIONS: dMRI may be useful to predict response to chemoradiation in pancreatic cancer. In our study, tumors with a low ADC mean value at baseline responded poorly to standard chemoradiation and would be candidates for intensified therapy.http://www.sciencedirect.com/science/article/pii/S1936523314000783 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kyle C. Cuneo Thomas L. Chenevert Edgar Ben-Josef Mary U. Feng Joel K. Greenson Hero K. Hussain Diane M. Simeone Matthew J. Schipper Michelle A. Anderson Mark M. Zalupski Mahmoud Al-Hawary Craig J. Galban Alnawaz Rehemtulla Felix Y. Feng Theodore S. Lawrence Brian D. Ross |
spellingShingle |
Kyle C. Cuneo Thomas L. Chenevert Edgar Ben-Josef Mary U. Feng Joel K. Greenson Hero K. Hussain Diane M. Simeone Matthew J. Schipper Michelle A. Anderson Mark M. Zalupski Mahmoud Al-Hawary Craig J. Galban Alnawaz Rehemtulla Felix Y. Feng Theodore S. Lawrence Brian D. Ross A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer Translational Oncology |
author_facet |
Kyle C. Cuneo Thomas L. Chenevert Edgar Ben-Josef Mary U. Feng Joel K. Greenson Hero K. Hussain Diane M. Simeone Matthew J. Schipper Michelle A. Anderson Mark M. Zalupski Mahmoud Al-Hawary Craig J. Galban Alnawaz Rehemtulla Felix Y. Feng Theodore S. Lawrence Brian D. Ross |
author_sort |
Kyle C. Cuneo |
title |
A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer |
title_short |
A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer |
title_full |
A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer |
title_fullStr |
A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer |
title_full_unstemmed |
A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer |
title_sort |
pilot study of diffusion-weighted mri in patients undergoing neoadjuvant chemoradiation for pancreatic cancer |
publisher |
Elsevier |
series |
Translational Oncology |
issn |
1936-5233 1944-7124 |
publishDate |
2014-10-01 |
description |
PURPOSE: In the current study we examined the ability of diffusion MRI (dMRI) to predict pathologic response in pancreatic cancer patients receiving neoadjuvant chemoradiation. METHODS: We performed a prospective pilot study of dMRI in patients with resectable pancreatic cancer. Patients underwent dMRI prior to neoadjuvant chemoradiation. Surgical specimens were graded according to the percent tumor cell destruction. Apparent diffusion coefficient (ADC) maps were used to generate whole-tumor derived ADC histogram distributions and mean ADC values. The primary objective of the study was to correlate ADC parameters with pathologic and CT response. RESULTS: Ten of the 12 patients enrolled on the study completed chemoradiation and had surgery. Three were found to be unresectable at the time of surgery and no specimen was obtained. Out of the 7 patients who underwent pancreaticoduodenectomy, 3 had a grade III histopathologic response (>90% tumor cell destruction), 2 had a grade IIB response (51% to 90% tumor cell destruction), 1 had a grade IIA response (11% to 50% tumor cell destruction), and 1 had a grade I response (>90% viable tumor). Median survival for patients with a grade III response, grade I-II response, and unresectable disease were 25.6, 18.7, and 6.1 months, respectively. There was a significant correlation between pre-treatment mean tumor ADC values and the amount of tumor cell destruction after chemoradiation with a Pearson correlation coefficient of 0.94 (P = .001). Mean pre-treatment ADC was 161 × 10−5 mm2/s (n = 3) in responding patients (>90% tumor cell destruction) compared to 125 × 10−5 mm2/s (n = 4) in non-responding patients (>10% viable tumor). CT imaging showed no significant change in tumor size in responders or non-responders. CONCLUSIONS: dMRI may be useful to predict response to chemoradiation in pancreatic cancer. In our study, tumors with a low ADC mean value at baseline responded poorly to standard chemoradiation and would be candidates for intensified therapy. |
url |
http://www.sciencedirect.com/science/article/pii/S1936523314000783 |
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