Dce-Mri For Early Evaluation Of Therapeutic Response In Esophageal Cancer After Concurrent Chemoradiotherapy And Its Values In Predicting Hif-1 Alpha Expression

To examine the feasibility of quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the early assessment of the therapeutic response to concurrent chemoradiotherapy (CRT) in esophageal cancer (EC) patients and to determine its value in predicting HIF-1 alpha expression. EC patients underwent DCE-MRI 1 week pre-CRT and 3 weeks post-CRT (3w-CRT). According to tumor regression post-treatment, patients were divided into sensitive group (SG) and resistant group (RG). HIF-1 alpha expression was assessed by immunohistochemistry (IHC). Quantitative parameters (ktrans, kep, and ve) were compared between the SG and RG groups, as well as between the HIF-1 alpha(+) and HIF-1 alpha(-) groups. Receiver operating characteristic (ROC) curve analysis was performed to detect the best predictor of the above parameters in the therapeutic response and in predicting HIF-1 alpha expression. Totally 34 and 5 patients were included in the SG and RG, respectively. Pre-ktrans and pre-kep were decreased significantly in the SG at 3w-CRT (p < .01), whereas only pre-kep was decreased in the RG (p = .037). Pre-ktrans was higher in the SG compared with the RG (p < .01). Meanwhile, absolute Delta ktrans (post-ktrans-pre-ktrans) was reduced more substantially in the SG compared with the RG. Delta ktrans also had the highest area under the curve (AUC = 0.929) in distinguishing SG from RG. Based on IHC, 13 and 11 patients were HIF-1 alpha(+) and HIF-1 alpha(-), respectively. At 3w-CRT, post-ktrans was markedly lower than pre-ktrans in the HIF-1 alpha(+) group (p < .01); however, both ktrans and kep in the HIF-1 alpha(-) group were dramatically reduced than pre-treatment values (both p < .01). Pre-ktrans was significantly higher in the HIF-1 alpha(-) group compared with the HIF-1 alpha(+) group (p = .002) and constituted an excellent parameter for predicting HIF-1 alpha expression (AUC = 0.881). DCE-MRI is effective in the early assessment of the therapeutic response after CRT, offering a novel noninvasive method for predicting HIF-1 alpha expression in advanced EC patients.