Research Presentation Session: Oncologic Imaging
RPS 1616 - Recent developments in colorectal cancer imaging
March 6, 16:00 - 17:30 CET
6 min
Prognostic impact of lateral nodes size in patients with locally advanced rectal cancer treated with neoadjuvant CRT
Pietro Varotto, Vicenza / Italy
Author Block: P. Varotto, G. Sussan, F. Scannapieco, G. Spolverato, E. Quaia, F. Crimì; Vicenza/IT
Purpose: The evaluation of pelvic lymph nodes in rectal cancer has traditionally emphasized mesorectal nodes, whereas the role of lateral pelvic lymph nodes (LLNs: obturator, internal and external iliac) remains less clearly defined. Their prognostic significance, particularly after neoadjuvant chemoradiotherapy (CRT), is debated. International guidelines diverge: some Western centers favor a conservative, rectum-sparing approach, while Japanese guidelines support more radical strategies. Assessment of LLN size, especially short-axis diameter, may provide valuable prognostic and therapeutic insights.
Methods or Background: A cohort of 138 patients with locally advanced rectal cancer was retrospectively analyzed (mean age 66 years, range 27–87; 44% female). All patients underwent baseline and restaging pelvic MRI after pCRT. Among the cohort, 96 underwent total mesorectal excision (TME) or Abdomino-Perineal Resection (APR) and 42 were managed with rectum-sparing strategies (watch and wait and transanal local excision). LLNs were evaluated in baseline MRI and considered positive when the short-axis diameter was ≥7 mm.
Results or Findings: At baseline, LLNs were detected in 50% of patients. One patient was lost at follow up. Among 137 patients, the median OS was 58 months (IQR 4-96 months). No patient developed metastases in LLNs. The cohorts of patients with short axis of LLNs ≥7 mm and LLNs< 7 mm showed no significant differences in Overall Survival (OS) p=0.2 and Distant Metastases Free Survival (DMFS) p=0.22.
Conclusion: This study demonstrates that LLN size is not associated with OS and DMFS in locally advanced rectal cancer treated with CRT. Routine LLN excision, an invasive procedure associated with increased morbidity and functional sequelae, does not appear to provide survival benefit. Our findings support conservative management.
Limitations: This was a single-center, retrospective study with a relatively small sample and variable follow-up (4–96 months).
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Protocol number 3554/AO/15
Purpose: The evaluation of pelvic lymph nodes in rectal cancer has traditionally emphasized mesorectal nodes, whereas the role of lateral pelvic lymph nodes (LLNs: obturator, internal and external iliac) remains less clearly defined. Their prognostic significance, particularly after neoadjuvant chemoradiotherapy (CRT), is debated. International guidelines diverge: some Western centers favor a conservative, rectum-sparing approach, while Japanese guidelines support more radical strategies. Assessment of LLN size, especially short-axis diameter, may provide valuable prognostic and therapeutic insights.
Methods or Background: A cohort of 138 patients with locally advanced rectal cancer was retrospectively analyzed (mean age 66 years, range 27–87; 44% female). All patients underwent baseline and restaging pelvic MRI after pCRT. Among the cohort, 96 underwent total mesorectal excision (TME) or Abdomino-Perineal Resection (APR) and 42 were managed with rectum-sparing strategies (watch and wait and transanal local excision). LLNs were evaluated in baseline MRI and considered positive when the short-axis diameter was ≥7 mm.
Results or Findings: At baseline, LLNs were detected in 50% of patients. One patient was lost at follow up. Among 137 patients, the median OS was 58 months (IQR 4-96 months). No patient developed metastases in LLNs. The cohorts of patients with short axis of LLNs ≥7 mm and LLNs< 7 mm showed no significant differences in Overall Survival (OS) p=0.2 and Distant Metastases Free Survival (DMFS) p=0.22.
Conclusion: This study demonstrates that LLN size is not associated with OS and DMFS in locally advanced rectal cancer treated with CRT. Routine LLN excision, an invasive procedure associated with increased morbidity and functional sequelae, does not appear to provide survival benefit. Our findings support conservative management.
Limitations: This was a single-center, retrospective study with a relatively small sample and variable follow-up (4–96 months).
