Treatment response of colorectal cancer liver metastases to neoadjuvant or conversion therapy : a prospective multicentre follow-up study using MRI, diffusion-weighted imaging and H-1-MR spectroscopy compared with histology (subgroup in the RAXO trial)

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RAXO Study Grp , Uutela , A , Ovissi , A , Hakkarainen , A , Ristimäki , A , Lundbom , N , Kallio , R , Soveri , L M , Salminen , T , Algars , A , Halonen , P , Ristamaki , R , Nordin , A , Sequeiros , R B , Rinta-Kiikka , I , Lantto , E , Virtanen , J , Paakko , E , Liukkonen , E , Saunavaara , J , Ryymin , P , Lammentausta , E , Osterlund , P & Isoniemi , H 2021 , ' Treatment response of colorectal cancer liver metastases to neoadjuvant or conversion therapy : a prospective multicentre follow-up study using MRI, diffusion-weighted imaging and H-1-MR spectroscopy compared with histology (subgroup in the RAXO trial) ' , ESMO open , vol. 6 , no. 4 , 100280 . https://doi.org/10.1016/j.esmoop.2021.100208

Title: Treatment response of colorectal cancer liver metastases to neoadjuvant or conversion therapy : a prospective multicentre follow-up study using MRI, diffusion-weighted imaging and H-1-MR spectroscopy compared with histology (subgroup in the RAXO trial)
Author: RAXO Study Grp; Uutela, A.; Ovissi, A.; Hakkarainen, A.; Ristimäki, A.; Lundbom, N.; Kallio, R.; Soveri, L. M.; Salminen, T.; Algars, A.; Halonen, P.; Ristamaki, R.; Nordin, A.; Sequeiros, R. Blanco; Rinta-Kiikka, I.; Lantto, E.; Virtanen, J.; Paakko, E.; Liukkonen, E.; Saunavaara, J.; Ryymin, P.; Lammentausta, E.; Osterlund, P.; Isoniemi, H.
Contributor: University of Helsinki, University of Helsinki
University of Helsinki, HUS Medical Imaging Center
University of Helsinki, HUS Medical Imaging Center
University of Helsinki, Department of Pathology
University of Helsinki, HUS Medical Imaging Center
University of Helsinki, University of Helsinki
University of Helsinki, HUS Abdominal Center
University of Helsinki, HUS Comprehensive Cancer Center
University of Helsinki, University of Helsinki
Date: 2021-08
Language: eng
Number of pages: 11
Belongs to series: ESMO open
ISSN: 2059-7029
URI: http://hdl.handle.net/10138/336703
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 diffusionweighted imaging and H-1-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 KaplaneMeier 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). H-1-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.
Subject: colorectal cancer
liver metastasis
neoadjuvant chemotherapy
liver surgery
diffusion-weighted imaging
magnetic resonance spectroscopy
PATHOLOGICAL RESPONSE
CHEMOTHERAPY
PREDICTION
TUMOR
BEVACIZUMAB
SURVIVAL
CRITERIA
OUTCOMES
SURGERY
FAT
3122 Cancers
3126 Surgery, anesthesiology, intensive care, radiology
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