Top

Published in:

01-01-2009 | Gastrointestinal

Can perfusion CT assessment of primary colorectal adenocarcinoma blood flow at staging predict for subsequent metastatic disease? A pilot study

Authors: Vicky Goh, Steve Halligan, David M. Wellsted, Clive I. Bartram

Published in: European Radiology | Issue 1/2009

Abstract

We aimed to determine whether perfusion CT measurements at colorectal cancer staging may predict for subsequent metastatic relapse. Fifty two prospective patients underwent perfusion CT at staging to estimate tumour blood flow, blood volume, mean transit time, and permeability surface area product. Patients considered metastasis free and suitable for surgery underwent curative resection subsequently. At final analysis, a median of 48.6 months post-surgery, patients were divided into those who remained disease free, and those with subsequent metastases. Vascular parameters for these two groups were compared using t-testing, and receiver operator curve analysis was performed to determine the sensitivity and specificity of these vascular parameters for predicting metastases. Thirty seven (71%) patients underwent curative surgery; data were available for 35: 26 (74%) remained disease free; 9 (26%) recurred (8 metastatic, 1 local). Tumour blood flow differed significantly between disease-free and metastatic patients (76.0 versus 45.7 ml/min/100 g tissue; p = 0.008). With blood flow <64 ml/min/100 g tissue, sensitivity and specificity (95% CI) for development of metastases were 100% (60–100%) and 73% (53–87%), respectively. Our preliminary findings suggest that primary tumour blood flow might potentially be a useful predictor warranting further study.

McArdle CS, Hole D, Hansell D et al (1990) Prospective study of colorectal cancer in the west of Scotland: 10-year follow-up. Br J Surg 77:280–282PubMedCrossRef

Sargent DJ, Waiend HS, Haller DG et al (2005) Disease-free survival versus overall survival as a primary end point for adjuvant colon studies: individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol 23:8664–8670PubMedCrossRef

Sargent DJ, Patiyil S, Yothers G et al (2007) End points for colon cancer adjuvant trials: observations and recommendations based on individual patient data from 20,898 patients enrolled onto 18 randomized trials from the ACCENT group. J Clin Oncol 25:4569–4574PubMedCrossRef

Punt CJ (2004) New options and old dilemmas in the treatment of patients with advanced colorectal cancer. Ann Oncol 15:1453–1459PubMedCrossRef

Goldberg RM, Hurwitz HI, Fuchs CS (2006) The role of targeted therapy in the treatment of colorectal cancer. Clin Adv Hematol Oncol 4(8 Supl 17):1–10PubMed

Ogura O, Takebayashi Y, Sameshima T et al (2001) Pre-operative assessment of vascularity by color Doppler ultrasonography in human rectal carcinoma. Dis Colon Rectum 44:538–548PubMedCrossRef

Chen CN, Cheng YM, Liang JT et al (2000) Color Doppler vascularity index can predict distant metastasis and survival in colon cancer patients. Cancer Res 60:2892–2897PubMed

Leen E, Angerson WJ, Wotherspoon H et al (1995) Detection of colorectal liver metastases: comparison of laparotomy, CT, US, and Doppler perfusion index and evaluation of postoperative follow-up results. Radiology 195:113–116PubMed

Leen E, Goldberg JA, Angerson WJ et al (2000) Potential role of doppler perfusion index in selection of patients with colorectal cancer for adjuvant chemotherapy. Lancet 355:34–37PubMedCrossRef

10.

Fowler RC, Harris KM, Swift SE et al (1998) Doppler perfusion index: measurement in nine healthy volunteers. Radiology 209:867–871PubMed

11.

Willett CG, Boucher Y, Di Tomaso E et al (2004) Direct evidence that the VEGF-specific antibody bevacizumab has antivascular effects in human rectal cancer. Nat Med 10:145–147PubMedCrossRef

12.

Meijerink MR, Van Cruijsen H, Hoekman K et al (2007) The use of perfusion CT for the evaluation of therapy combining AZD2171 with gefitinib in cancer patients. Eur Radiol 17:1700–1713PubMedCrossRef

13.

Ng QS, Goh V, Milner J et al (2007) Effect of nitric-oxide synthesis on tumour blood volume and vascular activity: a phase I study. Lancet Oncol 8:111–118PubMedCrossRef

14.

Ng QS, Goh V, Carnell D et al (2007) Tumor antivascular effects of radiotherapy combined with combretastatin a4 phosphate in human non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 67:1375–1380PubMed

15.

Tateishi U, Kusumoto M, Nishihara H, Nagashima K, Morikawa T, Moriyama N (2002) Contrast enhanced dynamic computed tomography for the evaluation of angiogenesis in patients with lung carcinoma. Cancer 95:835–842PubMedCrossRef

16.

