Digital Diagnostics (Oct 2021)
Objective criteria for MRI evaluation of the effectiveness of treatment of bone metastases in patients with prostate cancer and breast cancer: systematic review and meta-analysis
Abstract
BACKGROUND: The possibility of a personalized approach to the treatment of metastatic prostate cancer and breast cancer requires objective methods for the evaluation of the response of foci treatment in the skeleton. The proven high efficiency of MRI in detecting bone metastases, in combination with the absence of ionizing radiation, has laid the groundwork for using this method in monitoring the treatment course based on objective criteria for evaluation of the therapeutic outcome. AIM: To assess the possibilities of quantitative and semi-quantitative parameters of MRI-evaluation of treatment efficacy (radiation, chemotherapy, hormone therapy, and targeted therapy) of bone metastases that were used in prostate and breast cancer clinical trials. MATERIALS AND METHODS: We searched the databases Embase, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), eLibrary until April 1, 2021, using the following keywords: magnetic resonance imaging, MRI, DWI, treatment response, prostate or breast cancer, and bone metastasis. We only included studies related to the MRI-evaluation of treatment efficacy of any type of therapeutic intervention (with the exception of surgery) for metastatic skeletal lesions in this review. RESULTS: We selected and analyzed 11 out of 312 sources found as a result of the search. It allowed us to identify four groups of objective MRI criteria for evaluating the therapeutic effect in metastatic bone lesions in patients with prostate and breast cancer, including the dynamics of sizes, signal intensity on DWI, ADC, and tumor total diffusion volume (tDV). Changes in these quantitative and semi-quantitative indicators, with only one exception, had the same direction, although they differed in numerical values. A random-effects model was used for analysis considering the presence of statistically significant heterogeneity (p 0,1 for 2 test; I2 40%),. The change in ADC as a result of treatment averaged +0.35 [+0.12; +0.49] 103 mm2/s, with average values of ADC before treatment ― 0.83 [0.71; 1.03] 103 mm2/s, after treatment ― 1.18 [0.83; 1.49] 103 mm2/s. CONCLUSION: MRI is an informative technique for the objective evaluation of the response of bone metastases to therapy in patients with prostate cancer and breast cancer based on quantitative and semi-quantitative parameters. It has significant potential as a diagnostic test instrument for monitoring the effectiveness of treatment of metastatic skeletal lesions.
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