Korean J Radiol.  2019 Apr;20(4):589-598. 10.3348/kjr.2018.0306.

Prediction of Treatment Outcome of Chemotherapy Using Perfusion Computed Tomography in Patients with Unresectable Advanced Gastric Cancer

• Lee DH
• Kim SH
• Lee SM
• Han JK

• KMID: 2440482
• DOI: http://doi.org/10.3348/kjr.2018.0306

Abstract

OBJECTIVE
To evaluate whether data acquired from perfusion computed tomography (PCT) parameters can aid in the prediction of treatment outcome after palliative chemotherapy in patients with unresectable advanced gastric cancer (AGC).
MATERIALS AND METHODS
Twenty-one patients with unresectable AGCs, who underwent both PCT and palliative chemotherapy, were prospectively included. Treatment response was assessed according to Response Evaluation Criteria in Solid Tumors version 1.1 (i.e., patients who achieved complete or partial response were classified as responders). The relationship between tumor response and PCT parameters was evaluated using the Mann-Whitney test and receiver operating characteristic analysis. One-year survival was estimated using the Kaplan-Meier method.
RESULTS
After chemotherapy, six patients exhibited partial response and were allocated to the responder group while the remaining 15 patients were allocated to the non-responder group. Permeability surface (PS) value was shown to be significantly different between the responder and non-responder groups (51.0 mL/100 g/min vs. 23.4 mL/100 g/min, respectively; p = 0.002), whereas other PCT parameters did not demonstrate a significant difference. The area under the curve for prediction in responders was 0.911 (p = 0.004) for PS value, with a sensitivity of 100% (6/6) and specificity of 80% (12/15) at a cut-off value of 29.7 mL/100 g/min. One-year survival in nine patients with PS value > 29.7 mL/100 g/min was 66.7%, which was significantly higher than that in the 12 patients (33.3%) with PS value ≤ 29.7 mL/100 g/min (p = 0.019).
CONCLUSION
Perfusion parameter data acquired from PCT demonstrated predictive value for treatment outcome after palliative chemotherapy, reflected by the significantly higher PS value in the responder group compared with the non-responder group.

Keyword

Stomach; Functional imaging; Reproducibility; Survival; Permeability

MeSH Terms

Drug Therapy*
Humans
Methods
Perfusion*
Permeability
Prospective Studies
Response Evaluation Criteria in Solid Tumors
ROC Curve
Sensitivity and Specificity
Stomach
Stomach Neoplasms*
Treatment Outcome*

Figure

• 

  Fig. 1 Flow chart illustrating patient enrollment process.AGC = advanced gastric cancer, PCT = perfusion CT, PR = partial response, SD = stable disease

• 

  Fig. 2 PS value of each patient group.Mean PS value (51.0 mL/100 g/min) of AGCs in responder group was significantly higher than in non-responder group (23.4 mL/100 g/min) (p = 0.002). All values appear as circles. PS = permeability surface

• 

  Fig. 3 55-year-old man with histologically confirmed gastric cancer and liver metastasis.A, B. Contrast-enhanced axial CT images acquired during portal phase reveal marked enhancing wall thickening in antrum of stomach (arrows in A), suggesting AGC. Liver metastasis (arrowhead in A) is also noted. Other metastatic nodules in liver (arrowheads in B) and lymph nodes (arrows in B) are also apparent. C. On parametric perfusion map, PS value of primary gastric cancer was 69.32 mL/100 g/min, which is higher than cut-off value of 29.7 mL/100 g/min (arrows). D. Follow-up axial CT image obtained after two cycles of fluorouracil and oxaliplatin (i.e., FOLFOX) chemotherapy reveals marked decrease in size for both hepatic (arrowheads) and lymph node (arrow) metastases, indicating PR. CT = computed tomography

• 

  Fig. 4 56-year-old man with histologically confirmed gastric cancer and liver metastasis.A. Contrast-enhanced axial CT image acquired during portal phase demonstrates heterogeneously enhancing mass in lesser curvature side of gastric body (arrows), suggesting AGC. 3.5 cm metastasis is also noted in segment VI of liver (arrowhead). B. On parametric perfusion map, PS value of gastric cancer (arrows) was 11.30 mL/100 g/min, which is lower than cut-off value of 29.7 mL/100 g/min. C. On follow-up axial CT image acquired after two cycles of capecitabine and cisplatin chemotherapy, liver metastasis demonstrates increase in size from 3.5 cm to 4.8 cm (arrowhead), indicating PD. Primary stomach mass (arrows) did not exhibit significant size change after chemotherapy. PD = progressive disease

• 

  Fig. 5 Results of ROC analysis.ROC analysis revealed that area under curve for PS value was 0.911 (95% CI 0.780–1.000; p < 0.001). When cut-off value was set at 29.7 mL/100 g/min (arrow), sensitivity of 100% (6/6) and specificity of 80% (12/15) were achieved. CI = confidence interval, ROC = receiver operating characteristic curve

• 

  Fig. 6 Patient survival estimation after palliative chemotherapy for AGC.Kaplan-Meier plot reveals that survival rate in 9 patients with PS value > 29.7 mL/100 g/min was significantly better than that in 12 patients with PS value ≤ 29.7 mL/100 g/min (p = 0.019).

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