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Diffusion-weighted MRI in Advanced Epithelial Ovarian Cancer: Apparent Diffusion Coefficient as a Response Marker
Jessica M Winfield1, Jennifer C Wakefield1, David Dolling1
1From the Cancer Research UK Cancer Imaging Centre, Division of Radiation Therapy and Imaging, The Institute of Cancer Research, London, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, England (J.M.W., J.C.W., E.P., D.J.C., N.M.d.S.); Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, England (D.D., E.H.); Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, England (M.H.); Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England (S.F., A.N.P.); Cancer Research UK Cambridge Institute, Cambridge, England (J.D.B.); Addenbrooke's Hospital, Cambridge, England (J.D.B.); Department of Oncology, University of Cambridge, Cambridge, England (J.D.B.); Department of Gynaecological Oncology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (K.L.S.); Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, England (R.A.Q.); Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (N.J.T.); Imperial College London Hammersmith Campus, London, England (H.G.); Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, England (H.G.); Department of Radiology, Abertawe Bro Morgannwg Health Board, Morriston Hospital, Swansea, Wales (L.M.); and Gynaecology Unit, Royal Marsden NHS Foundation Trust, Sutton, England (S.B.).
Apparent diffusion coefficient (ADC) changes on MRI indicate treatment response in advanced ovarian cancer. An increased ADC after one chemotherapy cycle predicts longer progression-free survival in relapsed disease.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Advanced epithelial ovarian cancer has a high relapse rate (75%).
- Early response markers are crucial for optimizing treatment and improving outcomes in primary and recurrent disease.
Purpose of the Study:
- To evaluate the apparent diffusion coefficient (ADC) from diffusion-weighted MRI as a predictor of treatment response, progression-free survival (PFS), and overall survival.
- To assess ADC repeatability in newly diagnosed and relapsed ovarian cancer patients undergoing chemotherapy.
Main Methods:
- Prospective multicenter trial (2012-2016) including 125 patients with stage III/IV ovarian, primary peritoneal, or fallopian tube cancer.
- Diffusion-weighted MRI was used to measure ADC at baseline and after chemotherapy cycles.
- ADC changes were correlated with treatment response (biochemical and radiologic definitions) and survival outcomes (PFS and overall survival).
Main Results:
- Baseline ADC measurements were repeatable.
- ADC increased in a significant proportion of patients after chemotherapy (47-58%).
- ADC changes after three cycles differentiated responders from nonresponders (P=.02-.04).
- Increased ADC after one cycle was associated with longer PFS in relapsed disease (aHR=0.86, P=.03).
Conclusions:
- Apparent diffusion coefficient (ADC) changes after three chemotherapy cycles indicate treatment response in advanced ovarian cancer.
- Increased ADC after one cycle is a promising early indicator of improved progression-free survival in relapsed ovarian cancer.
