Utility of clinical and MRI imaging parameters for prediction and monitoring of response to CAP-TEM in patients with liver metas-tases of neuroendocrine tumors

Clinical and MRI imaging parameters for prediction and monitoring of response to CAPTEM in patients with NELM

Authors

  • Maria Ingenerf
  • Christoph Auernhammer
  • Roberto Lorbeer
  • Shiwa Mansournia
  • Nabeel Mansour
  • Nina Hesse
  • Kathrin Heinrich
  • Jens Ricke
  • Frank Berger
  • Christine Schmid-Tannwald Department of Radiology, University Hospital, LMU Munich, Germany
  • Michael Winkelmann

Abstract

Background. This study explores the predictive and monitoring capabilities of clinical and multiparametric MRI parameters in assessing CAPTEM therapy response in patients with NET.

Patients and methods. / Materials and methods. This retrospective study (n=44) assessed CAPTEM therapy response in neuroendocrine liver metastases (NELM) patients. Among 33 monitored patients, pretherapeutic and follow-up MRI data (size, ADC values, and signal intensities), along with clinical parameters (CgA and Ki-67%), were analyzed. Progression-Free Survival (PFS) served as the reference. Responders were defined as those with PFS > 6 months.

Results. Most patients were male (75%) and had G2 tumors (76%) with a pancreatic origin (84%). Median PFS was 5.7 months; Overall Survival (OS) was 25 months. Non-responders (NR) had higher Ki-67 in primary tumors (16.5 vs. 10 %, p=0.01) and increased hepatic burden (20% vs. 5 %, p=0.007). NR showed elevated CgA post-treatment, while responders (R) exhibited a mild decrease. ADC changes differed significantly between groups, with NR having decreased ADCmin (-23%) and liver-adjusted ADCmean/ADCmean liver (-16%), compared to R's increases of ADCmin (50%) and ADCmean/ADCmean liver (30%). ROC analysis identified the highest AUC (0.76) for a single parameter for ∆ ADC mean/ Liver ADCmean, with a cut-off of < 6.9 (76% sensitivity, 75% specificity). Combining ∆ Size NELM and ∆ ADCmin achieved the best balance (88% sensitivity, 60% specificity) outperforming ∆ Size NELM alone (69% sensitivity, 65% specificity). Kaplan-Meier analysis indicated significantly longer PFS for ∆ ADCmean/ADCmean liver < 6.9 (p= 0.024) and ∆ Size NELM > 0% + ∆ ADCmin < -2.9% (p= 0.021).

Conclusions. Survival analysis emphasizes the need for adapted response criteria, involving combined evaluation of CgA, ADC values, and tumor size for monitoring CAPTEM response in hepatic metastasized NETs.

 

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Published

2024-06-10

How to Cite

Ingenerf, M., Auernhammer, C., Lorbeer, R., Mansournia, S., Mansour, N., Hesse, N., … Winkelmann, M. (2024). Utility of clinical and MRI imaging parameters for prediction and monitoring of response to CAP-TEM in patients with liver metas-tases of neuroendocrine tumors : Clinical and MRI imaging parameters for prediction and monitoring of response to CAPTEM in patients with NELM. Radiology and Oncology, 58(2), 196–205. Retrieved from https://www.radioloncol.com/index.php/ro/article/view/4268

Issue

Section

Radiology