TY - JOUR
T1 - Predicting response to chemoradiotherapy in rectal cancer via visual morphologic assessment and staging on baseline MRI
T2 - a multicenter and multireader study
AU - El Khababi, Najim
AU - Beets-Tan, Regina G. H.
AU - Tissier, Renaud
AU - Lahaye, Max J. W.
AU - Maas, Monique
AU - Curvo-Semedo, Luis J.
AU - Dresen, Raphaela C.
AU - Nougaret, Stephanie
AU - Beets, Geerard L.
AU - Lambregts, Doenja M. J.
AU - rectal MRI study group
PY - 2023/10
Y1 - 2023/10
N2 - Purpose Pre-treatment knowledge of the anticipated response of rectal tumors to neoadjuvant chemoradiotherapy (CRT) could help to further optimize the treatment. Van Griethuysen et al. proposed a visual 5-point confidence score to predict the likelihood of response on baseline MRI. Aim was to evaluate this score in a multicenter and multireader study setting and compare it to two simplified (4-point and 2-point) adaptations in terms of diagnostic performance, interobserver agreement (IOA), and reader preference.Methods Twenty-two radiologists from 14 countries ( 5 MRI-experts,17 general/abdominal radiologists) retrospectively reviewed 90 baseline MRIs to estimate if patients would likely achieve a (near-)complete response (nCR); first using the 5-point score by van Griethuysen (1=highly unlikely to 5=highly likely to achieve nCR), second using a 4-point adaptation (with 1-point each for high-risk T-stage, obvious mesorectal fascia invasion, nodal involvement, and extramural vascular invasion), and third using a 2-point score (unlikely/likely to achieve nCR). Diagnostic performance was calculated using ROC curves and IOA using Krippendorf's alpha (a).Results Areas under the ROC curve to predict the likelihood of a nCR were similar for the three methods (0.71-0.74). IOA was higher for the 5- and 4-point scores (a=0.55 and 0.57 versus 0.46 for the 2-point score) with best results for the MRIexperts (a= 0.64-0.65). Most readers (55%) favored the 4-point score.Conclusions Visual morphologic assessment and staging methods can predict neoadjuvant treatment response with moderate-good performance. Compared to a previously published confidence-based scoring system, study readers preferred a simplified 4-point risk score based on high-risk T-stage, MRF involvement, nodal involvement, and EMVI.[GRAPHIS].
AB - Purpose Pre-treatment knowledge of the anticipated response of rectal tumors to neoadjuvant chemoradiotherapy (CRT) could help to further optimize the treatment. Van Griethuysen et al. proposed a visual 5-point confidence score to predict the likelihood of response on baseline MRI. Aim was to evaluate this score in a multicenter and multireader study setting and compare it to two simplified (4-point and 2-point) adaptations in terms of diagnostic performance, interobserver agreement (IOA), and reader preference.Methods Twenty-two radiologists from 14 countries ( 5 MRI-experts,17 general/abdominal radiologists) retrospectively reviewed 90 baseline MRIs to estimate if patients would likely achieve a (near-)complete response (nCR); first using the 5-point score by van Griethuysen (1=highly unlikely to 5=highly likely to achieve nCR), second using a 4-point adaptation (with 1-point each for high-risk T-stage, obvious mesorectal fascia invasion, nodal involvement, and extramural vascular invasion), and third using a 2-point score (unlikely/likely to achieve nCR). Diagnostic performance was calculated using ROC curves and IOA using Krippendorf's alpha (a).Results Areas under the ROC curve to predict the likelihood of a nCR were similar for the three methods (0.71-0.74). IOA was higher for the 5- and 4-point scores (a=0.55 and 0.57 versus 0.46 for the 2-point score) with best results for the MRIexperts (a= 0.64-0.65). Most readers (55%) favored the 4-point score.Conclusions Visual morphologic assessment and staging methods can predict neoadjuvant treatment response with moderate-good performance. Compared to a previously published confidence-based scoring system, study readers preferred a simplified 4-point risk score based on high-risk T-stage, MRF involvement, nodal involvement, and EMVI.[GRAPHIS].
KW - Rectal cancer
KW - Magnetic resonance imaging
KW - Chemoradiotherapy
KW - Response
KW - PATHOLOGICAL COMPLETE RESPONSE
KW - NEOADJUVANT CHEMORADIOTHERAPY
KW - PREOPERATIVE CHEMORADIOTHERAPY
KW - DCE-MRI
KW - CHEMORADIATION
KW - THERAPY
KW - RADIOMICS
KW - INTERVAL
KW - SURGERY
KW - PET/CT
U2 - 10.1007/s00261-023-03961-7
DO - 10.1007/s00261-023-03961-7
M3 - Article
C2 - 37358604
SN - 2366-004X
VL - 48
SP - 3039
EP - 3049
JO - Abdominal Radiology
JF - Abdominal Radiology
IS - 10
ER -