1. Treatment response of colorectal cancer liver metastases to neoadjuvant or conversion therapy:a prospective multicentre follow-up study using MRI, diffusion-weighted imaging and 1H-MR spectroscopy compared with histology (subgroup in the RAXO trial)
- Author
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Veera V. Salminen, Eila Lantto, Tuija Poussa, Raija Kallio, Maija Lavonius, Raija Ristamäki, Markus J. Mäkinen, Eija Pääkkö, Jari Sundström, Eetu Heervä, Sirpa Leppä, Johanna Mattson, Ari Ristimäki, P.J. Osterlund, Arno Nordin, Eija Sutinen, Eija Korkeila, T. Salminen, Kaisa Lehtomäki, Aki Uutela, P. Ryymin, Irina Rinta-Kiikka, Riikka Huuhtanen, Ali Ovissi, Olli Carpén, Marjut Timonen, Jani Saunavaara, Nina Lundbom, Heikki Mäkisalo, A.I. Hakkarainen, P. Halonen, Eveliina Lammentausta, Annika Ålgars, Helena Isoniemi, Johanna Virtanen, L. M. Soveri, R. Blanco Sequeiros, Nieminen Lasse, Niina Paunu, Heidi Penttinen, E. Liukkonen, Petri Bono, Siru Mäkelä, Martine Vornanen, Emerik Osterlund, Juhani Kosunen, Tampere University, Department of Oncology, Clinical Medicine, Department of Radiology, Physicists, University of Helsinki, IV kirurgian klinikka, HUS Medical Imaging Center, Department of Diagnostics and Therapeutics, HUS Diagnostic Center, Department of Pathology, HUSLAB, ATG - Applied Tumor Genomics, Clinicum, HUS Comprehensive Cancer Center, HUS Abdominal Center, Päijät-Häme Welfare Consortium, HYKS erva, and University Management
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Cancer Research ,Magnetic Resonance Spectroscopy ,PREDICTION ,SURGERY ,Colorectal cancer ,medicine.medical_treatment ,Systemic therapy ,030218 nuclear medicine & medical imaging ,0302 clinical medicine ,TUMOR ,CRITERIA ,Medicine ,Prospective Studies ,liver surgery ,Original Research ,OUTCOMES ,medicine.diagnostic_test ,Liver Neoplasms ,CHEMOTHERAPY ,Neoadjuvant Therapy ,3. Good health ,Oncology ,030220 oncology & carcinogenesis ,SURVIVAL ,Radiology ,Colorectal Neoplasms ,medicine.drug ,neoadjuvant chemotherapy ,medicine.medical_specialty ,Bevacizumab ,diffusion-weighted imaging ,BEVACIZUMAB ,3122 Cancers ,colorectal cancer ,03 medical and health sciences ,Humans ,Effective diffusion coefficient ,Chemotherapy ,business.industry ,PATHOLOGICAL RESPONSE ,Histology ,Magnetic resonance imaging ,3126 Surgery, anesthesiology, intensive care, radiology ,medicine.disease ,magnetic resonance spectroscopy ,liver metastasis ,Diffusion Magnetic Resonance Imaging ,FAT ,business ,Follow-Up Studies ,Diffusion MRI - Abstract
Background Colorectal cancer liver metastases respond to chemotherapy and targeted agents not only by shrinking, but also by morphologic and metabolic changes. The aim of this study was to evaluate the value of advanced magnetic resonance imaging (MRI) methods in predicting treatment response and survival. Patients and methods We investigated contrast-enhanced MRI, apparent diffusion coefficient (ADC) in diffusion-weighted imaging and 1H-magnetic resonance spectroscopy (1H-MRS) in detecting early morphologic and metabolic changes in borderline or resectable liver metastases, as a response to first-line neoadjuvant or conversion therapy in a prospective substudy of the RAXO trial (NCT01531621, EudraCT2011-003158-24). MRI findings were compared with histology of resected liver metastases and Kaplan–Meier estimates of overall survival (OS). Results In 2012-2018, 52 patients at four Finnish university hospitals were recruited. Forty-seven patients received neoadjuvant or conversion chemotherapy and 40 liver resections were carried out. Low ADC values (below median) of the representative liver metastases, at baseline and after systemic therapy, were associated with partial response according to RECIST criteria, but not with morphologic MRI changes or histology. Decreasing ADC values following systemic therapy were associated with improved OS compared to unchanged or increasing ADC, both in the liver resected subgroup (5-year OS rate 100% and 34%, respectively, P = 0.022) and systemic therapy subgroup (5-year OS rate 62% and 23%, P = 0.049). 1H-MRS revealed steatohepatosis induced by systemic therapy. Conclusions Low ADC values at baseline or during systemic therapy were associated with treatment response by RECIST but not with histology, morphologic or detectable metabolic changes. A decreasing ADC during systemic therapy is associated with improved OS both in all patients receiving systemic therapy and in the resected subgroup., Highlights • Colorectal liver metastases respond to systemic therapy by shrinking but also by morphological and metabolic changes. • Advanced MRI technologies (DWI and 1H-MRS) might provide more detailed insight into cancer treatment-induced changes. • We compare changes seen in MRI with histology. • Reduction of ADC during chemotherapy was associated with improved survival after liver resection.
- Published
- 2021