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Lura N, Wagner-Larsen KS, Forsse D, Trovik J, Halle MK, Bertelsen BI, Salvesen Ø, Woie K, Krakstad C, Haldorsen IS. What MRI-based tumor size measurement is best for predicting long-term survival in uterine cervical cancer? Insights Imaging 2022; 13:105. [PMID: 35715582 PMCID: PMC9206052 DOI: 10.1186/s13244-022-01239-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Tumor size assessment by MRI is central for staging uterine cervical cancer. However, the optimal role of MRI-derived tumor measurements for prognostication is still unclear. Material and methods This retrospective cohort study included 416 women (median age: 43 years) diagnosed with cervical cancer during 2002–2017 who underwent pretreatment pelvic MRI. The MRIs were independently read by three radiologists, measuring maximum tumor diameters in three orthogonal planes and maximum diameter irrespective of plane (MAXimaging). Inter-reader agreement for tumor size measurements was assessed by intraclass correlation coefficients (ICCs). Size was analyzed in relation to age, International Federation of Gynecology and Obstetrics (FIGO) (2018) stage, histopathological markers, and disease-specific survival using Kaplan–Meier-, Cox regression-, and time-dependent receiver operating characteristics (tdROC) analyses. Results All MRI tumor size variables (cm) yielded high areas under the tdROC curves (AUCs) for predicting survival (AUC 0.81–0.84) at 5 years after diagnosis and predicted outcome (hazard ratios [HRs] of 1.42–1.76, p < 0.001 for all). Only MAXimaging independently predicted survival (HR = 1.51, p = 0.03) in the model including all size variables. The optimal cutoff for maximum tumor diameter (≥ 4.0 cm) yielded sensitivity (specificity) of 83% (73%) for predicting disease-specific death after 5 years. Inter-reader agreement for MRI-based primary tumor size measurements was excellent, with ICCs of 0.83–0.85. Conclusion Among all MRI-derived tumor size measurements, MAXimaging was the only independent predictor of survival. MAXimaging ≥ 4.0 cm represents the optimal cutoff for predicting long-term disease-specific survival in cervical cancer. Inter-reader agreement for MRI-based tumor size measurements was excellent. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01239-y.
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Affiliation(s)
- Njål Lura
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway. .,Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Kari S Wagner-Larsen
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.,Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - David Forsse
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - Jone Trovik
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - Mari K Halle
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - Bjørn I Bertelsen
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Øyvind Salvesen
- Clinical Research Unit, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kathrine Woie
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - Camilla Krakstad
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | - Ingfrid S Haldorsen
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.,Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Dhamija E, Gulati M, Manchanda S, Singhal S, Sharma D, Kumar S, Bhatla N. Imaging in Carcinoma Cervix and Revised 2018 FIGO Staging System: Implications in Radiology Reporting. Indian J Radiol Imaging 2021; 31:623-634. [PMID: 34790308 PMCID: PMC8590564 DOI: 10.1055/s-0041-1735502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
The International Federation of Gynecology and Obstetrics (FIGO) staging system of carcinoma cervix saw a radical change in 2018 with the inclusion of cross-sectional imaging tools for the assessment of disease extent and staging. One of the major revisions is the inclusion of lymph node status, detected either on imaging or pathological evaluation, in the staging system. The changes were based on long-term patient follow-up and survival rates reported in literature. Thus, it becomes imperative for a radiologist to be well versed with the recent staging system, its limitations, and implications on the patient management.
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Affiliation(s)
- Ekta Dhamija
- Department of Radiodiagnosis, Dr B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Malvika Gulati
- Department of Radiodiagnosis, Dr B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, Dr B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Dayanand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Mahantshetty U, Banerjee S, Sturdza A, Kirisits C, Majercakova K, Schmid MP, Hande V, Pötter R. Quantitative and qualitative application of clinical drawings for image-guided brachytherapy in cervical cancer patients. J Contemp Brachytherapy 2021; 13:512-8. [PMID: 34759975 DOI: 10.5114/jcb.2021.110273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 08/03/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Clinical drawings are integral part of image-guided adaptive brachytherapy (IGABT) of cervical cancer. It was used in EMBRACE study protocol as a useful tool. In our study clinical drawings from EMBRACE study were modified to include scales in all the dimensions for more accurate representation of various tumor related volumes. The aim of the present study was to understand patterns of tumor regression and relationship between gross tumor at diagnosis (GTVD) and high-risk clinical target volume (CTV-THR)/intermediate-risk clinical target volume (CTV-TIR) in brachytherapy (BRT), using modified clinical drawings. Material and methods 42 cervical cancer patients, staged as FIGO IIB-IIIB according to EMBRACE study, were enrolled. Advanced schematic 3D mapping diagram (3D-MD) in axial, coronal, and sagittal orientations, with a measurement scale (grid with 10 mm distance) for precise assessment and documentation was applied (through MRI at diagnosis and during brachytherapy). Dimensions, including height, width, and thickness as well as volumes (GTVD, CTV-THR and CTV-TIR) were compared both qualitatively and quantitatively. Results and conclusions We found qualitative and quantitative correlation of the dimensions of final CTV-THR with initial GTVD. Meticulous mapping of tumor volumes can provide useful insights to CTV-THR volume during brachytherapy.
