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Dream Project

1527-GITCG-IG DREAM – Diffusion-weighted Magnetic Resonance Imaging Assessment for Liver Metastasis to improve Surgical planning

Officially Open

A landmark collaboration between Europe and Japan, the DREAM study (NCT02781935) (Diffusion-weighted magnetic resonance imaging to assess liver metastasis and improve surgical planning) has officially opened. This first intergroup study between EORTC’s Gastrointestinal Tract Cancer group, Japan Clinical Oncology Group (JCOG) – the leading cancer research network of Japan- and the European Society of Surgical Oncology (ESSO) will assess the accuracy of diffusion-weighted MRI in combination with other diagnostic modalities to predict complete response among patients with borderline resectable/unresectable colorectal liver metastasis who received conversion systemic therapy.

Surgical resection of liver metastasis still offers the best chance for cure for patients with colorectal liver metastasis. Improved imaging modalities and combinations of chemotherapy and targeted therapy have made it possible for patients with complex and extensive liver metastasis to undergo resection. In this process, some metastatic lesions might completely “disappear” in imaging. Whether this corresponds to true pathologic complete response or a durable clinical response is still debated. Thus, the management of “disappearing metastasis” by either resecting or leaving them behind remains a question. DREAM is the first international, multi-center and prospective study to assess the true nature of disappearing metastasis. It is also the first intergroup study between EORTC, ESSO and JCOG, three leaders in the field of cancer treatment and research. This is the first step in developing a tailored treatment for patients, with the objective to potentially decrease the risk of surgical complications.

DREAM will involve 16 European sites, 12 Japanese sites and 2 sites from the United States. An integrated quality assurance program involving surgery, imaging and pathology will be implemented in the study through the SURCARE platform led by EORTC. “DREAM marks the beginning of a dynamic collaboration between EORTC, ESSO and JCOG to develop prospective and innovative surgical clinical research, advocate quality assurance and pave the way for a unique educational exchange of a new generation of young researchers committed to cancer research across Europe and Japan,” said Serge Evrard, SURCARE Principal Investigator and EORTC Board member.

For more information about the collaboration between EORTC and JCOG, please go to https://www.ncbi.nlm.nih.gov/pubmed/27765814

For more information about SURCARE, please go to https://www.ncbi.nlm.nih.gov/pubmed/27828818

Background

  • More effective chemotherapy enables unresectable CRLM to be resectable (conversion therapy)
  • Sometimes small lesions respond well and disappear on CT (Disappearing Liver Metastases - DLM)
  • However, complete radiologic response doesn’t always correspond with complete pathologic response
  • Likewise some small lesions (scar tissues or calcified lesion), although present in the imaging, can reveal only fibrosis by pathology
  • Precise diagnosis of DLMs and small residual lesions after chemotherapy is vital to surgical planning and patient management

 
Controversy still exists…

  • Can imaging help to characterize treatment response after conversion chemo in CRLM?
    • Can DW-MRI offer a robust prediction of complete response?
  • How should DLMs and small residual lesions be managed?
    • Can DW-MRI guide surgical decision making in the management of DLMs and small residual metastases after conversion chemotherapy in complex CRLM?
  • There is no prospective, multi-center data with radiologic and pathologic correlation for those lesions available in literature.


Protocol treatment

  • Imaging
    • DW-MRI
      • Performed in the following time points: baseline, before surgery and 3-4 month post-op
  • CT Scan
    • Performed at baseline, before surgery and during follow-up
  • Gd-EOB-DPTA MRI
    • baseline and before surgery will be collected if available
       
  • Conversion chemotherapy
    • According to local practice
       
  • Surgery
    • According to local practice and surgeon’s preference
    • Resection of accessible DLM site will be recommended
       

Correspondence

Study coordinators:
Serge Evrard (Institut Bergonié)
Manabu Shiozawa (Kanagawa Cancer Center)

Clinical research fellows (EORTC HQ):
Carmela Caballero – carmela.caballero@eortc.be
Kozo Kataoka – kozo.kataoka@eortc.be

 

Participating countries

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