Predictive value of apparent diffusion coefficient for efficacy of preoperative chemoradiotherapy for locally advanced rectal cancer
Xiao Qin, Ye Feng, Jin Jing, Li Yexiong, Ouyang Han, Zou Shuangmei, Wang Weihu, Wang Shulian, Liu yueping, Song Yongwen, Ren Hua, Fang Hui, Wang xin, Liu Xinfan, Yu Zihao
*Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
Abstract：Objective To investigate the value of apparent diffusion coefficient (ADC) in predicting the efficacy of preoperative chemoradiotherapy (PCRT) for locally advanced rectal cancer. Methods From 2007 to 2011, 70 patients with histopathologically proven clinical stage Ⅱ/Ⅲ rectal cancer were enrolled prospectively. All patients received PCRT, with radiotherapy (44.0—50.4 Gy/22—28 fractions) delivered to the pelvis and concurrent chemotherapy with capecitabine (1650 mg/m2 per day, d 1—35) and oxaliplatin (50 mg/m2, once weekly, 5 times), and radical surgery performed at 4—8 weeks after PCRT. Diffusion-weighted MRI was performed in all patients before PCRT, and ADC values were calculated. The pathologic tumor regression grade was assessed after surgery. The difference in ADC between groups was analyzed by nonparametric Mann-Whitney U test. Survivals were analyzed by the Kaplan-Meier method and compared by the log-rank test. Results Among 70 patients, 7(10%) achieved a pathological complete response (pCR), and 38(54%) were downstaged. With a median follow-up of 34 months, 22(31%) patients experienced recurrence. The mean ADC values before, during, and after PCRT (pre-ADC, during-ADC, and post-ADC) were (1.09±0.19)×10－3 mm2/s,(1.28±0.19)×10－3 mm2/s, and (1.47±0.24)×10－3 mm2/s, respectively. The mean pre-ADCs for favorable groups (pCR, downstaging,and no recurrence) were significantly lower than those for unfavorable groups (P=0.049,0.001, and0.029). When a pre-ADC value of 1.06×10－3 mm2/s was used as the cut-off value for predictingdownstaging, the area under the receiver operating characteristic curve was 0.737(95%CI=0.618—0.856). The 3-year disease-free survival and distant metastasis-free survival for patients with pre-ADCs of<1.06×10－3 mm2/s were 86% and 90%, respectively, which were significantly higher than those for patients with pre-ADCs of ≥1.06×10－3 mm2/s (58% and 60%)(P=0.010 for both). Conclusions Pre-ADC correlates to the efficacy of PCRT for locally advanced rectal cancer, so it has good prognostic value for this disease after PCRT.
. Predictive value of apparent diffusion coefficient for efficacy of preoperative chemoradiotherapy for locally advanced rectal cancer[J]. Chinese Journal of Radiation Oncology, 2014, 23(3): 194-198.
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2014, Vol. 23 