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Jang W, Song JS. [Uterine Cervical Cancer: Emphasis on Revised FIGO Staging 2018 and MRI]. Taehan Yongsang Uihakhoe Chi 2021; 82:1083-1102. [PMID: 36238389 PMCID: PMC9432380 DOI: 10.3348/jksr.2021.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/05/2021] [Accepted: 09/17/2021] [Indexed: 11/15/2022]
Abstract
Uterine cervical cancer is a common gynecological cancer prevalent in Korea. Early detection, precise diagnosis, and appropriate treatment can affect its prognosis. Imaging approaches play an important role in staging, treatment planning, and follow-up. MRI specifically provides the advantage of assessing tumor size and disease severity with high soft tissue contrast. The revised version of the International Federation of Gynecology and Obstetrics (FIGO) staging system has been introduced in 2018, which incorporates subdivided primary tumor size and lymph node metastasis. In this review, the staging of uterine cervical cancer based on previous studies, the recently revised FIGO staging, and various post-treatment images are primarily described using MRI.
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Yang H, Zhang Y, Liu C, Feng B, Zhang J, Zhou Y, Yin Y, Li J, Li W, Balaya V, Shi M, Zhao L, Wei L. The integration of bevacizumab improves tumor response and survival in patients with refractory cervical cancer treated with radical chemoradiotherapy. Ann Transl Med 2021; 9:1184. [PMID: 34430625 PMCID: PMC8350679 DOI: 10.21037/atm-21-3521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/22/2021] [Indexed: 11/06/2022]
Abstract
Background Management of refractory cervical cancers (CC) is a debated question and rises dilemma in clinical practice. This study aimed to assess the safety and effectiveness of bevacizumab combined with concurrent chemoradiotherapy in the treatment of refractory CC. Methods A total of 129 patients with refractory CC who received radical concurrent chemoradiotherapy (CCRT) were included in this study. Among the patients, 64 received combination treatment with bevacizumab, while the 65 remaining patients did not receive bevacizumab. Treatment response was evaluated according to the Response Evaluation Criteria in Solid Tumorsversion1.1. The Cox proportional-hazards model was applied to determine prognostic factors associated with overall survival and the tumor response during treatment was analyzed for patients treated with bevacizumab. Results Bevacizumab was an independent prognostic factor (P=0.017). Therefore, we only analyzed 64 patients who received combination treatment with bevacizumab. In the 64 patients treated with bevacizumab, the 3-year OS, locoregional relapse-free survival, and distant metastasis-free survival rates were 87.2%, 98.1%, and 81%, respectively. Complete clinical response rates were 37.8% (17/45) for patients with neoadjuvant chemotherapy and chemoradiotherapy after neoadjuvant chemotherapy (NACT), complete clinical response rates were 62.5% (40/64), 73.3% (33/45) and 52.6% (10/19) before brachytherapy (BT), respectively for the entire cohort, patients with NACT and chemoradiotherapy and patients with chemoradiotherapy only. The 2-year OS rate was higher for patients who achieved a complete clinical response BT than for patients who did not, 94.6% vs. 73.2%, P=0.03. Among the 64 patients who received it, 28 (43.8%) experienced hematological toxicities of grade 3 or 4, and 3 (4.7%) experienced grade 3 gastrointestinal toxicities. Conclusions Bevacizumab combined with radical chemoradiotherapy is a safe and tolerable treatment option for refractory CC, with quicker tumor regression and high OS, locoregional relapse-free survival, and distant metastasis-free survival rates.
