Francesco Giganti MD, Presenter: Nothing to Disclose

Annalaura Salerno MD, Abstract Co-Author: Nothing to Disclose

Elena Orsenigo, Abstract Co-Author: Nothing to Disclose

Damiano Chiari, Abstract Co-Author: Nothing to Disclose

Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

Francesco Aldo De Cobelli MD, Abstract Co-Author: Nothing to Disclose

Treatment options for esophageal cancer (EC) vary from endoscopic to surgical resection, with or without neo-adjuvant therapy (NT), but prognosis still remains poor. This pilot study was designated to evaluate the role of apparent diffusion coefficient (ADC) as a potential prognostic biomarker in the management of EC.

Ethics approval was obtained from our research committee and informed, written consent was obtained from each patient. Over a period of 4 years, 23 Patients (18 men-5 women; mean age 64 ± 11 years) with biopsy-confirmed esophageal tumor (16 esophageal and 7 Siewert I) prospectively underwent 1.5T MR system including T1, T2 and DWI (b values: 0-600 s/mm2) sequences and ADC measurements were calculated. Specifically, 14/23 patients (61%) were directly treated with radical surgery whereas 9/23 patients (39%) were submitted to NT before undergoing surgical resection, with histopathological evaluation. All participants were followed up for a median of 19 months. Pathological ADC, tumor location, pT (T1-2 vs T3-4), pN and histotype were investigated by univariate and multivariate analysis using Cox regression and Kaplan-Meier curves.

At the end of the follow up, 19 (83%) patients were alive and 4 (17%) had died. Median overall survival was superior to 24 months. In the univariate analysis, assuming an ADC cut off of 1.4 x 10-3 mm2/s, our results showed significant results in detecting patients with a better (>1.4) or worse (<1.4) prognosis both in the total population (n=23, p=0.02) and in patients directly treated with surgery (n=14, p=0.02) but not in those addressed to NT (n=9, p=0.58). In the multivariate analysis, the same ADC cut off did not show significant results. This is mainly due, in our opinion, to the small number of patients enrolled.

This preliminary study suggests the innovative role of ADC as a diagnostic tool able to predict the aggressiveness of EC. DW-MRI might be added in the staging of EC and, although further studies are needed, ADC could be considered a non-invasive prognostic parameter capable of distinguishing between patients with better or worse prognosis with important implications in therapeutic regimens.

ADC could be considered a non-invasive prognostic parameter able to distinguish between patients with better or worse prognosis in esophageal cancer, with important implications in therapeutic regimens.

Giganti, F, Salerno, A, Orsenigo, E, Chiari, D, Del Maschio, A, De Cobelli, F, Prognostic Utility of Pre-treatment Apparent Diffusion Coefficient in Esophageal Cancer: A Pilot Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012533.html