Journal article
Prediction of tumor control in patients with cervical cancer : Analysis of combined volume and dynamic enhancement pattern by MR imaging
American journal of roentgenology (1976), Vol.170(1), pp.177-182
1998
DOI: 10.2214/ajr.170.1.9423627
PMID: 9423627
Abstract
Quantitative analysis of either tumor volume or dynamic enhancement pattern using MR imaging has been reported as useful in the prediction of response to radiation therapy in cancer of the cervix. Because data for both analyses can be obtained in a single MR examination, the purpose of this study was to evaluate whether combining both analyses can further improve the efficacy of using MR imaging to predict tumor control after radiation therapy.
Twenty patients with bulky carcinomas of the cervix, stages bulky IB (n = 2), IIB (n = 6), IIIA (n = 1), IIIB (n = 9), IVA (n = 1), and recurrent (n = 1), were studied. Initial tumor volumes were calculated by outlining the area of tumor in each slice on T2-weighted images and multiplying by the slice profile. Two dynamic contrast-enhanced MR studies were obtained in each patient immediately before the start of radiation therapy and after 20-22 Gy in 2 weeks of radiation therapy. Dynamic enhancement imaging was performed at 3-sec intervals in the sagittal plane for 120 sec after rapid (9 ml/sec) i.v. injection of MR contrast agent (0.1 mmol/kg of gadoteridol) using a power injector. Time and signal intensity curves reflecting the relative signal intensity of contrast enhancement in the tumor region were generated, and the relative signal intensity of the tumor region during the early plateau phase was calculated. Median follow-up was 25 months (range, 11-35 months).
The combined analysis did not improve the prediction rate of local recurrence in small-sized tumors, which responded well to radiation therapy regardless of their dynamic enhancement pattern. However, the combined analysis did improve the prediction rate of local recurrence in intermediate- and large-sized tumors (75% and 80%, respectively) over assessment by either volume analysis (33% and 60%, respectively) or dynamic enhancement pattern analysis (64% and 64%, respectively). The combined analysis was most useful in intermediate-sized tumors (40-99 cm3; 33% recurrence), significantly improving differentiation between high-risk (80% recurrence) and low-risk 10% recurrence) patients (p = .010).
Our preliminary results suggest that the combined data of both tumor morphologic (volume) and microcirculatory (dynamic enhancement pattern) parameters allow more accurate prediction of local failure in patients with advanced cervical cancer than does each individual parameter alone. Combined data appear to have the greatest potential in patients with intermediate-sized tumors, who constitute most patients (60%) and remain a challenge for outcome prediction and management.
Details
- Title: Subtitle
- Prediction of tumor control in patients with cervical cancer : Analysis of combined volume and dynamic enhancement pattern by MR imaging
- Creators
- Nina A Mayr - Division of Radiation Oncology, Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United StatesWilliam T C Yuh - Magnetic Resonance Imaging Center, Department of Radiology, The University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52242, United StatesJie Zheng - Magnetic Resonance Imaging Center, Department of Radiology, The University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52242, United StatesJames C Ehrhardt - Magnetic Resonance Imaging Center, Department of Radiology, The University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52242, United StatesVincent A Magnotta - Magnetic Resonance Imaging Center, Department of Radiology, The University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52242, United StatesJoel I Sorosky - Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United StatesRetta E Pelsang - Magnetic Resonance Imaging Center, Department of Radiology, The University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52242, United StatesLarry W Oberley - Radiation Research Laboratory, The University of Iowa College of Medicine, Iowa City, IA 52242, United StatesDavid H Hussey - Division of Radiation Oncology, Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
- Resource Type
- Journal article
- Publication Details
- American journal of roentgenology (1976), Vol.170(1), pp.177-182
- Publisher
- American Roentgen Ray Society; Leesburg, VA
- DOI
- 10.2214/ajr.170.1.9423627
- PMID
- 9423627
- ISSN
- 0361-803X
- eISSN
- 1546-3141
- Language
- English
- Date published
- 1998
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Psychiatry; Iowa Neuroscience Institute
- Record Identifier
- 9984051558302771
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