Ultra-Early Predictive Assay for Treatment Failure Using Functional Magnetic Resonance Imaging and Clinical Prognostic Parameters in Cervical Cancer

Nina A MAYR; William T. C YUH; David JAJOURA; Jian Z WANG; Simon S LO; Joseph F MONTEBELLO; Kyle PORTER; Dongqing Zhang; D. Scott MCMEEKIN; John M BUATTI

doi:10.1002/cncr.24822

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Ultra-Early Predictive Assay for Treatment Failure Using Functional Magnetic Resonance Imaging and Clinical Prognostic Parameters in Cervical Cancer

Journal article

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Ultra-Early Predictive Assay for Treatment Failure Using Functional Magnetic Resonance Imaging and Clinical Prognostic Parameters in Cervical Cancer

Nina A MAYR, William T. C YUH, David JAJOURA, Jian Z WANG, Simon S LO, Joseph F MONTEBELLO, Kyle PORTER, Dongqing Zhang, D. Scott MCMEEKIN and John M BUATTI

Cancer, Vol.116(4), pp.903-912

2010

DOI: 10.1002/cncr.24822

PMCID: PMC4362726

PMID: 20052727

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Abstract

BACKGROUND: The authors prospectively evaluated magnetic resonance imaging (MRI) parameters quantifying heterogeneous perfusion pattern and residual tumor volume early during treatment in cervical cancer, and compared their predictive power for primary tumor recurrence and cancer death with the standard clinical prognostic factors. A novel approach of augmenting the predictive power of clinical prognostic factors with MRI parameters was assessed. METHODS: Sixty‐two cervical cancer patients underwent dynamic contrast‐enhanced (DCE) MRI before and during early radiation/chemotherapy (2‐2.5 weeks into treatment). Heterogeneous tumor perfusion was analyzed by signal intensity (SI) of each tumor voxel. Poorly perfused tumor regions were quantified as lower 10th percentile of SI (SI[10%]). DCE‐MRI and 3‐dimensional (3D) tumor volumetry MRI parameters were assessed as predictors of recurrence and cancer death (median follow‐up, 4.1 years). Their discriminating capacity was compared with clinical prognostic factors (stage, lymph node status, histology) using sensitivity/specificity and Cox regression analysis. RESULTS: SI(10%) and 3D volume 2‐2.5 weeks into therapy independently predicted disease recurrence (hazard ratio [HR], 2.6; 95% confidence interval [95% CI], 1.0‐6.5 [P = .04] and HR, 1.9; 95% CI, 1.1‐3.5 [P = .03], respectively) and death (HR, 1.9; 95% CI, 1.0‐3.5 [P = .03] and HR, 1.9; 95% CI, 1.2‐2.9 [P = .01], respectively), and were superior to clinical prognostic factors. The addition of MRI parameters to clinical prognostic factors increased sensitivity and specificity of clinical prognostic factors from 71% and 51%, respectively, to 100% and 71%, respectively, for predicting recurrence, and from 79% and 54%, respectively, to 93% and 60%, respectively, for predicting death. CONCLUSIONS: MRI parameters reflecting heterogeneous tumor perfusion and subtle tumor volume change early during radiation/chemotherapy are independent and better predictors of tumor recurrence and death than clinical prognostic factors. The combination of clinical prognostic factors and MRI parameters further improves early prediction of treatment failure and may enable a window of opportunity to alter treatment strategy.

Tumors

Gynecology. Andrology. Obstetrics

Biological and medical sciences

Medical sciences

Female genital diseases

Details

Title: Subtitle: Ultra-Early Predictive Assay for Treatment Failure Using Functional Magnetic Resonance Imaging and Clinical Prognostic Parameters in Cervical Cancer
Creators: Nina A MAYR - Department of Radiation Oncology, College for Public Health, Ohio State University, Columbus, Ohio, United States
William T. C YUH - Department of Radiology, College for Public Health, Ohio State University, Columbus, Ohio, United States
David JAJOURA - Center for Biostatistics, College for Public ?Health, Ohio State University, Columbus, Ohio, United States
Jian Z WANG - Department of Radiation Oncology, College for Public Health, Ohio State University, Columbus, Ohio, United States
Simon S LO - Department of Radiation Oncology, College for Public Health, Ohio State University, Columbus, Ohio, United States
Joseph F MONTEBELLO - Department of Radiation Oncology, College for Public Health, Ohio State University, Columbus, Ohio, United States
Kyle PORTER - Center for Biostatistics, College for Public ?Health, Ohio State University, Columbus, Ohio, United States
Dongqing Zhang - Department of Radiation Oncology, College for Public Health, Ohio State University, Columbus, Ohio, United States
D. Scott MCMEEKIN - Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, United States
John M BUATTI - Department of Radiation Oncology, University of lowa College of Medicine, Iowa City, Iowa, United States
Resource Type: Journal article
Publication Details: Cancer, Vol.116(4), pp.903-912
DOI: 10.1002/cncr.24822
PMID: 20052727
PMCID: PMC4362726
NLM abbreviation: Cancer
ISSN: 0008-543X
eISSN: 1097-0142
Publisher: Wiley-Blackwell; Hoboken, NJ
Language: English
Date published: 2010
Academic Unit: Radiation Oncology; Neurosurgery; Otolaryngology
Record Identifier: 9984040219902771

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