ArticlePhysics and imaging in radiation oncology2023
Imaging the tumour microenvironment in rectal cancer: Decline in tumour blood flow during radiotherapy predicts good outcome.
Article in Physics and imaging in radiation oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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5 citing papers in PubMed, 5 citations in OpenAlex.
- Phenotypic and ultrastructural heterogeneity of fibroblasts and vasculogenic mimicry in rectal adenocarcinoma following neoadjuvant chemoradiotherapy.Histochemistry and cell biology · 2025Article
- Efficient strategy for magnetic resonance image-guided adaptive radiotherapy of rectal cancer using a library of reference plans.Physics and imaging in radiation oncology · 2025Article
- Assessment of the imaging quality and heterogeneous predictive value of readout-segmented echo planar imaging for diffusion-weighted rectal MRI.Frontiers in oncology · 2025Article
- Biomarker-driven molecular imaging probes in radiotherapy.Theranostics · 2024Review
- Watch and wait: staying the course?Updates in surgery · 2023Article
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Authors and funding
13 authors at 4 institutions in 1 country.
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Abstract
Background and purpose: Measuring rectal tumour response to radiation is pivotal to restaging patients and for possibly stratification to a watch-and-wait strategy. Recognizing the importance of the tumour microenvironment, we investigated a less explored quantitative imaging marker assessing tumour blood flow (BF) for its potential to predict overall survival (OS). Materials and methods: 24 rectal cancer patients given curative-intent neoadjuvant radiotherapy underwent a multi-echo dynamic magnetic resonance imaging (MRI) sequence with gadolinium contrast for quantification of tumour BF before either 25x2 Gy (n = 18) with concomitant chemotherapy or 5x5 Gy (n = 6). CD34 staining of excised tumour tissue was performed and baseline blood samples were analysed for lactate dehydrogenase (LDH) and angiopoietin-2 (ANGPT-2). Tumour volumes were measured before and after treatment. After subsequent surgery, ypTN scoring assessed tumour response. Cox regression for 5-year OS analysis and Results: The change in tumour BF (ΔBF) during neoadjuvant radiotherapy was a significant marker of OS, whereas tumour stage and volume were not related to OS. All patients with >20 % decline in BF were long-term survivors. Separating cases in two groups based on ΔBF revealed that patients with increase or a low decrease had higher baseline LDH (p = 0.032) and ANGPT-2 (p = 0.028) levels. Conclusion: MRI-assessed tumour ΔBF during neoadjuvant treatment is a significant predictor of OS in rectal cancer patients, making ΔBF a potential quantitative imaging biomarker for treatment stratification. Blood LDH and ANGPT-2 indicate that non-responding tumours may have a hypoxic microenvironment resistant to radiotherapy.
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