rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2021-102-1-6-17rentrad-608Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL RESEARCHПроспективная оценка использования системы mrTRG в определении эффективности неоадъювантной химиолучевой терапии у больных раком прямой кишкиProspective Assessment of mrTRG System Used for Determining the Efficiency of Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancerhttps://orcid.org/0000-0002-3549-4499БерезовскаяТ. П.BerezovskaiaT. P.

Березовская Татьяна Павловна, д. м. н., профессор, гл. науч. сотр.

ул. Королева, 4, Калужская обл., Обнинск, 249036

Тatiana P. Berezovskaia, Dr. Med. Sc., Professor, Chief Researcher

ul. Koroleva, 4, Obninsk, 249036

https://orcid.org/0000-0002-4524-0839ДайнекоЯ. А.DaynekoYa. A.

Дайнеко Яна Александровна, науч. сотр.

ул. Королева, 4, Калужская обл., Обнинск, 249036

Yana А. Dayneko, Researcher

ul. Koroleva, 4, Obninsk, 249036

vorobeyana@gmail.comhttps://orcid.org/0000-0001-5961-2958НевольскихА. А.NevolskikhA. A.

Невольских Алексей Алексеевич, д. м. н., зам. директора по лечебной работе

ул. Королева, 4, Калужская обл., Обнинск, 249036

Аleksey А. Nevolskikh, Dr. Med. Sc., Deputy Director

ul. Koroleva, 4, Obninsk, 249036

https://orcid.org/0000-0001-7689-6032ИвановС. А.IvanovS. A.

Иванов Сергей Анатольевич, д. м. н., директор

ул. Королева, 4, Калужская обл., Обнинск, 249036

Sergei А. Ivanov, Dr. Med. Sc., Director

ul. Koroleva, 4, Obninsk, 249036

https://orcid.org/0000-0001-8784-8415КапринА. Д.KaprinA. D.

Каприн Андрей Дмитриевич, д. м. н., профессор, академик РАН, генеральный директор

ул. Королева, 4, Калужская обл., Обнинск, 249036

Andrey D. Kaprin, Dr. Med. Sc., Professor, Academician of RAS, Director General

ul. Koroleva, 4, Obninsk, 249036

Медицинский радиологический научный центр им. А.Ф. Цыба филиал ФГБУ «Научный медицинский исследовательский центр радиологии» Минздрава РоссииРоссияTsyb Medical Radiological Research Center branch of the National Medical Research Radiological Center, Ministry of Health of the Russian FederationRussian Federation2021100320211021617Copyright © Березовская Т.П., Дайнеко Я.А., Невольских А.А., Иванов С.А., Каприн А.Д., 20212021Березовская Т.П., Дайнеко Я.А., Невольских А.А., Иванов С.А., Каприн А.Д.Berezovskaia T.P., Dayneko Y.A., Nevolskikh A.A., Ivanov S.A., Kaprin A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/608Введение

Введение. Оценка лечебного эффекта неоадъювантной химиолучевой терапии (НХЛТ) при раке прямой кишки (РПК) имеет прогностическое значение и позволяет индивидуально планировать вид и объем дальнейшего хирургического вмешательства. Одним из наиболее перспективных вариантов оценки ответа опухоли с помощью магнитно-резонансной томографии (МРТ) является подход, основанный на определении степени регрессии опухоли (magnetic resonance tumour regression grade, mrTRG). Однако его надежность и безопасность должны быть подтверждены результатами клинических испытаний и практического применения.

Цель

Цель: провести анализ собственного опыта проспективного использования системы mrTRG и оценить дополнительный вклад в ее диагностическую эффективность диффузионно-взвешенных изображений (ДВИ).

Материал и методы

Материал и методы. Показатели mrTRG были определены у 125 (в том числе у 30 – с учетом ДВИ) больных местнораспространенным РПК, получивших комбинированное лечение с НХЛТ в клинике МРНЦ им. А.Ф. Цыба в период с 2015 по 2019 г. Полученные данные были сопоставлены со степенью патоморфоза по Е.Ф. Лушникову, вычислены диагностические параметры дифференциации пациентов, ответивших и не ответивших на НХЛТ.

Результаты

Результаты. При определении mrTRG без учета ДВИ были получены следующие значения чувствительности, специфичности, прогностичности положительного и отрицательного результатов: 75%, 60%, 70% и 67% соответственно, с учетом ДВИ – 87%, 87%, 87% и 87% соответственно.

Заключение

Заключение. Проспективная оценка результатов НХЛТ с помощью mrTRG имеет умеренную точность для стратификации пациентов, ответивших и не ответивших на терапию, что требует привлечения дополнительных критериев МРТ-оценки для отбора больных, которые могут получать менее агрессивное хирургическое лечение. Несмотря на небольшое количество пациентов, у которых анализ результатов МРТ проводился с учетом ДВИ, мы получили более высокие значения параметров диагностики. В связи с этим считаем целесообразным включать ДВИ в МРТ-оценку ответа опухоли на лечение.

Background

Background. Evaluation of the therapeutic effect of neoadjuvant chemoradiotherapy (nCRT) for rectal cancer (RC) is of prognostic value and allows to individually plan the type and extent of further surgical intervention. One of the most promising methods of MRI evaluation is magnetic resonance tumour regression grade (mrTRG) system. However, the reliability and safety of this method must be confirmed by the results of clinical trials and practical application.

Objective

Objective: to analyze our experience in the prospective use of mrTRG system and evaluate the additional contribution of diffusion-weighted images (DWI) to its diagnostic efficiency.

Material and methods

Material and methods. The mrTRG values were determined in 125 (including 30 with DWI) patients with locally advanced RC who received combined treatment with nCRT in Tsyb Medical Radiological Research Centre from 2015 to 2019. The obtained data were compared with the modified pathologic response based on Lushnikov’s definition, and the diagnostic parameters of differentiation of patients responding and nonresponding to nCRT were calculated.

Results

Results. When the mrTRG system was used without DWI, the following sensitivity and specificity values as well as positive and negative predictive values were obtained: 75%, 60%, 70% and 67%, respectively, with DWI – 87%, 87%, 87% and 87%, respectively.

Conclusion

Conclusion. A prospective evaluation of the result of nCRT using the mrTRG system has moderate accuracy for stratification of patients responding and non-responding to nCRT, which requires the use of additional criteria for MRI scores to select patients who may receive less aggressive surgical treatment. Despite the small number of patients with DWI, we obtained higher values of the diagnostic parameters. In this regard, we consider it appropriate to use DWI when assessing the treatment response.

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The authors declare that there are no conflicts of interest present.