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Affiliation(s)
- Hua Yang
- Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Ying Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Changhao Liu
- Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Bin Feng
- Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Jianjun Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yan Zhou
- Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Yutian Yin
- Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Jianping Li
- Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Weiwei Li
- Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Vincent Balaya
- Département Femme-Mère-Enfant, Service de Gynécologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mei Shi
- Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Lina Zhao
- Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Lichun Wei
- Department of Radiation Oncology, First Affiliated Hospital of Air Force Medical University, Xi'an, China
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Lu H, Wu Y, Liu X, Huang H, Jiang H, Zhu C, Man Y, Liu P, Li X, Chen Z, Long X, Pang Q, Deng S, Gu J. The Role of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Predicting Treatment Response for Cervical Cancer Treated with Concurrent Chemoradiotherapy. Cancer Manag Res 2021; 13:6065-6078. [PMID: 34377025 PMCID: PMC8349537 DOI: 10.2147/cmar.s314289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting early treatment response. Materials and Methods Patients with locally advanced cervical cancer (LACC) treated with concurrent chemoradiotherapy (CCRT) were enrolled. Pelvic DCE-MRI scans were performed before RT (pre-RT), in the middle of RT (mid-RT), and at the end of RT (post-RT), separately. Parameters (ie, Ktrans, Kep, and Ve) were measured. Pre-, mid-, and post-RT Ktrans were denoted as Ktrans-preTx, Ktrans-midTx, and Ktrans-postTx, respectively. And the same denoting rule also went for Kep and Ve. Difference for the same parameter such as Ktrans measured between two consecutive time points was calculated as second Ktrans value minus first Ktrans value. The differences in Ktrans between pre-RT and post-RT, between pre-RT and mid-RT, and between mid-RT and post-RT were denoted as ΔKtrans-post-preTx, ΔKtrans-mid-preTx, and ΔKtrans-post-midTx, respectively, and the same denoting rule was also applied to Kep and Ve. Results A total of 57 patients were enrolled. After the treatment, 31 patients had complete response (CR group). The remaining 26 patients had partial response (NCR group). Significant differences were found in Ktrans-postTx, Kep-postTx, Ve-midTx, ΔKtrans-post-preTx, ΔKtrans-post-midTx, ΔKep-post-preTx, ΔKep-mid-preTx and ΔKep-post-midTx between the two groups. Receiver operating characteristic (ROC) analysis for their performances in predicting treatment response showed an area under curve (AUC) of 0.656-0.849, sensitivity of 61.3-93.5%, specificity of 46.1-73.1%, and maximal Youden Index of 36.5-66.6. Among those parameters, Kep-postTx was the best, and its AUC, sensitivity, specificity, maximal Youden Index, and cutoff value were 0.849, 87.1%, 73.1%, 60.2, and 0.341, respectively. These combined parameters showed an AUC of 0.952, with sensitivity of 87.1%, specificity of 96.1%, and maximal Youden Index of 83.2. Conclusion DCE-MRI parameters can predict early treatment outcome. Among those parameters, Kep-postTx is the best predictor. The combination of multi-parameters can increase the predictive potency.
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Affiliation(s)
- Heming Lu
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Yuying Wu
- Department of Gynecology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Xu Liu
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Huixian Huang
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Hailan Jiang
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Chaohua Zhu
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Yuping Man
- Department of Radiology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Pei Liu
- Department of Oncology, Youjiang Medical University for Nationalities, Baise, 533000, People's Republic of China
| | - Xianglong Li
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Zhaohong Chen
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Xianfeng Long
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Qiang Pang
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Shan Deng
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
| | - Junzhao Gu
- Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, People's Republic of China
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Salvo G, Odetto D, Saez Perrotta MC, Noll F, Perrotta M, Pareja R, Wernicke A, Ramirez PT. Measurement of tumor size in early cervical cancer: an ever-evolving paradigm. Int J Gynecol Cancer 2020; 30:1215-23. [DOI: 10.1136/ijgc-2020-001436] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/25/2020] [Accepted: 06/02/2020] [Indexed: 02/01/2023] Open
Abstract
The major tenets in accurately assessing tumor size in patients with early stage cervical cancer currently include physical examination, imaging studies, and pathologic evaluation. It is estimated that when comparing clinical stage based on physical examination and final pathology, the concordance diminishes as stage increases: 85.4%, 77.4%, 35.3%, and 20.5% for stage IB1, IB2, IIA, and IIB, respectively. Vaginal involvement and larger tumor diameter are considered the main causes of stage inaccuracy. When considering imaging studies, magnetic resonance imaging (MRI) provides the highest level of accuracy in the assessment of cervical tumor size. Its accuracy in determining tumor location within the cervix is approximately 91% and in predicting tumor size 93%. MRI imaging is also significantly more accurate in measuring tumor size, delineating cervical tumor boundaries, and local tumor extension when compared with computed tomography (CT) scan. When comparing with pelvic ultrasound, the accuracy of both imaging techniques (MRI and pelvic ultrasound) in the assessment of tumor size in small versus large tumors is comparable. Pertaining to pathology, the depth of invasion should be measured by convention from the nearest surface epithelium, which equates to tumor thickness. In the setting where tumor is found both in the conization and hysterectomy specimen, the horizontal extent should be measured by summing the maximum horizontal measurement in the different specimens and the depth of invasion measured as the maximum depth in either specimen. A new pattern-based classification for endocervical adenocarcinomas recommends the description of patterns of invasion for human papillomavirus (HPV)-related adenocarcinomas as this is associated with differing risks of lymph node involvement.
