The study cohort consisted of 23 MIBC patients (cT2/T3?= 7/16) who underwent induction CRT consisting of radiotherapy to the small pelvis (40 Gy) with two cycles of cisplatin (20 mg/day for 5 days), followed by partial or radical cystectomy. All patients underwent DW-MRI before the initiation of treatment. Associations of apparent diffusion coefficient (ADC) values with CRT sensitivity were analyzed. The proliferative potential of MIBC was also assessed by analyzing the Ki-67 labeling index (LI) in pretherapeutic biopsy specimens.
Thirteen patients (57 % ) achieved pathologic complete response (pCR) to CRT. These CRT-sensitive MIBCs showed significantly lower ADC values (median, 0.63 ¡Á 10? mm2/s; range, 0.43-0.77) than CRT-resistant (no pCR) MIBCs (median, 0.84 ¡Á 10? mm2/s; range, 0.69-1.09; p?= 0.0003).
Multivariate analysis identified ADC value as the only significant and independent predictor of CRT sensitivity (p < 0.0001; odds ratio per 0.001 ¡Á10? mm2/s increase, 1.03; 95 % confidence interval, 1.01-1.08). With a cutoff ADC value at 0.74 ¡Á 10? mm2/s, sensitivity/specificity/accuracy in predicting CRT sensitivity was 92/90/91 % . Ki-67 LI was significantly higher in CRT-sensitive MIBCs (p?= 0.0005) and significantly and inversely correlated with ADC values (¦Ñ?= ?.67, p?= 0.0007).
DW-MRI is a potential biomarker for predicting CRT sensitivity in MIBC. DW-MRI may be useful to optimize patient selection for CRT-based bladder-sparing approaches.