Predicting Treatment Response From Extracellular Volume Fraction for Chemoradiation Therapy of Pancreatic Cancer

Dual-energy computed tomography (DECT) data can be used to calculate the extracellular volume fraction (ECVf) in tumors, which has been correlated with treatment outcome. This study sought to find a correlation between ECVf and treatment response as measured by the change in cancer antigen (CA) 19 to 9 during chemoradiation therapy (CRT) for pancreatic cancer.

Dual-energy CT data acquired during the late arterial contrast phase in the standard radiation therapy simulation on a dual-source DECT simulator for 25 patients with pancreatic cancer, along with their CA19-9 and hematocrit data, were analyzed. Each patient underwent preoperative CRT with a prescription of 50.4 Gy in 28 fractions. The patients were chosen based on the presence of a solid tumor in the pancreas that could be clearly delineated. A region of interest (ROI) was placed in the tumor and in the aorta. From the ratio of the iodine density calculated from the DECT in the ROI and the hematocrit taken at the time of simulation, the ECVf was calculated. The ECVf was then compared with the change in CA19-9 before and after the CRT. Distant metastases as the cause of CA19-9 elevation were ruled out on subsequent restaging images before surgery. The DECT-derived iodine ratio was validated using a phantom study.

The DECT-derived iodine concentration agreed with the phantom measurements (R², 1.0). The average hematocrit, ECVf, and change in CA19-9 during the treatment for the 25 patients was 35.6 ± 5.4%, 7.3 ± 4.9%, and -4.6 ± 21.8 respectively. A linear correlation was found between the ECVf and the change in CA19-9, with an R² of 0.7: ΔCA19-9 = 3.63 × ECVf - 31.1. The correlation was statistically significant (P = .006).

The calculated ECV fraction based on iodine maps from dual-source DECT may be used to predict treatment response after neoadjuvant chemoradiation therapy for pancreatic cancer.