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The value of intravoxel incoherent motion model-based diffusion-weighted imaging for outcome prediction in resin-based radioembolization of breast cancer liver metastases.

Pieper CC, Meyer C, Sprinkart AM, Block W, Ahmadzadehfar H, Schild HH, Mürtz P, Kukuk GM - Onco Targets Ther (2016)

Bottom Line: An ECOG status ≤1 resulted in longer median OS than >1 (7.6 [range 2.6-54.9] vs 1.7 [range 1.5-4.5] months, P<0.0001).Pretreatment IVIM parameters and the other clinical characteristics were not associated with OS.Classification by f'-value changes and ECOG status remained as independent predictors of OS on multivariate analysis, while RECIST response and D'-value changes did not predict survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology.

ABSTRACT

Purpose: To evaluate prognostic values of clinical and diffusion-weighted magnetic resonance imaging-derived intravoxel incoherent motion (IVIM) parameters in patients undergoing primary radioembolization for metastatic breast cancer liver metastases.

Subjects and methods: A total of 21 females (mean age 54 years, range 43-72 years) with liver-dominant metastatic breast cancer underwent standard liver magnetic resonance imaging (1.5 T, diffusion-weighted imaging with b-values of 0, 50, and 800 s/mm(2)) before and 4-6 weeks after radioembolization. The IVIM model-derived estimated diffusion coefficient D' and the perfusion fraction f' were evaluated by averaging the values of the two largest treated metastases in each patient. Kaplan-Meier and Cox regression analyses for overall survival (OS) were performed. Investigated parameters were changes in f'- and D'-values after therapy, age, sex, Eastern Cooperative Oncology Group (ECOG) status, grading of primary tumor, hepatic tumor burden, presence of extrahepatic disease, baseline bilirubin, previous bevacizumab therapy, early stasis during radioembolization, chemotherapy after radioembolization, repeated radioembolization and Response Evaluation Criteria in Solid Tumors (RECIST) response at 6-week follow-up.

Results: Median OS after radioembolization was 6 (range 1.5-54.9) months. In patients with therapy-induced decreasing or stable f'-values, median OS was significantly longer than in those with increased f'-values (7.6 [range 2.6-54.9] vs 2.6 [range 1.5-17.4] months, P<0.0001). Longer median OS was also seen in patients with increased D'-values (6 [range 1.6-54.9] vs 2.8 [range 1.5-17.4] months, P=0.008). Patients with remission or stable disease (responders) according to RECIST survived longer than nonresponders (7.2 [range 2.6-54.9] vs 2.6 [range 1.5-17.4] months, P<0.0001). An ECOG status ≤1 resulted in longer median OS than >1 (7.6 [range 2.6-54.9] vs 1.7 [range 1.5-4.5] months, P<0.0001). Pretreatment IVIM parameters and the other clinical characteristics were not associated with OS. Classification by f'-value changes and ECOG status remained as independent predictors of OS on multivariate analysis, while RECIST response and D'-value changes did not predict survival.

Conclusion: Following radioembolization of breast cancer liver metastases, early changes in the IVIM model-derived perfusion fraction f' and baseline ECOG score were predictive of patient outcome, and may thus help to guide treatment strategy.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier curves.Notes: (A) Overall survival (OS) by f’-value changes (broken line, f’-value increase; continuous line, f’-value decrease); (B) OS by D’-value changes (broken line, D’-value increase; continuous line, D’-value decrease); (C) hepatic progression-free survival (hPFS) by f’-value changes (broken line, f’-value increase; continuous line, f’-value decrease); (D) hPFS by D’-value changes (broken line, D’-value increase; continuous line, D’-value decrease).Abbreviations:D’, estimated true diffusion coefficient (ie, ADC50/800); f’, estimated perfusion fraction.
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f2-ott-9-4089: Kaplan–Meier curves.Notes: (A) Overall survival (OS) by f’-value changes (broken line, f’-value increase; continuous line, f’-value decrease); (B) OS by D’-value changes (broken line, D’-value increase; continuous line, D’-value decrease); (C) hepatic progression-free survival (hPFS) by f’-value changes (broken line, f’-value increase; continuous line, f’-value decrease); (D) hPFS by D’-value changes (broken line, D’-value increase; continuous line, D’-value decrease).Abbreviations:D’, estimated true diffusion coefficient (ie, ADC50/800); f’, estimated perfusion fraction.

Mentions: Median OS after the first radioembolization procedure was 151 (range 46–1,647) days. Univariate analysis of OS showed significant interrelations with therapy-induced f’-value changes, while no other IVIM parameters were associated with OS (Table 5). When categorized according to changes in D’- and f’-values (stable or decreasing vs increasing values), patients with increasing D’- and decreasing f’-values had a significantly longer median OS (216 vs 83 days and 237 vs 78 days, respectively). Comparable to hPFS, an ECOG score ≤1 and PR/SD as evaluated by RECIST on first follow-up were associated with longer median OS (227 vs 50 days and 221 vs 78 days, respectively). Multivariate Cox regression showed that the ECOG score and categorization according to f’-value changes were the only independent predictors of OS. An ECOG score >1 and an increase in f’-value were associated with shorter OS (HR 13.33, 95% CI 2.60–71.43, P=0.002 and HR 6.73, 95% CI 1.98–22.89, P=0.002, respectively). Results of survival analyses are summarized in Tables 5–7 and Figure 2A–D. Group A and B in Table 6 are categorized according to values given in Table 2.