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Mansoori B, Khatri G, Rivera-Colón G, Albuquerque K, Lea J, Pinho DF. Multimodality Imaging of Uterine Cervical Malignancies. AJR Am J Roentgenol 2020; 215:292-304. [PMID: 32551909 DOI: 10.2214/AJR.19.21941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE. In this article, we provide an updated review on the role of imaging in initial staging, treatment monitoring, and follow-up of cervical cancer with a focus on the role of MRI and FDG PET/CT. In addition, the 2018 International Federation of Gynecology and Obstetrics staging system and its implication on management of cervical cancer are explored. CONCLUSION. Imaging plays a major role in treatment planning and as a prognostic indicator in patients with cervical cancer. MRI and PET/CT have complementary roles: MRI is essential for the local staging of the primary tumor, and PET/CT is the most useful modality for detecting regional nodal and distant metastases.
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Affiliation(s)
- Susanna I. Lee
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114 (S.I.L.); and Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.A.)
| | - Mostafa Atri
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114 (S.I.L.); and Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.A.)
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Okonogi N, Wakatsuki M, Kato S, Karasawa K, Miyasaka Y, Murata H, Nakano T, Kamada T, Shozu M. A Phase 1/2 Study of Carbon Ion Radiation Therapy With Concurrent Chemotherapy for Locally Advanced Uterine Cervical Squamous Cell Carcinoma (Protocol 1302). Int J Radiat Oncol Biol Phys 2019; 104:631-639. [PMID: 30825494 DOI: 10.1016/j.ijrobp.2019.02.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE This study evaluated the safety and efficacy of carbon-ion radiation therapy (C-ion RT) with concurrent chemotherapy for locally advanced uterine cervical squamous cell carcinoma in a phase 1/2 clinical trial. METHODS AND MATERIALS Twenty-two patients were treated with C-ion RT with concurrent weekly cisplatin at a dose of 40 mg/m2. The phase 1 component evaluated the safety of 72.0 Gy (relative biological effectiveness) of C-ion RT with concurrent chemotherapy. In the phase 2 component, the safety and efficacy of C-ion RT with concurrent chemotherapy were assessed using the dose determined in phase 1. RESULTS The median follow-up period was 32 months, and the median tumor size was 71 mm (range, 51-150 mm). No patient had dose-limiting toxicities in the phase 1 component; the recommended dose was determined to be 72.0 Gy (relative biological effectiveness) with 40 mg/m2 of cisplatin. In the phase 2 component, 2 patients developed grade 3 gastrointestinal tract toxicities. In patients treated with the recommended dose, the 2-year local control (LC), LC including salvage therapy, and overall survival rates were 67%, 81%, and 82%, respectively. The 2-year LC and overall survival rates for patients with tumor sizes ≤7.1 cm were 92% and 100%, respectively; for those with tumor sizes >7.1 cm they were 33% and 60%, respectively. CONCLUSIONS C-ion RT with concurrent weekly cisplatin was tolerated by patients with locally advanced uterine cervical squamous cell carcinoma. Outcomes were good in patients with tumor sizes ≤7.1 cm but not in those with larger tumors. The results of the present study should be validated with larger multi-institutional prospective studies. Further study is needed, and perhaps incorporating carbon ion external beam radiation with brachytherapy will further reduce the risk of central recurrence.
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Affiliation(s)
- Noriyuki Okonogi
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.
| | - Masaru Wakatsuki
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kumiko Karasawa
- Department of Radiation Oncology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yuhei Miyasaka
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hiroto Murata
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan; Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tadashi Kamada
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Irie D, Okonogi N, Wakatsuki M, Kato S, Ohno T, Karasawa K, Kiyohara H, Kobayashi D, Tsuji H, Nakano T, Kamada T, Shozu M. Carbon-ion radiotherapy for inoperable endometrial carcinoma. J Radiat Res 2018; 59:309-315. [PMID: 29528414 PMCID: PMC5967462 DOI: 10.1093/jrr/rry003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/18/2017] [Indexed: 09/29/2023]
Abstract
This is a pooled analysis to evaluate the toxicity and efficacy of carbon-ion radiotherapy (C-ion RT) for inoperable endometrial carcinoma. Eligible patients had previously untreated Stage I-III endometrial carcinoma without para-aortic lymph node metastasis. Total dose to the tumor was 62.4-74.4 Gy [relative biological effectiveness (RBE)] in 20 fractions, and the dose to the gastrointestinal tract was limited to <60 Gy (RBE). Intracavitary brachytherapy was not combined in the present study. Fourteen patients with endometrial carcinoma were analyzed. Ten of the 14 patients were judged medically inoperable, and the others refused surgery. The numbers of patients with Stage I, II and III disease were 1, 9 and 4, respectively. Tumor size was 3.8-13.8 cm in maximum diameter. Median follow-up periods for all patients and surviving patients were 50 months (range, 12-218 months) and 78 months (range, 23-218 months), respectively. Two of three patients receiving 62.4-64.8 Gy (RBE) had local recurrence whereas none of 11 patients receiving 68.0 Gy (RBE) or more had local recurrence. Three patients developed distant metastases and one of them also had local recurrence. The 5-year local control, progression-free survival, overall survival, and cause-specific survival rates were 86%, 64%, 68% and 73%, respectively. No patient developed Grade 3 or higher acute or late toxicity. The present study showed that C-ion RT alone could be a safe and curative treatment modality for inoperable endometrial carcinoma.
