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A TCP-based early regression index predicts the pathological response in neo-adjuvant radio-chemotherapy of rectal cancer.
Fiorino, Claudio; Gumina, Calogero; Passoni, Paolo; Palmisano, Anna; Broggi, Sara; Cattaneo, Giovanni M; Di Chiara, Alessandra; Esposito, Antonio; Mori, Martina; Raso, Roberta; Ronzoni, Monica; Rosati, Riccardo; Slim, Najla; De Cobelli, Francesco; Calandrino, Riccardo; Di Muzio, Nadia G.
Afiliación
  • Fiorino C; Medical Physics, San Raffaele Scientific Institute, Milano, Italy. Electronic address: fiorino.claudio@hsr.it.
  • Gumina C; Radiotherapy, San Raffaele Scientific Institute, Milano, Italy.
  • Passoni P; Radiotherapy, San Raffaele Scientific Institute, Milano, Italy.
  • Palmisano A; Radiology, San Raffaele Scientific Institute, Milano, Italy.
  • Broggi S; Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
  • Cattaneo GM; Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
  • Di Chiara A; Radiology, San Raffaele Scientific Institute, Milano, Italy.
  • Esposito A; Radiology, San Raffaele Scientific Institute, Milano, Italy.
  • Mori M; Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
  • Raso R; Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
  • Ronzoni M; Oncology, San Raffaele Scientific Institute, Milano, Italy.
  • Rosati R; Gastroenterology Surgery, San Raffaele Scientific Institute, Milano, Italy.
  • Slim N; Radiotherapy, San Raffaele Scientific Institute, Milano, Italy.
  • De Cobelli F; Radiology, San Raffaele Scientific Institute, Milano, Italy.
  • Calandrino R; Medical Physics, San Raffaele Scientific Institute, Milano, Italy.
  • Di Muzio NG; Radiotherapy, San Raffaele Scientific Institute, Milano, Italy.
Radiother Oncol ; 128(3): 564-568, 2018 09.
Article en En | MEDLINE | ID: mdl-30196982
PURPOSE: Introducing a radiobiological index based on early tumor regression during neo-adjuvant radio-chemotherapy (RCT, including oxaliplatin) of rectal adenocarcinoma and testing its discriminative power in predicting the tumor response. METHODS: Seventy-four patients were treated with Helical Tomotherapy following an adaptive (ART) protocol (41.4 Gy/18 fr, 2.3 Gy/fr) delivering a simultaneous integrated boost on the residual tumor in the last 6 fractions up to 45.6 Gy. T2-weighted MRI were taken before (MRIpre) and at mid (MRImid) therapy and the corresponding tumor volumes were considered (Vpre,Vmid). The "Early Regression Index" [Formula: see text] was introduced and its discriminative power was assessed in terms of AUC, sensitivity/specificity, positive/negative predictive value (PPV/NPV). Two end-points were considered: (a) pathological complete response (pCR) or clinical complete response followed by watch-and-wait, (cCR); (b) limited response (residual vital cells (RVC) in the surgical specimen >10%). RESULTS: Complete data were available for 65 patients: pCR, cCR and RVC >10% were 20, 2 and 19 respectively. The discriminative power of ERITCP was moderately high (AUC = 0.81/0.75 for /pCRorcCR/RVC >10% respectively, p < 0.0005). ERITCP was highly sensitive (86-89%) with very high NPV (90-94%). The discriminative power of ERITCP was confirmed on a subgroup of 44/65 patients when considering tumor volumes delineated by a skilled radiologist. CONCLUSION: A radiobiologically consistent index based on early regression showed high performances in predicting the pathological response after neo-adjuvant RCT for rectal cancer with relevant potentialities for ART/treatment customization.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias del Recto / Quimioradioterapia Tipo de estudio: Guideline / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Radiother Oncol Año: 2018 Tipo del documento: Article Pais de publicación: Irlanda
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias del Recto / Quimioradioterapia Tipo de estudio: Guideline / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Radiother Oncol Año: 2018 Tipo del documento: Article Pais de publicación: Irlanda