Predictive value of mono-exponential and mathematical models in rectal cancer responsiveness to neoadjuvant chemoradiotherapy

Motivation: Although it is challenging to predict LARC responsiveness to nCRT, the potential of emerging non-Gaussian DWI models for this purpose remains unexplored. Goal(s): To assess the efficacies of mono-exponential ADC and various non-Gaussian DWI models, including SEM, FROC, and CTRW, in predicting LARC responsiveness to nCRT. Approach: This prospective study included 103 LARC patients. Various DWI models were assessed, and post-surgery histopathology was utilized to classify patients based on responsiveness to nCRT. Results: Non-Gaussian models, especially CTRW parameters, demonstrated robust capacity to predict both pCR and T-downstaging. The combination of CTRW parameters yielded the best diagnostic performance. Impact: This study demonstrated the potential for novel non-Gaussian DWI models to enhance predictions of LARC responsiveness to nCRT, facilitating optimized treatment plans and encouraging further research in precision oncology.