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Affiliation(s)
- Daisuke Irie
- Hospital, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-shi, Gunma, 371-8511, Japan
| | - Noriyuki Okonogi
- Hospital, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Masaru Wakatsuki
- Hospital, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-shi, Gunma, 371-8511, Japan
| | - Kumiko Karasawa
- Department of Radiology, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroki Kiyohara
- Department of Radiology, Maebashi Red Cross Hospital, 3-21-36 Asahi-cho, Maebashi-shi, Gunma, 371-0014, Japan
| | - Daijiro Kobayashi
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-shi, Gunma, 371-8511, Japan
| | - Hiroshi Tsuji
- Hospital, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-shi, Gunma, 371-8511, Japan
| | - Tadashi Kamada
- Hospital, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Ciba, 260-8670, Japan
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Okonogi N, Wakatsuki M, Kato S, Karasawa K, Kiyohara H, Shiba S, Kobayashi D, Nakano T, Kamada T, Shozu M. Clinical outcomes of carbon ion radiotherapy with concurrent chemotherapy for locally advanced uterine cervical adenocarcinoma in a phase 1/2 clinical trial (Protocol 1001). Cancer Med 2018; 7:351-359. [PMID: 29341491 PMCID: PMC5806111 DOI: 10.1002/cam4.1305] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 12/23/2022] Open
Abstract
We conducted a phase 1/2 study to evaluate the efficacy and safety of carbon ion radiotherapy (C-ion RT) with concurrent chemotherapy for locally advanced uterine cervical adenocarcinoma. Thirty-three patients were enrolled between April 2010 and March 2014. Treatment consisted of C-ion RT with concurrent weekly cisplatin at a dose of 40 mg/m2 . In the phase 1 component, the total dose was escalated from 68.0 Gy (relative biological effectiveness [RBE]) to 74.4 Gy (RBE) to determine the maximum tolerated dose of C-ion RT. In the phase 2 component, the efficacy and safety of C-ion RT with concurrent chemotherapy were evaluated using the dose determined in the phase 1 component. The median follow-up duration was 30 months. Two patients did not receive chemotherapy because of anemia or leukocytopenia immediately prior to commencing treatment; 31 patients were analyzed. None of the patients developed dose-limiting toxicities. The recommended dose (RD) was determined to be 74.4 Gy (RBE). In the phase 2 component, two patients developed Grade 3-4 toxicities in the gastrointestinal tract, due to repeated laser coagulation or peritonitis caused by appendicitis. In the patients treated with the RD, the 2-year local control, progression-free survival, and overall survival rates were 71%, 56%, and 88%, respectively. C-ion RT with concurrent weekly cisplatin was well tolerated in patients with locally advanced uterine cervical adenocarcinoma. Our findings support further investigations into the efficacy of this strategy.
