Quantitative diffusion-weighted MRI response assessment in rhabdomyosarcoma: an international retrospective study on behalf of the European paediatric Soft tissue sarcoma Study Group Imaging Committee
Pediatric Radiology, vol. 53, pp. 2539–2551
Abstract
Abstract Objective To investigate the feasibility of diffusion-weighted magnetic resonance imaging (DW-MRI) as a predictive imaging marker after neoadjuvant chemotherapy in patients with rhabdomyosarcoma. Material and methods We performed a multicenter retrospective study including pediatric, adolescent and young adult patients with rhabdomyosarcoma, Intergroup Rhabdomyosarcoma Study group III/IV, treated according to the European paediatric Soft tissue sarcoma Study Group (EpSSG) RMS2005 or MTS2008 studies. DW-MRI was performed according to institutional protocols. We performed two-dimensional single-slice tumor delineation. Areas of necrosis or hemorrhage were delineated to be excluded in the primary analysis. Mean, median and 5th and 95th apparent diffusion coefficient (ADC) were extracted. Results Of 134 included patients, 82 had measurable tumor at diagnosis and response and DW-MRI scans of adequate quality and were included in the analysis. Technical heterogeneity in scan acquisition protocols and scanners was observed. Mean ADC at diagnosis was 1.1 (95% confidence interval [CI]: 1.1–1.2) (all ADC expressed in * 10−3 mm2/s), versus 1.6 (1.5–1.6) at response assessment. The 5th percentile ADC was 0.8 (0.7–0.9) at diagnosis and 1.1 (1.0–1.2) at response. Absolute change in mean ADC after neoadjuvant chemotherapy was 0.4 (0.3–0.5). Exploratory analyses for association between ADC and clinical parameters showed a significant difference in mean ADC at diagnosis for alveolar versus embryonal histology. Landmark analysis at nine weeks after the date of diagnosis showed no significant association (hazard ratio 1.3 [0.6–3.2]) between the mean ADC change and event-free survival. Conclusion A significant change in the 5th percentile and the mean ADC after chemotherapy was observed. Strong heterogeneity was identified in DW-MRI acquisition protocols between centers and in individual patients. Graphical Abstract
Authors 40
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Roelof van Ewijk corresponding
Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands. r.vanewijk-2@prinsesmaximacentrum.nl
Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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University Medical Center Utrecht · Princess Máxima Center
Affiliation as printed
Image Sciences Institute, UMC Utrecht, Utrecht, The Netherlands
Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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Affiliation as printed
Department of Paediatric Oncology, Children's Hospital for Wales, University Hospital, Cardiff, UK
Department of Paediatric Oncology, Children’s Hospital for Wales, University Hospital, Cardiff, UK
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University of Parma · Ospedale di Parma
Affiliation as printed
Pediatric Hematology-Oncology Unit University-Hospital of Parma, Parma, Italy
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University of Padua · Azienda Ospedale - Università Padova
Affiliation as printed
Department of Women's and Children's Health, University of Padua, Padua, Italy
Pediatric Hematology Oncology Division, University Hospital of Padua, Padua, Italy
Department of Women’s and Children’s Health, University of Padua, Padua, Italy
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Affiliation as printed
Service de Radiologie Interventionnelle Oncologique, Centre Léon Bérard, Lyon, France
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Hospital Universitario Virgen del Rocío
Affiliation as printed
Pediatric Radiology Unit, Department of Radiology, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot S/N, Seville, Spain
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Centre Hospitalier Universitaire de Rennes
Affiliation as printed
Radiology Department, CHU Rennes, Rennes, France
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Vall d'Hebron Hospital Universitari
Affiliation as printed
Paediatric Radiology Unit, Vall d´Hebron Hospital Campus, Barcelona, Spain
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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Université Libre de Bruxelles · Queen Fabiola Children's University Hospital
Affiliation as printed
Department of Hemato-Oncology, HUB, ULB, HUDERF, Brussels, Belgium
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University Medical Center Utrecht
Affiliation as printed
Image Sciences Institute, UMC Utrecht, Utrecht, The Netherlands
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Fondazione IRCCS Istituto Nazionale dei Tumori
Affiliation as printed
Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Leiden University · Princess Máxima Center
Affiliation as printed
Mathematical Institute, Leiden University, Leiden, The Netherlands
Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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Vall d'Hebron Hospital Universitari