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Protocol number 3554/AO/15
6 min
Preoperative Prognostic Value of Gadoxetic Acid–Enhanced MRI in Patients with Colorectal Cancer Liver Metastases after Chemotherapy
Philip Eckwolf, Wien / Austria
Author Block: P. Eckwolf, S. Pötter-Lang, A. Ba-Ssalamah, C. Kuntner, I. PASHKUNOVA-MARTIC, U. I. Attenberger, N. Bastati-Huber; Wien/AT
Purpose: To evaluate the prognostic value of gadoxetic acid–enhanced MRI (gaMRI) for predicting treatment response (TR) and overall survival (OS) in patients with colorectal cancer liver metastases (CRCLM).
Methods or Background: In this retrospective study, 79 patients (mean age, 61.8 ± 9.7 years) with 124 CRCLM underwent gaMRI after chemotherapy and before hepatic resection. Hepatobiliary phase (HBP) enhancement was qualitatively assessed by two independent readers and categorized as homogeneous hypointensity (favorable) or heterogeneous hypointensity (unfavorable). Apparent diffusion coefficient (ADC) values were measured. The primary outcome was residual vital tumor (RVT). Correlations of HBP pattern, TR, and ADC with RVT were analyzed, and OS was assessed using the log-rank test.
Results or Findings: Interobserver agreement was substantial (κ = 0.80). Median RVT was 37.8% (range, 0–95%) and was significantly associated with HBP pattern (p < 0.001) and ADC (p = 0.021). Heterogeneous hypointensity correlated with higher RVT (r = 0.510, p < 0.001), unfavorable regression categories (r = 0.501, p < 0.001), lower ADC (r = –0.207, p < 0.05), and higher vitality (r = 0.264, p < 0.05). Conversely, homogeneous hypointensity strongly predicted major pathological response (≤10% RVT, r = 0.547, p < 0.001) and, to a lesser degree, response ≤50% RVT (r = 0.309, p < 0.001). OS analysis showed a trend toward improved survival in patients with homogeneous hypointense lesions, although not statistically significant (p = 0.066).
Conclusion: Homogeneous hypointensity on HBP after gaMRI is a favorable biomarker, predicting major pathological response and higher ADC values, while heterogeneous hypointensity indicates poor response, greater residual vitality, and restricted diffusion.
Limitations: The retrospective, single-center design and modest sample size limit generalizability. OS analysis did not reach statistical significance.
Funding for this study: No funding was provided for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethic committee number: 2064/2015
Purpose: To evaluate the prognostic value of gadoxetic acid–enhanced MRI (gaMRI) for predicting treatment response (TR) and overall survival (OS) in patients with colorectal cancer liver metastases (CRCLM).
Methods or Background: In this retrospective study, 79 patients (mean age, 61.8 ± 9.7 years) with 124 CRCLM underwent gaMRI after chemotherapy and before hepatic resection. Hepatobiliary phase (HBP) enhancement was qualitatively assessed by two independent readers and categorized as homogeneous hypointensity (favorable) or heterogeneous hypointensity (unfavorable). Apparent diffusion coefficient (ADC) values were measured. The primary outcome was residual vital tumor (RVT). Correlations of HBP pattern, TR, and ADC with RVT were analyzed, and OS was assessed using the log-rank test.
Results or Findings: Interobserver agreement was substantial (κ = 0.80). Median RVT was 37.8% (range, 0–95%) and was significantly associated with HBP pattern (p < 0.001) and ADC (p = 0.021). Heterogeneous hypointensity correlated with higher RVT (r = 0.510, p < 0.001), unfavorable regression categories (r = 0.501, p < 0.001), lower ADC (r = –0.207, p < 0.05), and higher vitality (r = 0.264, p < 0.05). Conversely, homogeneous hypointensity strongly predicted major pathological response (≤10% RVT, r = 0.547, p < 0.001) and, to a lesser degree, response ≤50% RVT (r = 0.309, p < 0.001). OS analysis showed a trend toward improved survival in patients with homogeneous hypointense lesions, although not statistically significant (p = 0.066).
Conclusion: Homogeneous hypointensity on HBP after gaMRI is a favorable biomarker, predicting major pathological response and higher ADC values, while heterogeneous hypointensity indicates poor response, greater residual vitality, and restricted diffusion.
Limitations: The retrospective, single-center design and modest sample size limit generalizability. OS analysis did not reach statistical significance.