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Affiliation(s)
- Noriyuki Okonogi
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Masaru Wakatsuki
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kumiko Karasawa
- Department of Radiation Oncology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hiroki Kiyohara
- Department of Radiation Oncology, Maebashi Red Cross Hospital, Gunma, Japan
| | - Shintaro Shiba
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Daijiro Kobayashi
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tadashi Kamada
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Jastaniyah N, Yoshida K, Tanderup K, Lindegaard JC, Sturdza A, Kirisits C, Šegedin B, Mahantshetty U, Rai B, Jürgenliemk-Schulz IM, Haie-Meder C, Banerjee S, Pötter R. A volumetric analysis of GTVD and CTVHR as defined by the GEC ESTRO recommendations in FIGO stage IIB and IIIB cervical cancer patients treated with IGABT in a prospective multicentric trial (EMBRACE). Radiother Oncol 2016; 120:404-411. [DOI: 10.1016/j.radonc.2016.05.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/24/2016] [Accepted: 05/30/2016] [Indexed: 11/24/2022]
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Hamoud Al-Tamimi MS, Sulong G, Shuaib IL. Alpha shape theory for 3D visualization and volumetric measurement of brain tumor progression using magnetic resonance images. Magn Reson Imaging 2015; 33:787-803. [PMID: 25865822 DOI: 10.1016/j.mri.2015.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/17/2015] [Accepted: 03/30/2015] [Indexed: 01/30/2023]
Abstract
Resection of brain tumors is a tricky task in surgery due to its direct influence on the patients' survival rate. Determining the tumor resection extent for its complete information via-à-vis volume and dimensions in pre- and post-operative Magnetic Resonance Images (MRI) requires accurate estimation and comparison. The active contour segmentation technique is used to segment brain tumors on pre-operative MR images using self-developed software. Tumor volume is acquired from its contours via alpha shape theory. The graphical user interface is developed for rendering, visualizing and estimating the volume of a brain tumor. Internet Brain Segmentation Repository dataset (IBSR) is employed to analyze and determine the repeatability and reproducibility of tumor volume. Accuracy of the method is validated by comparing the estimated volume using the proposed method with that of gold-standard. Segmentation by active contour technique is found to be capable of detecting the brain tumor boundaries. Furthermore, the volume description and visualization enable an interactive examination of tumor tissue and its surrounding. Admirable features of our results demonstrate that alpha shape theory in comparison to other existing standard methods is superior for precise volumetric measurement of tumor.
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Affiliation(s)
- Mohammed Sabbih Hamoud Al-Tamimi
- UTM-IRDA Digital Media Centre (MaGIC-X), Faculty of Computing, University Technology Malaysia, 81310 Skudai, Johor Bahru, Malaysia; Department of Higher Studies, University of Baghdad, Al-Jaderia, Baghdad, Iraq.
| | - Ghazali Sulong
- UTM-IRDA Digital Media Centre (MaGIC-X), Faculty of Computing, University Technology Malaysia, 81310 Skudai, Johor Bahru, Malaysia
| | - Ibrahim Lutfi Shuaib
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 13200 Kepala Batas Pulau Pinang, Malaysia
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Liu R, Wang X, Tian JH, Yang K, Wang J, Jiang L, Hao XY. High dose rate versus low dose rate intracavity brachytherapy for locally advanced uterine cervix cancer. Cochrane Database Syst Rev 2014; 2014:CD007563. [PMID: 25300170 PMCID: PMC8734152 DOI: 10.1002/14651858.cd007563.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane review published in 2010 (Issue 7).Carcinoma of the uterine cervix is the second most common cancer and the third leading cause of cancer death among women. Radiotherapy has been used successfully to treat cervical cancer for nearly a century. The combination of external beam radiotherapy (EBRT) and intracavity brachytherapy (ICBT) has become a standard treatment for cervical cancer. Whether high dose rate (HDR) or low dose rate (LDR) brachytherapy improves outcomes in terms of local control rates, survival and complications for women with cervical cancer remains controversial. OBJECTIVES To assess the efficacy and safety of HDR versus LDR ICBT in combination with EBRT for women with uterine cervical cancer. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE (1966 to March 2014), EMBASE (1974 to March 2014), and the Chinese Biomedical Literature Database (CBM) (1978 to March 2014) for relevant original, published trials. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs that compared HDR with LDR ICBT, combined with EBRT, for women with locally advanced uterine cervical cancer. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data using standardised forms. Primary outcome measures included overall survival (OS), relapse-free survival (RFS) and pelvic control rate, while secondary outcomes included rates of recurrence and complications. MAIN RESULTS Four studies involving 1265 women met the inclusion criteria. In our meta-analysis to compare HDR and LDR ICBT, the pooled risk ratios (RRs) were 0.95 (95% confidence interval (CI) 0.79 to 1.15), 0.93 (95% CI 0.84 to 1.04) and 0.79 (95% CI 0.52 to 1.20) for 3-, 5- and 10-year overall survival rates respectively; and 0.95 (95% CI 0.84 to 1.07) and 1.02 (0.88 to 1.19) for 5- and 10-year disease-specific survival (DSS) rates respectively. The RR for RFS was 1.04 (95% CI 0.71 to 1.52) and 0.96 (95% CI 0.81 to 1.14) at 3- and 5- years. For local control rates the RR was 0.95 (95% CI 0.86 to 1.05) and 0.95 (95% CI 0.87 to 1.05) at 3- and 5- years; with a RR of 1.09 (95% CI 0.83 to 1.43) for locoregional recurrence, 0.79 (95% CI 0.40 to 1.53) for local and distant recurrence, 2.23 (95% CI 0.78 to 6.34) for para-aortic lymph node metastasis, and 0.99 (95% CI 0.72 to 1.35) for distance metastasis. For bladder, rectosigmoid and small bowel complications, the RR was 1.33 (95% CI 0.53 to 3.34), 1.00 (95% CI 0.52 to 1.91) and 3.37 (95% CI 1.06 to 10.72) respectively. These results indicated that there were no significant differences except for increased small bowel complications with HDRs (P = 0.04). AUTHORS' CONCLUSIONS Since the last version of this review, no new studies were identified for inclusion in this review to provide additional information. This review showed no significant differences between HDR and LDR ICBT when considering OS, DSS, RFS, local control rate, recurrence, metastasis and treatment related complications for women with cervical carcinoma. Due to some potential advantages of HDR ICBT (rigid immobilization, outpatient treatment, patient convenience, accuracy of source and applicator positioning, individualized treatment) we recommend the use of HDR ICBT for all clinical stages of cervix cancer. The overall risk of bias was high for the included studies as many of the items were either of high or unclear risk. The GRADE assessment of the quality of the evidence was low to moderate.