The value of intravoxel incoherent motion model-based diffusion-weighted imaging for outcome prediction in resin-based radioembolization of breast cancer liver metastases.

Pieper CC, Meyer C, Sprinkart AM, Block W, Ahmadzadehfar H, Schild HH, Mürtz P, Kukuk GM - Onco Targets Ther (2016)

Kaplan–Meier curves.Notes: (A) Overall survival (OS) by f’-value changes (broken line, f’-value increase; continuous line, f’-value decrease); (B) OS by D’-value changes (broken line, D’-value increase; continuous line, D’-value decrease); (C) hepatic progression-free survival (hPFS) by f’-value changes (broken line, f’-value increase; continuous line, f’-value decrease); (D) hPFS by D’-value changes (broken line, D’-value increase; continuous line, D’-value decrease).Abbreviations:D’, estimated true diffusion coefficient (ie, ADC50/800); f’, estimated perfusion fraction.
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getmorefigures.php?uid=PMC4940017&req=5

f2-ott-9-4089: Kaplan–Meier curves.Notes: (A) Overall survival (OS) by f’-value changes (broken line, f’-value increase; continuous line, f’-value decrease); (B) OS by D’-value changes (broken line, D’-value increase; continuous line, D’-value decrease); (C) hepatic progression-free survival (hPFS) by f’-value changes (broken line, f’-value increase; continuous line, f’-value decrease); (D) hPFS by D’-value changes (broken line, D’-value increase; continuous line, D’-value decrease).Abbreviations:D’, estimated true diffusion coefficient (ie, ADC50/800); f’, estimated perfusion fraction.
Mentions: Median OS after the first radioembolization procedure was 151 (range 46–1,647) days. Univariate analysis of OS showed significant interrelations with therapy-induced f’-value changes, while no other IVIM parameters were associated with OS (Table 5). When categorized according to changes in D’- and f’-values (stable or decreasing vs increasing values), patients with increasing D’- and decreasing f’-values had a significantly longer median OS (216 vs 83 days and 237 vs 78 days, respectively). Comparable to hPFS, an ECOG score ≤1 and PR/SD as evaluated by RECIST on first follow-up were associated with longer median OS (227 vs 50 days and 221 vs 78 days, respectively). Multivariate Cox regression showed that the ECOG score and categorization according to f’-value changes were the only independent predictors of OS. An ECOG score >1 and an increase in f’-value were associated with shorter OS (HR 13.33, 95% CI 2.60–71.43, P=0.002 and HR 6.73, 95% CI 1.98–22.89, P=0.002, respectively). Results of survival analyses are summarized in Tables 5–7 and Figure 2A–D. Group A and B in Table 6 are categorized according to values given in Table 2.

Bottom Line: An ECOG status ≤1 resulted in longer median OS than >1 (7.6 [range 2.6-54.9] vs 1.7 [range 1.5-4.5] months, P<0.0001).Pretreatment IVIM parameters and the other clinical characteristics were not associated with OS.Classification by f'-value changes and ECOG status remained as independent predictors of OS on multivariate analysis, while RECIST response and D'-value changes did not predict survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology.

ABSTRACT

Purpose: To evaluate prognostic values of clinical and diffusion-weighted magnetic resonance imaging-derived intravoxel incoherent motion (IVIM) parameters in patients undergoing primary radioembolization for metastatic breast cancer liver metastases.

Subjects and methods: A total of 21 females (mean age 54 years, range 43-72 years) with liver-dominant metastatic breast cancer underwent standard liver magnetic resonance imaging (1.5 T, diffusion-weighted imaging with b-values of 0, 50, and 800 s/mm(2)) before and 4-6 weeks after radioembolization. The IVIM model-derived estimated diffusion coefficient D' and the perfusion fraction f' were evaluated by averaging the values of the two largest treated metastases in each patient. Kaplan-Meier and Cox regression analyses for overall survival (OS) were performed. Investigated parameters were changes in f'- and D'-values after therapy, age, sex, Eastern Cooperative Oncology Group (ECOG) status, grading of primary tumor, hepatic tumor burden, presence of extrahepatic disease, baseline bilirubin, previous bevacizumab therapy, early stasis during radioembolization, chemotherapy after radioembolization, repeated radioembolization and Response Evaluation Criteria in Solid Tumors (RECIST) response at 6-week follow-up.

Results: Median OS after radioembolization was 6 (range 1.5-54.9) months. In patients with therapy-induced decreasing or stable f'-values, median OS was significantly longer than in those with increased f'-values (7.6 [range 2.6-54.9] vs 2.6 [range 1.5-17.4] months, P<0.0001). Longer median OS was also seen in patients with increased D'-values (6 [range 1.6-54.9] vs 2.8 [range 1.5-17.4] months, P=0.008). Patients with remission or stable disease (responders) according to RECIST survived longer than nonresponders (7.2 [range 2.6-54.9] vs 2.6 [range 1.5-17.4] months, P<0.0001). An ECOG status ≤1 resulted in longer median OS than >1 (7.6 [range 2.6-54.9] vs 1.7 [range 1.5-4.5] months, P<0.0001). Pretreatment IVIM parameters and the other clinical characteristics were not associated with OS. Classification by f'-value changes and ECOG status remained as independent predictors of OS on multivariate analysis, while RECIST response and D'-value changes did not predict survival.

Conclusion: Following radioembolization of breast cancer liver metastases, early changes in the IVIM model-derived perfusion fraction f' and baseline ECOG score were predictive of patient outcome, and may thus help to guide treatment strategy.

No MeSH data available.


Related in: MedlinePlus