Funding for this study: No funding was provided for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethic committee number: 2064/2015
6 min
Body composition as a predictor of cancer specific death in colon cancer: an AI-based volumetric analysis
Daniela Capece, Roma / Italy
Author Block: D. Capece, M. Polici, B. Masci, L. Nardoni, S. Nardacci, F. Pacelli, M. Zerunian, D. Caruso, M. Francone; Rome/IT
Purpose: To investigate body composition as a predictive biomarker of cancer specific death in
patients with non-metastatic colon cancer.
Methods or Background: Patients with colon cancer (stage II-III) treated with up-front surgery, with availability of
baseline CT, clinical, and histological data, survival data were retrospectively enrolled.
Patients with stage IV disease or those with CT unavailability were excluded. Body
composition parameters were derived from baseline abdominal CT using AI-based
automatic segmentation software. Up to 76 parameters regarding adipose visceral fat
(AVF), subcutaneous fat (SF), bone density, liver density and fat-fraction were
automatically extracted from both whole segmentation volume and multi-slices region (last
rib-iliac crest). According to the Colon Cancer specific death (CC-specific death), the
population was divided into Group 1 (CC-specific death) and Group 2 (non CC-specific
death). Body composition features were compared between the two groups. Predictive
model and survival analysis were performed with ROC curves, Cox regression and the
Kaplan-Meier method. P<0.05 was considered significant.
Results or Findings: 293 patients were included in the study, 101/293 (34.5%) with CC-specific deaths. Mean
HU of AVF (Group1 vs Group2, -77 HU vs -82 HU) and SF (Group1 vs Group2, -87 HU vs
-90 HU) resulted directly correlated with CC-specific death (P=0.004 and HR=1.03,
P=0.002 and HR=1.04, respectively) for the multislice analysis. Mean HU of AVF resulted
in direct correlation with CC- CC-specific deaths, also for the volumetric analysis (P=0.04
and HR=1.02). In the Kaplan-Meier analysis, the AVF and SF for the multislice analysis
resulted in statistically significant differences (P=0.033 and <0.001, Chi-Square=4.56 and
11.7, respectively).
Conclusion: In conclusion, our study demonstrated that the body composition metrics of visceral and
subcutaneous fat was significantly associated with cancer-specific death in non-metastatic
colon cancer patients.
Limitations: Retrospective study, lack of validation cohort
Funding for this study: Funded by AIRC IG 2020–ID 24974
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This retrospective analysis was conducted within the framework of a
5-year multicenter trial, approved by the ethical committee of Sant’Andrea University
Hospital (ref. nr. CE 6597/2021), registered on ClinicalTrials.gov (NCT06108310).
Purpose: To investigate body composition as a predictive biomarker of cancer specific death in
patients with non-metastatic colon cancer.
Methods or Background: Patients with colon cancer (stage II-III) treated with up-front surgery, with availability of
baseline CT, clinical, and histological data, survival data were retrospectively enrolled.
Patients with stage IV disease or those with CT unavailability were excluded. Body
composition parameters were derived from baseline abdominal CT using AI-based
automatic segmentation software. Up to 76 parameters regarding adipose visceral fat
(AVF), subcutaneous fat (SF), bone density, liver density and fat-fraction were
automatically extracted from both whole segmentation volume and multi-slices region (last
rib-iliac crest). According to the Colon Cancer specific death (CC-specific death), the
population was divided into Group 1 (CC-specific death) and Group 2 (non CC-specific
death). Body composition features were compared between the two groups. Predictive
model and survival analysis were performed with ROC curves, Cox regression and the
Kaplan-Meier method. P<0.05 was considered significant.
Results or Findings: 293 patients were included in the study, 101/293 (34.5%) with CC-specific deaths. Mean
HU of AVF (Group1 vs Group2, -77 HU vs -82 HU) and SF (Group1 vs Group2, -87 HU vs
-90 HU) resulted directly correlated with CC-specific death (P=0.004 and HR=1.03,
P=0.002 and HR=1.04, respectively) for the multislice analysis. Mean HU of AVF resulted
in direct correlation with CC- CC-specific deaths, also for the volumetric analysis (P=0.04
and HR=1.02). In the Kaplan-Meier analysis, the AVF and SF for the multislice analysis
resulted in statistically significant differences (P=0.033 and <0.001, Chi-Square=4.56 and
11.7, respectively).