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Affiliation(s)
- Ruifeng Liu
- Radiation Oncology Centre of Gansu Tumour Hospital, Lanzhou Univeristy, No. 2, Xioaxihu East Road, Lanzhou City, Gansu, China, 730050
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Huang Z, Yuh KA, Lo SS, Grecula JC, Sammet S, Sammet CL, Jia G, Knopp MV, Wu Q, Beauchamp NJ 3rd, Yuh WT, Wang R, Mayr NA. Validation of optimal DCE-MRI perfusion threshold to classify at-risk tumor imaging voxels in heterogeneous cervical cancer for outcome prediction. Magn Reson Imaging 2014; 32:1198-205. [PMID: 25179141 DOI: 10.1016/j.mri.2014.08.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 08/15/2014] [Accepted: 08/25/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE To classify tumor imaging voxels at-risk for treatment failure within the heterogeneous cervical cancer using DCE MRI and determine optimal voxel's DCE threshold values at different treatment time points for early prediction of treatment failure. MATERIAL AND METHOD DCE-MRI from 102 patients with stage IB2-IVB cervical cancer was obtained at 3 different treatment time points: before (MRI 1) and during treatment (MRI 2 at 2-2.5 weeks and MRI 3 at 4-5 weeks). For each tumor voxel, the plateau signal intensity (SI) was derived from its time-SI curve from the DCE MRI. The optimal SI thresholds to classify the at-risk tumor voxels was determined by the maximal area under the curve using ROC analysis when varies SI value from 1.0 to 3.0 and correlates with treatment outcome. RESULTS The optimal SI thresholds for MRI 1, 2 and 3 were 2.2, 2.2 and 2.1 for significant differentiation between local recurrence/control, respectively, and 1.8, 2.1 and 2.2 for death/survival, respectively. CONCLUSION Optimal SI thresholds are clinically validated to quantify at-risk tumor voxels which vary with time. A single universal threshold (SI=1.9) was identified for all 3 treatment time points and remained significant for the early prediction of treatment failure.
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Sefidgar M, Soltani M, Raahemifar K, Bazmara H, Nayinian SM, Bazargan M. Effect of tumor shape, size, and tissue transport properties on drug delivery to solid tumors. J Biol Eng 2014; 8:12. [PMID: 24987457 DOI: 10.1186/1754-1611-8-12] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/30/2014] [Indexed: 12/21/2022] Open
Abstract
Background The computational methods provide condition for investigation related to the process of drug delivery, such as convection and diffusion of drug in extracellular matrices, drug extravasation from microvessels or to lymphatic vessels. The information of this process clarifies the mechanisms of drug delivery from the injection site to absorption by a solid tumor. In this study, an advanced numerical method is used to solve fluid flow and solute transport equations simultaneously to investigate the effect of tumor shape and size on drug delivery to solid tumor. Methods The advanced mathematical model used in our previous work is further developed by adding solute transport equation to the governing equations. After applying appropriate boundary and initial conditions on tumor and surrounding tissue geometry, the element-based finite volume method is used for solving governing equations of drug delivery in solid tumor. Also, the effects of size and shape of tumor and some of tissue transport parameters such as effective pressure and hydraulic conductivity on interstitial fluid flow and drug delivery are investigated. Results Sensitivity analysis shows that drug delivery in prolate shape is significantly better than other tumor shapes. Considering size effect, increasing tumor size decreases drug concentration in interstitial fluid. This study shows that dependency of drug concentration in interstitial fluid to osmotic and intravascular pressure is negligible. Conclusions This study shows that among diffusion and convection mechanisms of drug transport, diffusion is dominant in most different tumor shapes and sizes. In tumors in which the convection has considerable effect, the drug concentration is larger than that of other tumors at the same time post injection.
