Journal article
Predicting Control of Primary Tumor and Survival by DCE MRI During Early Therapy in Cervical Cancer
Investigative radiology, Vol.44(6), pp.343-350
06/2009
DOI: 10.1097/RLI.0b013e3181a64ce9
PMCID: PMC2782687
PMID: 19661844
Abstract
PURPOSE:To assess the early predictive power of MRI perfusion and volume parameters, during early treatment of cervical cancer, for primary tumor control and disease-free-survival.
MATERIALS AND METHODS:Three MRI examinations were obtained in 101 patients before and during therapy (at 2–2.5 and 4–5 weeks) for serial dynamic contrast enhanced (DCE) perfusion MRI and 3-dimensional tumor volume measurement. Plateau Signal Intensity (SI) of the DCE curves for each tumor pixel of all 3 MRI examinations was generated, and pixel-SI distribution histograms were established to characterize the heterogeneous tumor. The degree and quantity of the poorly-perfused tumor subregions, which were represented by low-DCE pixels, was analyzed by using various lower percentiles of SI (SI%) from the pixel histogram. SI% ranged from SI2.5% to SI20% with increments of 2.5%. SI%, mean SI, and 3-dimensional volume of the tumor were correlated with primary tumor control and disease-free-survival, using Student t test, Kaplan-Meier analysis, and log-rank test. The mean post-therapy follow-up time for outcome assessment was 6.8 years (range0.2–9.4 years).
RESULTS:Tumor volume, mean SI, and SI% showed significant prediction of the long-term clinical outcome, and this prediction was provided as early as 2 to 2.5 weeks into treatment. An SI5% of <2.05 and residual tumor volume of ≥30 cm in the MRI obtained at 2 to 2.5 weeks of therapy provided the best prediction of unfavorable 8-year primary tumor control (73% vs. 100%, P = 0.006) and disease-free-survival rate (47% vs. 79%, P = 0.001), respectively.
CONCLUSIONS:Our results show that MRI parameters quantifying perfusion status and residual tumor volume provide very early prediction of primary tumor control and disease-free-survival. This functional imaging based outcome predictor can be obtained in the very early phase of cytotoxic therapy within 2 to 2.5 weeks of therapy start. The predictive capacity of these MRI parameters, indirectly reflecting the heterogeneous delivery pattern of cytotoxic agents, tumor oxygenation, and the bulk of residual presumably therapy-resistant tumor, requires future study.
Details
- Title: Subtitle
- Predicting Control of Primary Tumor and Survival by DCE MRI During Early Therapy in Cervical Cancer
- Creators
- William Yuh - From the Departments of Radiology, †Radiation Medicine, and #Obstetrics and Gynecology, and ‡Center for Biostatistics, Ohio State University, Columbus, Ohio; §Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; ¶Department of Radiology, University of Iowa, Iowa City, IowaNina MayrDavid JarjouraDee WuJohn GreculaSimon LoSusan EdwardsVincent MagnottaSteffen SammetHualin ZhangJoseph MontebelloJeffrey FowlerMichael KnoppJian Wang
- Resource Type
- Journal article
- Publication Details
- Investigative radiology, Vol.44(6), pp.343-350
- DOI
- 10.1097/RLI.0b013e3181a64ce9
- PMID
- 19661844
- PMCID
- PMC2782687
- NLM abbreviation
- Invest Radiol
- ISSN
- 0020-9996
- eISSN
- 1536-0210
- Publisher
- Lippincott Williams & Wilkins, Inc
- Language
- English
- Date published
- 06/2009
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Psychiatry; Iowa Neuroscience Institute
- Record Identifier
- 9984051517202771
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