Conclusion: In conclusion, our study demonstrated that the body composition metrics of visceral and
subcutaneous fat was significantly associated with cancer-specific death in non-metastatic
colon cancer patients.
Limitations: Retrospective study, lack of validation cohort
Funding for this study: Funded by AIRC IG 2020–ID 24974
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This retrospective analysis was conducted within the framework of a
5-year multicenter trial, approved by the ethical committee of Sant’Andrea University
Hospital (ref. nr. CE 6597/2021), registered on ClinicalTrials.gov (NCT06108310).
6 min
CT-derived visceral adiposity and sarcopaenia demonstrate stronger correlation with epigenetic age compared to age by birth in early onset colorectal cancer (EOCRC) treated with curative intent
Aine Daly, Co. Clare / Ireland
Author Block: A. Daly; Craughwell/IE
Purpose: EOCRC is increasing globally and in Ireland. One hypothesis is accelerated aging (AA). Epigenetic Age (EpiAge) is calculated using a blood-based algorithm and correlates strongly with age in whole body tissue/cell testing and is considered a more accurate predictor of DNA methylation than age by birth. This study aimed to examine the strength of relationship between dysmetabolic body composition with EpiAge and age by birth to better understand why it is prognostic of worse outcomes in EOCRC.
EOCRC patients diagnosed in the MidWest of Ireland from 2015-2024 (inclusive) and treated with curative intent (Stage I-III) were included. EpiAge was calculated using a validated blood-based algorithm. CT-derived body composition was measured on staging CTAP. Visceral adipose area was quantified on a single CT slice 6 cm above L4–L5, and skeletal muscle area at L3. Pearson and Spearman correlation coefficients were used depending on data distribution, significance was observed <0.05.
Results or Findings: Ninety one patients were suitable for inclusion (N=49 colon, n=42 rectal). 41% (n=37) had high visceral adiposity and 35% (n=32) sarcopaenia. EpiAge was older than age by birth in 77% (n=70) EOCRC and 83% (n=35) rectal cancers. Visceral adiposity correlated with EpiAge stronger than age by birth in EOCRC (r=0.69, p=0.005; r=0.25, p=0.1). This difference was more significant in colon cancer (r=0.79, p=<0.001; r=0.35, p=0.55) than rectal cancer. Sarcopenia correlated with EpiAge stronger than age by birth also (r=0.94, p=<0.01; r=0.48, p=0.65). EpiAge was significantly associated with disease specific mortality unlike age by birth [OR 6.6 (95%CI 0.84-0.95), p=0.028].
Conclusion: EpiAge correlates strongly with dysmetabolic body composition in EOCRC further strengthening the aetiological relationship between accelerated aging and EOCRC.
Limitations: Interpretation is limited by the retrospective design and sample size, but the findings highlight important associations warranting further study.
Funding for this study: No funding received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: University Hospital Limerick Research Ethics Committee
Purpose: EOCRC is increasing globally and in Ireland. One hypothesis is accelerated aging (AA). Epigenetic Age (EpiAge) is calculated using a blood-based algorithm and correlates strongly with age in whole body tissue/cell testing and is considered a more accurate predictor of DNA methylation than age by birth. This study aimed to examine the strength of relationship between dysmetabolic body composition with EpiAge and age by birth to better understand why it is prognostic of worse outcomes in EOCRC.
EOCRC patients diagnosed in the MidWest of Ireland from 2015-2024 (inclusive) and treated with curative intent (Stage I-III) were included. EpiAge was calculated using a validated blood-based algorithm. CT-derived body composition was measured on staging CTAP. Visceral adipose area was quantified on a single CT slice 6 cm above L4–L5, and skeletal muscle area at L3. Pearson and Spearman correlation coefficients were used depending on data distribution, significance was observed <0.05.
Results or Findings: Ninety one patients were suitable for inclusion (N=49 colon, n=42 rectal). 41% (n=37) had high visceral adiposity and 35% (n=32) sarcopaenia. EpiAge was older than age by birth in 77% (n=70) EOCRC and 83% (n=35) rectal cancers. Visceral adiposity correlated with EpiAge stronger than age by birth in EOCRC (r=0.69, p=0.005; r=0.25, p=0.1). This difference was more significant in colon cancer (r=0.79, p=<0.001; r=0.35, p=0.55) than rectal cancer. Sarcopenia correlated with EpiAge stronger than age by birth also (r=0.94, p=<0.01; r=0.48, p=0.65). EpiAge was significantly associated with disease specific mortality unlike age by birth [OR 6.6 (95%CI 0.84-0.95), p=0.028].
