Dynamic contrast-enhanced MRI for treatment response assessment in patients with oesophageal cancer receiving neoadjuvant chemoradiotherapy.
To explore and evaluate the potential value of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for the prediction of pathologic response to neoadjuvant chemoradiotherapy (nCRT) in oesophageal cancer.



Twenty-six patients underwent DCE-MRI before, during (week 2-3) and after nCRT, but before surgery (pre/per/post, respectively). Histopathologic tumour regression grade (TRG) was assessed after oesophagectomy. Tumour area-under-the-concentration time curve (AUC), time-to-peak (TTP) and slope were calculated. The ability of these DCE-parameters to distinguish good responders (GR, TRG 1-2) from poor responders (noGR, TRG⩾3), and pathologic complete responders (pCR) from no-pCR was assessed.



Twelve patients (48%) showed GR of which 8 patients (32%) pCR. Analysis of AUC change throughout treatment, AUCper-pre, was most predictive for GR, at a threshold of 22.7% resulting in a sensitivity of 92%, specificity of 77%, PPV of 79%, and a NPV of 91%. AUCpost-pre was most predictive for pCR, at a threshold of -24.6% resulting in a sensitivity of 83%, specificity of 88%, PPV of 71%, and a NPV of 93%. TTP and slope were not associated with pathologic response.



This study demonstrates that changes in AUC throughout treatment are promising for prediction of histopathologic response to nCRT for oesophageal cancer.
Department of Radiotherapy, University Medical Center Utrecht, Netherlands. Electronic address: s.e.heethuis@umcutrecht.nl.
Sophie E
SE
Heethuis
Department of Radiotherapy, University Medical Center Utrecht, Netherlands; Department of Surgery, University Medical Center Utrecht, Netherlands.
Peter S N
PS
van Rossum
Department of Radiotherapy, University Medical Center Utrecht, Netherlands.
Irene M
IM
Lips
Department of Radiotherapy, University Medical Center Utrecht, Netherlands; Department of Surgery, University Medical Center Utrecht, Netherlands.
Lucas
L
Goense
Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.
Francine E
FE
Voncken
Department of Radiotherapy, University Medical Center Utrecht, Netherlands.
Onne
O
Reerink
Department of Surgery, University Medical Center Utrecht, Netherlands.
Richard
R
van Hillegersberg
Department of Surgery, University Medical Center Utrecht, Netherlands.
Jelle P
JP
Ruurda
Department of Radiotherapy, University Medical Center Utrecht, Netherlands.
Marielle E
ME
Philippens
Department of Radiotherapy, University Medical Center Utrecht, Netherlands.
Marco
M
van Vulpen
Department of Radiotherapy, University Medical Center Utrecht, Netherlands.
Gert J
GJ
Meijer
Department of Radiotherapy, University Medical Center Utrecht, Netherlands.
Jan J W
JJ
Lagendijk
Department of Radiotherapy, University Medical Center Utrecht, Netherlands.
Astrid L H M W
AL
van Lier
D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D003287:Contrast Media; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading
D003287:Contrast Media
Chemoradiotherapy; Dynamic contrast-enhanced MRI; Neoadjuvant therapy; Oesophageal cancer; Treatment Outcome