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Radiologic Assessment of Rectosigmoid Cancer Before and After Neoadjuvant Radiation Therapy: Comparison Between Quantitation Techniques

¹ Fondazione Biomedica Europea–onlus, Via Nizza, 53–00198, Rome, Italy.
² Department of Radiology, University of Rotterdam 30156D, The Netherlands.
³ Department of Surgery, University of Parma 43100, Italy.
⁴ Department of Radiology, University of Parma 43100, Italy.

View larger version (143K): [in a new window]   Fig. 1A. —Axial contrast-enhanced CT scans of rectosigmoid junction of 72-year-old man. Tumor is visible as thickening of walls (white arrows). Fluid remnant is visible (asterisk) with liquid density and air–fluid level. EIV = external iliac vessels, IIV = internal iliac vessels, S = sacrum.

View larger version (102K): [in a new window]   Fig. 1B. —Axial contrast-enhanced CT scans of rectosigmoid junction of 72-year-old man. Tumor and endoluminal content are defined manually for segmentation (area outlined in blue). Endoluminal content was included because neoplasm involved whole circumference.

View larger version (101K): [in a new window]   Fig. 1C. —Axial contrast-enhanced CT scans of rectosigmoid junction of 72-year-old man. Luminal content alone is defined manually for segmentation (area outlined in blue). Tumor volume was then calculated by subtracting volume of lumen from entire volume.

View larger version (82K): [in a new window]   Fig. 2A. —Three-dimensional reconstructions with volume rendering of pre– and post–radiation therapy CT scans of rectum, sigmoid, and segmented tumor in 72-year-old man. Volume of segmented tumor is 97.9 mL on pre– radiation therapy scan (A) and is 64.1 mL on post–radiation therapy CT scan (B).

View larger version (84K): [in a new window]   Fig. 2B. —Three-dimensional reconstructions with volume rendering of pre– and post–radiation therapy CT scans of rectum, sigmoid, and segmented tumor in 72-year-old man. Volume of segmented tumor is 97.9 mL on pre– radiation therapy scan (A) and is 64.1 mL on post–radiation therapy CT scan (B).

View larger version (10K): [in a new window]   Fig. 3. —Two drawings illustrate method of volumetric analysis for assessing response of rectosigmoid cancer to radiation therapy. In this example, for simplicity, lesion is assumed to be cubic shaped, with side length (L). Right-hand drawing shows size of lesion before radiation therapy (dotted lines) and after partial response to radiation therapy (solid lines). Side lengths of cube were reduced by 30%—from 1 L to 0.7 L. This change leads to reduction close to 50% of area of base (gray) and reduction of 65.7% of volume of cube. According to Response Evaluation Criteria in Solid Tumors guidelines [8], partial response to therapy is present with decrease in lesion maximal diameter of more than 30%. According to World Health Organization criteria [6], partial response is present if decrease of product of maximal perpendicular diameter of lesion is more than 50%. Relationship between maximal diameter, area, and volume of lesion has been used to obtain partial response threshold for volumetric analysis (65.7%).

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