Conclusion: EpiAge correlates strongly with dysmetabolic body composition in EOCRC further strengthening the aetiological relationship between accelerated aging and EOCRC.
Limitations: Interpretation is limited by the retrospective design and sample size, but the findings highlight important associations warranting further study.
Funding for this study: No funding received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: University Hospital Limerick Research Ethics Committee
6 min
Delta total tumour volume and radiomics as predictive biomarkers in MSI-H metastatic colorectal cancer treated with immunotherapy
Jules Dupont, Villejuif / France
Author Block: J. Dupont1, S. JOURNO1, R. Barbe1, P-H. Cournède2, Y. Menu1, C. S. Balleyguier1, A. HOLLEBECQUE1, T. André3, N. Lassau1; 1Villejuif/FR, 2Gif-Sur-Yvettes/FR, 3Paris/FR
Purpose: To evaluate whether variations (delta-) in total tumour volume (TTV) and radiomic features can early predict Overall Survival (OS) in rare cohort of patients with metastatic colorectal cancer (mCRC) with high microsatellite instability (MSI-H) undergoing immunotherapy.
Methods or Background: One hundred forty-five patients diagnosed with MSI-H mCRC (mean age, 56 ± 15 years; 89 men) were retrospectively included from two centers. Radiologists manually annotated all tumours on chest-abdomen-pelvis computed-tomography at baseline (BL) and first evaluation (E1) scans. The median time between BL and E1 was 50 days (interquartile range: 45 - 64 days).
Tumour volume and radiomics were extracted for each lesion to predict OS. Every scan was resampled to isotropic voxel spacing of 1×1×1 mm3 to reduce variability. The delta-TTV and delta-radiomics were defined as their relative between BL and E1.
The ability to stratify patients into long- and short-term survival groups was assessed using the Restricted Mean Survival Time (RMST) ratio, AUC at 3 years, and C-index. Generalization was assessed through 75 train/test cohort splits.
Results or Findings: A total of 2079 lesions at BL and 2112 at E1 were annotated.
Delta-TTV outperformed TTV at BL and E1 across all metrics (p<0.001). Specifically, delta-TTV achieved an RMST ratio of 2.215 (95% CI: [2.106-2.324]), an AUC of 0.854 [0.840-0.868], and a C-index of 0.830 [0.819-0.841], with a cut-off of 17.31% relative increase in TTV.
Combining delta-radiomics with delta-TTV enhanced performance, yielding an RMST ratio of 2.450 (2.248-2.652, p=0.019), an AUC of 0.875 (0.862-0.888, p<0.001), and a C-index of 0.839 (0.819-0.841, p<0.001).
Conclusion: Delta-TTV is a strong predictor of survival in MSI-H mCRC patients. Adding radiomic features enhances this biomarker’s efficiency for early survival prediction.
Limitations: External validation is recommended for this two-center retrospective study.
Funding for this study: No fundings to disclose
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics committee N°2020-CER 2020-6
Purpose: To evaluate whether variations (delta-) in total tumour volume (TTV) and radiomic features can early predict Overall Survival (OS) in rare cohort of patients with metastatic colorectal cancer (mCRC) with high microsatellite instability (MSI-H) undergoing immunotherapy.
Methods or Background: One hundred forty-five patients diagnosed with MSI-H mCRC (mean age, 56 ± 15 years; 89 men) were retrospectively included from two centers. Radiologists manually annotated all tumours on chest-abdomen-pelvis computed-tomography at baseline (BL) and first evaluation (E1) scans. The median time between BL and E1 was 50 days (interquartile range: 45 - 64 days).
Tumour volume and radiomics were extracted for each lesion to predict OS. Every scan was resampled to isotropic voxel spacing of 1×1×1 mm3 to reduce variability. The delta-TTV and delta-radiomics were defined as their relative between BL and E1.
The ability to stratify patients into long- and short-term survival groups was assessed using the Restricted Mean Survival Time (RMST) ratio, AUC at 3 years, and C-index. Generalization was assessed through 75 train/test cohort splits.
Results or Findings: A total of 2079 lesions at BL and 2112 at E1 were annotated.
