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Value of BOLD MR in early evaluating the response and prognosis of esophageal squamous cell carcinoma treated with definitive chemoradiotherapy
Huanhuan Zheng1, Hailong Zhang1, Yan Zhu1, Xiaolei Wei1, Song Liu1, and Wei Ren2
1Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 2The Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University and Clinical Cancer Institute of Nanjing University, Nanjing, China

Synopsis

Keywords: Digestive, fMRI

To confirm a quantitative imaging predictor for evaluation of early treatment response and prognosis to definitive chemoradiotherapy (dCRT) in patients with esophageal squamous cell carcinoma , using BOLD MR images. R2* values were obtained pre- and post-dCRT in 28 patients using BOLD MR. Independent samples t-test (normality) or Mann-Whitney U test (non-normality) was used to compare differences of R2*-related parameters between CR and non-CR groups. Diagnostic performance of parameters in predicting response was tested with receiver operating characteristic curve analysis. 3-years overall survival (OS) was evaluated using by Kaplan Meier curve, log rank test, and Cox proportional hazards regression analysis.

Purpose

To confirm a quantitative imaging predictor for evaluation of early treatment response and prognosis to definitive chemoradiotherapy (dCRT) in patients with esophageal squamous cell carcinoma (ESCC), using blood oxygenation level-dependent (BOLD) magnetic resonance (MR) images.

Methods:

R2* values were obtained pre- and 2-3 weeks post-dCRT in 28 patients with EC using BOLD MR. Independent samples t-test (normality) or Mann-Whitney U test (non-normality) was used to compare differences of R2*-related parameters between complete response (CR) and non-CR groups. Diagnostic performance of parameters in predicting response was tested with receiver operating characteristic curve analysis. 3-years overall survival (OS) was evaluated using by Kaplan Meier curve, log rank test, and Cox proportional hazards regression analysis.

Results

Post-R2*, ∆R2*, and ∆%R2* in CR group were significantly higher than those in non-CR group (P = 0.002, 0.003, and 0.006, respectively). The R2*-related parameters showed good prediction of tumor response with AUC ranging from 0.813 to 0.872. 3-year OS rate in patients with ∆R2* >-7.54 s-1 or a CR were significantly longer than those with ∆R2* ≤ -7.54 s-1 (72.37% vs. 0.00%; Hazard ratio, HR = 0.196; 95% confidence interval, 95%CI = 0.047-0.807; P = 0.024) or non-CR (76.47% vs. 29.27%; HR = 0.238, 95%CI = 0.059-0.963; P = 0.044).

Conclusion

Our preliminary results demonstrated that the R2* value might be a useful hypoxia imaging predictor for response and prognosis of ESCC treated with dCRT. BOLD MR imaging might be used as a potential tool for evaluating tumor oxygenation metabolism, which is routinely applied in clinical practice and beneficial to clinical decision-making.

Keywords

Esophageal neoplasms; Blood oxygenation level-dependent; Response; Prognosis; Chemoradiotherapy

Acknowledgements

This study received funding from the Nanjing Drum Tower Hospital New Technology Development Fund (XJSFZJJ202035); Bethune·Young and Middle-aged Physician Scientific Research Ability Training Project (BQE-TY-SSPC(7)-N-01); Special Fund for Clinical Scientific Research of Wu Jieping Medical Foundation (320.6750.2021-01-36).

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Figures

Fig. 1. The flowchart of study design.

Fig. 2. Before dCRT, T2W and BOLD MR images shows a mass lesion at the upper thoracic esophagus (white arrow). On the corresponding color-coded R2* maps, blue-green represents low-medium R2* values, reflecting low-medium concentration of deoxyhemoglobin. After dCRT, T2W, BOLD, and corresponding color-coded R2* maps show the mass shrinking (white arrow), and red represents high R2* values, reflecting high concentration of deoxyhemoglobin.

Fig. 3. Receiver operating characteristic (ROC) curves of R2* values in early identifying complete response (CR) from non-CR of esophageal cancer. The post-R2* (2 - 3 weeks post-dCRT), ∆R2*, ∆%R2* and the fitting parameter (pre-R2* combined with post-R2*) values show good prediction performance, yielding an AUC of 0.829, 0.813, 0.813, and 0.872 (A - D), respectively.

Fig. 4. Kaplan–Meier survival curves showing 3-year overall survival (OS) for patients with a ∆R2* value ≤ -7.54 s-1 compared with those with a ∆R2* value > -7.54 s-1 (A), and patients with a complete response (CR) compared with those with a non-CR (B). Both P values obtained by log rank test were < 0.001.

Proc. Intl. Soc. Mag. Reson. Med. 31 (2023)
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DOI: https://doi.org/10.58530/2023/4113