Wang JH, Min PQ, Wang PJ et al (2006) Dynamic CT evaluation of tumor vascularity in renal cell carcinoma. AJR Am J Roentgenol 186:1423–1430PubMedCrossRef

17.

Purdie TG, Henderson E, Lee TY (2001) Functional CT imaging of angiogenesis in rabbit VX2 soft-tissue tumour. Phys Med Biol 46:3161–3175PubMedCrossRef

18.

Goh V, Halligan S, Hugill JA et al (2006) Quantitative assessment of tissue perfusion using MDCT: comparison of colorectal cancer and skeletal muscle measurement reproducibility. AJR Am J Roentgenol 187:164–169PubMedCrossRef

19.

Goh V, Halligan S, Hugill JA et al (2005) Quantitative colorectal cancer perfusion measurements using MDCT: inter and intra-observer agreement. AJR Am J Roentogenol 185:225–231

20.

St Lawrence KS, Lee TY (1998) An adiabatic approximation to the tissue homogeneity model for water exchange in the brain: I. Theoretical derivation. J Cereb Blood Flow Metab 18:1365–1377PubMedCrossRef

21.

Moertel CG, Fleming TR, MacDonald JS et al (1990) Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 322:352–358PubMed

22.

Andre T, Boni C, Mounedji-Boudiaf L et al (2004) Oxaliplatin, flurouracil and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 350:2343–2351PubMedCrossRef

23.

Benson AB 3rd, Schrag D, Somerfield MR et al (2004) American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 22:3408–3419PubMedCrossRef

24.

Andre T, Sargent D, Tabernero J et al (2006) Current issues in adjuvant treatment of stage II colon cancer. Ann Surg Oncol 13:887–898PubMedCrossRef

25.

Efficacy of adjuvant flurouracil and folinic acid in B2 colon cancer (1999) International multicentre pooled analysis of B2 colon cancer trials (IMPACT B2) investigators. J Clin Oncol 17:1356–1363

26.

Des Guetz G, Uzzan B, Nicolas P et al (2006) Microvessel density and VEGF expression are prognostic factors in colorectal cancer. Meta-analysis of the literature. Br J Cancer 94:1823–1832PubMedCrossRef

27.

Werther K, Christensen IJ, Brunner N et al (2000) Soluble vascular endothelial growth factor levels in patients with primary colorectal carcinoma. The Danish RANX05 Colorectal Cancer Study Group. Eur J Surg Oncol 26:657–662PubMedCrossRef

28.

Cascinu S, Staccioli MP, Gasparini G et al (2000) Expression of vascular endothelial growth factor can predict event-free survival in stage II colon cancer. Clin Cancer Res 6:2803–2807PubMed

29.

Vermeulen PB, Van den Eynden GG, Huget P et al (1999) Prospective study of intratumoral microvessel density, p53 expression, and survival in colorectal cancer. Br J Cancer 79:316–322PubMedCrossRef

30.

Furudoi A, Tanaka S, Haruma K et al (2002) Clinical significance of vascular endothelial growth factor C expression and angiogenesis at the deepest invasive site of advanced colorectal carcinoma. Oncology 62:157–166PubMedCrossRef

31.

Frank RE, Saclarides TJ, Leurgens S et al (1995) Tumor angiogenesis as predictor of recurrence and survival in patients with node negative colon cancer. Ann Surg 222:695–699PubMedCrossRef

32.

Graziano F, Cascinu S (2003) Prognostic molecular markers for planning adjuvant chemotherapy trials in Dukes’ B colorectal cancer patients: how much evidence is enough? Ann Oncol 14:1026–1038PubMedCrossRef

33.

Miles KA, Hayball M, Dixon AK (1991) Colour perfusion imaging: a new application of computed tomography. Lancet 337:643–645PubMedCrossRef

34.

Miles KA (1991) Measurement of tissue perfusion by dynamic computed tomography. Br J Radiol 64:409–412PubMedCrossRef

35.

Haider MA, Milosevic M, Fyles A et al (2005) Assessment of the tumor microenvironment in cervix cancer using dynamic contrast enhanced CT, interstitial fluid pressure and oxygen measurements. Int J Radiat Oncol Biol Phys 62:1100–1107PubMed

36.

Graeber TG, Osmanian C, Jacks T et al (1996) Hypoxia mediated selection of cells with diminished apoptotic potential in solid tumours. Nature 379:88–91PubMedCrossRef

37.

Reynolds TY, Rockwell S, Glazer PM (1996) Genetic instability induced by the tumor microenvironment. Cancer Res 56:5754–5757PubMed

38.

Hockel M, Schlenger K, Aral B et al (1996) Association between tumor hypoxia and malignant progression in advanced cancer of the uterine cervix. Cancer Res 56:4509–4515PubMed

39.

Sundfor K, Lyng H, Rofstad EK (1998) Tumour hypoxia and vascular density as predictors of metastasis in squamous cell carcinoma of the uterine cervix. Br J Cancer 78:822–827PubMed

40.