Delta-TTV outperformed TTV at BL and E1 across all metrics (p<0.001). Specifically, delta-TTV achieved an RMST ratio of 2.215 (95% CI: [2.106-2.324]), an AUC of 0.854 [0.840-0.868], and a C-index of 0.830 [0.819-0.841], with a cut-off of 17.31% relative increase in TTV.
Combining delta-radiomics with delta-TTV enhanced performance, yielding an RMST ratio of 2.450 (2.248-2.652, p=0.019), an AUC of 0.875 (0.862-0.888, p<0.001), and a C-index of 0.839 (0.819-0.841, p<0.001).
Conclusion: Delta-TTV is a strong predictor of survival in MSI-H mCRC patients. Adding radiomic features enhances this biomarker’s efficiency for early survival prediction.
Limitations: External validation is recommended for this two-center retrospective study.
Funding for this study: No fundings to disclose
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics committee N°2020-CER 2020-6
6 min
The Efficacy of Interventional Transarterial Treatments for Unresectable Colorectal Carcinoma
Andreea-Ioana Nica, Frankfurt / Germany
Author Block: T. J. Vogl, A-I. Nica, C. Booz, I. Yel, C. Wolfram, H. Adwan; Frankfurt/DE
Purpose: To evaluate the efficacy of transarterial chemoperfusion (TACP) and transarterial chemoembolization (TACE) as palliative and symptomatic treatments for unresectable colorectal carcinoma (CRC), focusing on local tumor response and survival outcomes.
Methods or Background: Between January 2000 and October 2023, 67 consecutive patients diagnosed with unresectable CRC underwent 318 TACP and 80 TACE procedures. Of these, 48 patients were treated with TACP, 14 with TACE, and 5 received a combination of both therapies. We retrospectively assessed local tumor response using the Response Evaluation Criteria in Solid Tumors (RECIST) and calculated overall survival (OS) and progression-free survival (PFS) using the Kaplan-Meier estimator.
Results or Findings: No major complications were reported. A total of 49 patients (73%) exhibited stable disease, while 3 patients (5%) achieved a partial response. The rate of progressive disease was 22%. The median OS for the entire cohort was 16.17 months, and the median PFS was 11.25 months. There were no statistically significant differences in OS (p=0.82) or PFS (p=0.37) between patients receiving TACP, TACE, or both treatments.
Conclusion: TACP and TACE are minimally invasive procedures that provide a viable treatment option for patients with unresectable CRC who cannot tolerate, refuse, or do not respond to chemotherapy. These treatments can serve as both palliative and symptomatic measures, potentially preventing tumor progression and improving quality of life. However, their benefits in the treatment of CRC warrant further investigation.
Limitations: Limitations of the study include its retrospective nature.
Funding for this study: No funding.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics Committee approval was obtained for this study.
Purpose: To evaluate the efficacy of transarterial chemoperfusion (TACP) and transarterial chemoembolization (TACE) as palliative and symptomatic treatments for unresectable colorectal carcinoma (CRC), focusing on local tumor response and survival outcomes.
Methods or Background: Between January 2000 and October 2023, 67 consecutive patients diagnosed with unresectable CRC underwent 318 TACP and 80 TACE procedures. Of these, 48 patients were treated with TACP, 14 with TACE, and 5 received a combination of both therapies. We retrospectively assessed local tumor response using the Response Evaluation Criteria in Solid Tumors (RECIST) and calculated overall survival (OS) and progression-free survival (PFS) using the Kaplan-Meier estimator.
Results or Findings: No major complications were reported. A total of 49 patients (73%) exhibited stable disease, while 3 patients (5%) achieved a partial response. The rate of progressive disease was 22%. The median OS for the entire cohort was 16.17 months, and the median PFS was 11.25 months. There were no statistically significant differences in OS (p=0.82) or PFS (p=0.37) between patients receiving TACP, TACE, or both treatments.
Conclusion: TACP and TACE are minimally invasive procedures that provide a viable treatment option for patients with unresectable CRC who cannot tolerate, refuse, or do not respond to chemotherapy. These treatments can serve as both palliative and symptomatic measures, potentially preventing tumor progression and improving quality of life. However, their benefits in the treatment of CRC warrant further investigation.
Limitations: Limitations of the study include its retrospective nature.
Funding for this study: No funding.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics Committee approval was obtained for this study.