Affiliation as printed
Pediatric Oncology Department, Vall d'Hebron Hospital, Barcelona, Spain
Pediatric Oncology Department, Vall d’Hebron Hospital, Barcelona, Spain
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Affiliation as printed
Unit of Advanced Clinical and Translational Imaging, Department of Medicine-DIMED, University of Padova, 35122, Padua, Italy
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Affiliation as printed
Department of Paediatric Research, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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University Medical Center Utrecht · Wilhelmina Children's Hospital
Affiliation as printed
Department of Radiology and Nuclear Medicine, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
Department of Radiology and Nuclear Medicine, Wilhelmina Children’s Hospital, UMC Utrecht, Utrecht, The Netherlands
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Affiliation as printed
Paediatric Oncology, Cardiff and Vale UHB, Cardiff, UK
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Radboud University Medical Center
Affiliation as printed
Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
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University Medical Center Utrecht
Affiliation as printed
Image Sciences Institute, UMC Utrecht, Utrecht, The Netherlands
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Affiliation as printed
Service de Radiothérapie, Centre Eugène Marquis, Rennes, France
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Institute of Cancer Research · Royal Marsden Hospital
Affiliation as printed
Department of Radiotherapy, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, UK
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Great Ormond Street Hospital · Great Ormond Street Hospital for Children NHS Foundation Trust
Affiliation as printed
Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Utrecht University · University Medical Center Utrecht · Princess Máxima Center
Affiliation as printed
Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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Université Paris-Saclay · Institut Gustave Roussy
Affiliation as printed
Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
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Affiliation as printed
Department of Imaging, Institut Gustave Roussy, Villejuif, France
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Fondazione IRCCS Istituto Nazionale dei Tumori
Affiliation as printed
Diagnostic and Interventional Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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Université Paris Sciences et Lettres · Institut Curie
Affiliation as printed
SIREDO Oncology Center (Care, Innovation and Research for Children and AYA With Cancer), Institut Curie, PSL Research University, Paris, France
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Affiliation as printed
Department of Radiology and Intervention Unit for Paediatric Radiology, Oslo University Hospital, Ullevål, Norway
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Royal Marsden NHS Foundation Trust · Royal Marsden Hospital
Affiliation as printed
Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
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Bambino Gesù Children's Hospital
Affiliation as printed
Department of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
Department of Radiology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Azienda Ospedaliera di Perugia
Affiliation as printed
Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria, Ospedale Santa Maria Della Misericordia, Perugia, Italy
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Affiliation as printed
Neuro-Oncology Unit, Department of Paediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
Neuro-Oncology Unit, Department of Paediatric Oncology, Santobono-Pausilipon Children’s Hospital, Naples, Italy
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Universitair Ziekenhuis Leuven
Affiliation as printed
Department of Paediatric Hemato-Oncology, University Hospital Leuven, Louvain, Belgium
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Amsterdam UMC Location University of Amsterdam
Affiliation as printed
Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
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Università Cattolica del Sacro Cuore · Agostino Gemelli University Polyclinic · Istituti di Ricovero e Cura a Carattere Scientifico
Affiliation as printed
Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Hospital Infantil Universitario Niño Jesús
Affiliation as printed
Pediatric Radiology Department, Hospital Niño Jesús, Madrid, Spain
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University Medical Center Utrecht
Affiliation as printed
Department of Neurology, UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands
Image Sciences Institute, UMC Utrecht, Utrecht, The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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