Brizel DM, Scully SP, Harrelson JM et al (1996) Tumor oxygenation predicts the likelihood of distant metastases in human soft tissue sarcoma. Cancer Res 56:941–943PubMed

41.

Hockel M, Vaupel P (2001) Tumor hypoxia: definitions, and current clinical, biological, and molecular aspects. J Natl Canc Inst 93:266–276CrossRef

42.

Goethals L, Debucquoy A, Perneel C et al (2006) Hypoxia in human colorectal adenocarcinoma: comparison between extrinsic and potential intrinsic hypoxia markers. Int J Radiation Oncology Biol Phys 65:246–254

43.

Shweiki D, Itin A, Soffer D et al (1992) Vascular endothelial growth factor induced by hypoxia may mediate hypoxia initiated angiogenesis. Nature 359:843–845PubMedCrossRef

44.

Yao K, Gietama JA, Shida S et al (2005) In vitro hypoxia-conditioned colon cancer cell lines derived from HCT116 and HT29 exhibit altered apoptosis susceptibility and a more angiogenic profile in vivo. Br J Cancer 93:1356–1363PubMedCrossRef

45.

Sahani DV, Kalva SP, Hamberg LM et al (2005) Assessing tumor perfusion and treatment response in rectal cancer with multisection CT: initial observations. Radiology 234:785–792PubMedCrossRef

46.

Bellomi M, Petralia G, Sonzogni A, Zampino MG, Rocca A (2007) CT perfusion for the monitoring of neo-adjuvant chemoradiation therapy in rectal carcinoma. Radiology 244:486–493PubMedCrossRef

47.

Hermans R, Meijerink M, Van den Bogaert W et al (2003) Tumor perfusion rate determined noninvasively by dynamic computed tomography predicts outcome in head and neck cancer after radiotherapy. Int J Radiat Oncol Biol Phys 57:1351–1356PubMed

48.

Mooteri S, Rubin D, Leurgans S et al (1996) Tumor angiogenesis in primary and metastatic colorectal cancers. Dis Colon Rectum 39:1073–1080PubMedCrossRef

49.

Berney CR, Yang YL, Fisher RJ et al (1998) Vascular endothelial growth factor expression is reduced in liver metastasis from colorectal cancer and correlates with urokinase-type plasminogen activator. Anticancer Res 18:973–977PubMed

50.

De Lussanet QG, Backes WH, Griffioen AW et al (2005) Dynamic contrast-enhanced magnetic resonance imaging of radiation therapy-induced microcirculation changes in rectal cancer. Int J Radiat Oncol Biol 63:1309–1315CrossRef

51.

DeVries AF, Griebel J, Kremser C et al (2001) Tumor microcirculation evaluated by dynamic contrast enhanced magnetic resonance imaging predicts therapy outcome for primary rectal carcinoma. Cancer Res 61:2513–2516PubMed

52.

De Vries A, Griebel J, Kremser C et al (2000) Monitoring of tumor microcirculation during fractionated radiation therapy in patients with rectal carcinoma: preliminary results and implications for therapy. Radiology 217:385–391PubMed

53.

Altman DG, Royston P (2000) What do we mean by validating a prognostic model? Stat Med 53:219–221

54.

Goh V, Halligan S, Bartram CI (2007) Quantitative tumor perfusion assessment using MDCT: Are measurements from two different commercial software packages interchangeable? Radiology 242:777–782PubMedCrossRef

55.

Ng QS, Goh V, Fichte H et al (2006) Lung cancer perfusion at multidetector row CT: reproducibility of whole tumor quantitative measurements. Radiology 239:547–553PubMedCrossRef

56.

Ng QS, Goh V, Klotz E et al (2006) Quantitative assessment of lung cancer perfusion using MDCT:does measurement reproducibility improve with greater tumor volume coverage? AJR Am J Roentgenol 187:1079–1084PubMedCrossRef

Title: Can perfusion CT assessment of primary colorectal adenocarcinoma blood flow at staging predict for subsequent metastatic disease? A pilot study
Authors: Vicky Goh
Steve Halligan
David M. Wellsted
Clive I. Bartram
Publication date: 01-01-2009
Publisher: Springer-Verlag
Published in: European Radiology / Issue 1/2009
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-008-1128-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Can perfusion CT assessment of primary colorectal adenocarcinoma blood flow at staging predict for subsequent metastatic disease? A pilot study

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2009

Pediatric liver tumors – a pictorial review

Multidetector CT angiography of renal vasculature: normal anatomy and variants

Can abdominal multi-detector CT diagnose spinal osteoporosis?

Image-guided biopsy in patients with suspected ovarian carcinoma: a safe and effective technique?

Multidetector CT angiography in the evaluation of acute mesenteric ischemia

Reply to: enteroclysis vs enterography: the unsettled issue