6 min
Cost-effectiveness analysis of dedicated MR imaging vs. surgical staging in patients with colorectal peritoneal metastases
Max Lahaye, Amsterdam / Netherlands
Author Block: L. Van der Snee, A. Kramer, N. Kok, A. Aalbers, M. Lopez, V. Retel, M. Lahaye; Amsterdam/NL
Purpose: In patients with colorectal peritoneal metastases (PM-CRC), cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is potentially life-prolonging but carries substantial morbidity. Standard staging with computed tomography (CT) and diagnostic laparoscopy often results in preventable surgical procedures. The randomized multicenter DISCO trial demonstrated that adding diffusion-weighted magnetic resonance imaging (DW-MRI) reduces such procedures. This study evaluated the cost-effectiveness of additional DW-MRI in the Netherlands.
Methods or Background: A decision-analytic cohort model combined a decision tree of diagnostic strategies with a Markov model simulating survival. Patients were staged with either standard care (CT ± laparoscopy) or additional DW-MRI. Model inputs were derived from 149 Dutch patients randomized in DISCO (DW-MRI n=74, 49.7%; standard care n=75, 50.3%). Outcomes included short-term metrics (staging laparoscopies, CRS-HIPEC rates, diagnostic costs) and long-term outcomes (quality-adjusted life years [QALYs], total costs). Deterministic and probabilistic sensitivity analyses tested robustness.
Results or Findings: DW-MRI markedly reduced staging laparoscopies and lowered diagnostic costs, saving €2087 per patient. Over a lifetime horizon, DW-MRI yielded a gain of 0.162 QALYs and total cost savings of €455 compared with standard care. Both deterministic and probabilistic analyses confirmed cost-effectiveness. National implementation could generate annual diagnostic savings of ~€2.8 million.
Conclusion: Adding DW-MRI to the staging work-up for PM-CRC is a cost-effective strategy that reduces unnecessary surgical procedures and patient burden. In the Dutch healthcare setting, DW-MRI implementation would improve patient selection for CRS-HIPEC and result in significant cost savings.
Limitations: This analysis was based on Dutch trial data, and results may not fully generalize to healthcare systems with different surgical practices, cost structures, or MRI expertise.
Funding for this study: This study was investigator-initiated and sponsored by ZonMw. This study was approved by the Medical Ethics Committee of the Netherlands Cancer Institute (13 September 2019; NL70045.031.19) and registered in the ClinicalTrials.gov registry of the U.S.
National Library of Medicine (NCT04231175), and the study protocol was published in BMC Cancer (PMID: 33902498).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the ethics committee.
Purpose: In patients with colorectal peritoneal metastases (PM-CRC), cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is potentially life-prolonging but carries substantial morbidity. Standard staging with computed tomography (CT) and diagnostic laparoscopy often results in preventable surgical procedures. The randomized multicenter DISCO trial demonstrated that adding diffusion-weighted magnetic resonance imaging (DW-MRI) reduces such procedures. This study evaluated the cost-effectiveness of additional DW-MRI in the Netherlands.
Methods or Background: A decision-analytic cohort model combined a decision tree of diagnostic strategies with a Markov model simulating survival. Patients were staged with either standard care (CT ± laparoscopy) or additional DW-MRI. Model inputs were derived from 149 Dutch patients randomized in DISCO (DW-MRI n=74, 49.7%; standard care n=75, 50.3%). Outcomes included short-term metrics (staging laparoscopies, CRS-HIPEC rates, diagnostic costs) and long-term outcomes (quality-adjusted life years [QALYs], total costs). Deterministic and probabilistic sensitivity analyses tested robustness.
Results or Findings: DW-MRI markedly reduced staging laparoscopies and lowered diagnostic costs, saving €2087 per patient. Over a lifetime horizon, DW-MRI yielded a gain of 0.162 QALYs and total cost savings of €455 compared with standard care. Both deterministic and probabilistic analyses confirmed cost-effectiveness. National implementation could generate annual diagnostic savings of ~€2.8 million.
Conclusion: Adding DW-MRI to the staging work-up for PM-CRC is a cost-effective strategy that reduces unnecessary surgical procedures and patient burden. In the Dutch healthcare setting, DW-MRI implementation would improve patient selection for CRS-HIPEC and result in significant cost savings.
Limitations: This analysis was based on Dutch trial data, and results may not fully generalize to healthcare systems with different surgical practices, cost structures, or MRI expertise.
