title: Usefulness of dynamic contrast-enhanced magnetic resonance imaging for predicting treatment response to vinorelbine-cisplatin with or without recombinant human endostatin in bone metastasis of non-small cell lung cancer.
abstract: Metastatic bone disease is a frequent complication of advanced non-small cell lung cancer (NSCLC) and causes skeletal-related events, which result in a poor prognosis. Currently, no standard method has been developed to precisely assess the therapeutic response of bone metastases (BM) and the early efficacy of anti-angiogenic therapy, which does not conform to the concept of precision medicine. This study aimed to investigate the usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for precise evaluation of the response to chemotherapy with anti-angiogenic agents in NSCLC patients with BM. Patients were randomly assigned to a treatment group (vinorelbine + cisplatin [NP] + recombinant human endostatin [rh-endostatin]) or a control group (NP + placebo). All patients were evaluated before treatment and after 2 cycles of treatment using DCE-MRI quantitative analysis technology for BM lesions and chest computed tomography (CT). Correlations between changes in the DCE-MRI quantitative parameters and treatment effect were analyzed. We enrolled 33 patients, of whom 28 were evaluable (20 in the treatment group and 8 in the control group). The results suggested a higher objective response rate (30% vs. 0%), better overall survival (21.44 ± 17.28 months vs. 7.71 ± 4.68 months), and a greater decrease in the transport constant (Ktrans) value (60% vs. 4.4%) in the treatment group than in the control group (P< 0.05). The Ktrans values in the "partial remission plus stable disease (PR + SD)" group were significantly lower after treatment (P< 0.05). Patients with a decrease of > 50% in the Ktrans value showed a significantly better overall survival than those with a decrease of ≤ 50% (13.2 vs. 9.8 months,P< 0.05). Ktrans as a DEC-MRI quantitative parameter could be used for the precise evaluation of BM lesions after anti-angiogenic therapy and as a predictor of survival. In addition, we reconfirmed the anti-angiogenic effect of rh-endostatin in NSCLC patients with BM.
authors.affiliation: Department of Internal Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200233, People's Republic of China.
authors.forename: Rui
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Internal Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200233, People's Republic of China.
authors.forename: Zhi-Yu
authors.initials: ZY
authors.lastname: Wang
authors.affiliation: Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200233, People's Republic of China.
authors.forename: Yue-Hua
authors.initials: YH
authors.lastname: Li
authors.affiliation: Department of Clinical Skill Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200233, People's Republic of China.
authors.forename: Yao-Hong
authors.initials: YH
authors.lastname: Lu
authors.affiliation: Department of Internal Oncology, Shanghai Sixth People's Hospital, Soochow University Shanghai 200233, People's Republic of China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Internal Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200233, People's Republic of China.
authors.forename: Wen-Xi
authors.initials: WX
authors.lastname: Yu
authors.affiliation: Department of Internal Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200233, People's Republic of China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
keywords: DCE-MRI; anti-angiogenic therapy; bone metastases; non-small cell lung cancer; quantitative parameters; recombinant human endostatin; therapeutic response