Funding for this study: This study was investigator-initiated and sponsored by ZonMw. This study was approved by the Medical Ethics Committee of the Netherlands Cancer Institute (13 September 2019; NL70045.031.19) and registered in the ClinicalTrials.gov registry of the U.S.
National Library of Medicine (NCT04231175), and the study protocol was published in BMC Cancer (PMID: 33902498).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the ethics committee.
6 min
Correlation of FDG Uptake with Serum Tumor Markers in Gynecologic and Gastrointestinal Malignancies
Farook Abubacker Sulaiman, Chennai / India
Author Block: F. Abubacker Sulaiman, S. Zainamb Begum, R. Praveenkumar, M. Nivitha, J. Lydia, A. Raashid Ibrahim; Chennai/IN
Purpose: To evaluate the correlation between ^18F-FDG uptake parameters on PET/CT and serum tumor markers in patients with gynecologic and gastrointestinal malignancies, and to assess their combined prognostic and diagnostic utility in disease characterization.
Methods or Background: A prospective study was conducted on 80 patients—40 with gynecologic (ovarian, endometrial, cervical) and 40 with gastrointestinal (colorectal, gastric, pancreatic) cancers—who underwent baseline ^18F-FDG PET/CT and serum tumor marker analysis (CA-125, CEA, and CA 19-9). Quantitative PET parameters including SUVmax, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were recorded. Correlations between imaging and biochemical markers were analyzed using Pearson’s correlation coefficient and regression modeling. Diagnostic and prognostic significance were assessed against histopathologic grade and clinical stage.
Results or Findings: A strong positive correlation was observed between SUVmax and CA-125 in ovarian and endometrial carcinomas (r = 0.76, p < 0.001), and between SUVmax and CEA in colorectal cancer (r = 0.71, p < 0.001). Elevated TLG values correlated with advanced FIGO and TNM stages. Combined FDG and tumor marker evaluation improved detection of metastatic disease by 19% and provided better prognostic stratification for recurrence risk. Patients with discordantly high CA-125 or CEA and low FDG uptake demonstrated low-grade or mucinous histology, reflecting reduced glycolytic activity.
Conclusion: FDG uptake shows significant correlation with serum tumor markers in gynecologic and GI malignancies, supporting their complementary role in staging, prognosis, and treatment monitoring.
Limitations: Single-center study with modest sample size and absence of longitudinal follow-up. Multicentric validation is recommended to standardize combined metabolic–biochemical assessment.
Funding for this study: No external funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Institutional ethical committee approval was obtained.
Purpose: To evaluate the correlation between ^18F-FDG uptake parameters on PET/CT and serum tumor markers in patients with gynecologic and gastrointestinal malignancies, and to assess their combined prognostic and diagnostic utility in disease characterization.
Methods or Background: A prospective study was conducted on 80 patients—40 with gynecologic (ovarian, endometrial, cervical) and 40 with gastrointestinal (colorectal, gastric, pancreatic) cancers—who underwent baseline ^18F-FDG PET/CT and serum tumor marker analysis (CA-125, CEA, and CA 19-9). Quantitative PET parameters including SUVmax, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were recorded. Correlations between imaging and biochemical markers were analyzed using Pearson’s correlation coefficient and regression modeling. Diagnostic and prognostic significance were assessed against histopathologic grade and clinical stage.
Results or Findings: A strong positive correlation was observed between SUVmax and CA-125 in ovarian and endometrial carcinomas (r = 0.76, p < 0.001), and between SUVmax and CEA in colorectal cancer (r = 0.71, p < 0.001). Elevated TLG values correlated with advanced FIGO and TNM stages. Combined FDG and tumor marker evaluation improved detection of metastatic disease by 19% and provided better prognostic stratification for recurrence risk. Patients with discordantly high CA-125 or CEA and low FDG uptake demonstrated low-grade or mucinous histology, reflecting reduced glycolytic activity.
Conclusion: FDG uptake shows significant correlation with serum tumor markers in gynecologic and GI malignancies, supporting their complementary role in staging, prognosis, and treatment monitoring.
Limitations: Single-center study with modest sample size and absence of longitudinal follow-up. Multicentric validation is recommended to standardize combined metabolic–biochemical assessment.
Funding for this study: No external funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Institutional ethical committee approval was obtained.