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Wakatsuki M, Kato S, Ohno T, Karasawa K, Kiyohara H, Tamaki T, Ando K, Tsujii H, Nakano T, Kamada T, Shozu M. Clinical outcomes of carbon ion radiotherapy for locally advanced adenocarcinoma of the uterine cervix in phase 1/2 clinical trial (protocol 9704). Cancer 2014; 120:1663-9. [PMID: 24591084 DOI: 10.1002/cncr.28621] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 01/20/2014] [Accepted: 01/23/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study sought to evaluate the toxicity and efficacy of carbon ion radiotherapy (C-ion RT) for locally advanced adenocarcinoma of the uterine cervix in a phase 1/2 clinical trial. METHODS The treatment consisted of whole-pelvic irradiation of 36.0 gray equivalents (GyE) in 12 fractions and local boost with dose escalation from 26.4 to 38.4 GyE in 8 fractions. The dose escalation was performed with careful observation of acute normal tissue responses. Total dose to the cervical tumor was 62.4 to 74.4 GyE in 20 fractions. RESULTS Between April 1998 and February 2010, 58 patients were treated with C-ion RT in this clinical trial. The number of patients with stage IIB, IIIB, and IVA disease were 20, 35, and 3, respectively. Median tumor size was 5.5 cm (range, 3.0-11.8 cm). Twenty-seven patients had pelvic lymph node metastases. The median follow-up period was 38 months. All patients completed the treatment schedule. Grade 2 or higher late toxicity was found in 8 patients: 5 with bladder and 2 with small intestine grade 2 toxicities, and 1 patient had grade 4 rectal complication, which was surgically salvaged. The 5-year local control rate, local control rate including salvage surgery, and overall survival rate in all cases were 54.5%, 68.2%, and 38.1%, respectively. CONCLUSIONS Dose escalation of C-ion RT for adenocarcinoma of the uterine cervix was accomplished without severe toxicities except in 1 case. Although the number of patients in this study was small, the results support continued investigation and analysis to confirm therapeutic efficacy.
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Affiliation(s)
- Masaru Wakatsuki
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
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Wakatsuki M, Kato S, Ohno T, Karasawa K, Ando K, Kiyohara H, Tsujii H, Nakano T, Kamada T, Shozu M. Dose-escalation study of carbon ion radiotherapy for locally advanced squamous cell carcinoma of the uterine cervix (9902). Gynecol Oncol 2013; 132:87-92. [PMID: 24183732 DOI: 10.1016/j.ygyno.2013.10.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/08/2013] [Accepted: 10/22/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The authors performed phase I/II clinical trial to evaluate the toxicity and efficacy of carbon ion radiotherapy (C-ion RT) for locally advanced squamous cell carcinoma of the uterine cervix. METHODS Between April 2000 and January 2006, 22 patients for Protocol 9902 were treated with C-ion RT. The number of patients with stage IIB, IIIB, and IVA diseases was 1, 18, and 3, respectively. All patients had bulky tumors measuring 4.0-12.0 cm (median 6.2 cm). The whole pelvic dose was fixed at 39.0 GyE for 13 fractions, and additional 15.0 GyE for 5 fractions was given to the gross tumor volume (GTV) and surrounding tissues. With regard to local boost, a dose-escalation study was planned for 2 fractions to GTV. Total dose to the cervical tumor was 64.0-72.0 GyE for 20 fractions. RESULTS All patients completed the scheduled therapy and no patient developed Grade 2 or higher acute toxicity. There was no Grade 3 or higher late complications at each dose. The 5-year overall survival rate and local control rate were 50.0% and 68.2%, respectively. Seven out of the 16 patients who received 64.0-68.0 GyE developed local recurrences, but all patients who received 72.0 GyE maintained local control. CONCLUSIONS There were no severe acute or late complications in this trial. C-ion RT has the potential to improve the treatment for locally advanced bulky cervical cancer by applying a total dose of 72.0 GyE, with the results lending incentive to further investigations to confirm the therapeutic efficacy.
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Affiliation(s)
- Masaru Wakatsuki
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan.
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kumiko Karasawa
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Ken Ando
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroki Kiyohara
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hirohiko Tsujii
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Kamada
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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Kim HJ, Kim W. Method of tumor volume evaluation using magnetic resonance imaging for outcome prediction in cervical cancer treated with concurrent chemotherapy and radiotherapy. Radiat Oncol J 2012; 30:70-7. [PMID: 22984685 PMCID: PMC3429891 DOI: 10.3857/roj.2012.30.2.70] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 06/13/2012] [Accepted: 06/22/2012] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To evaluate the patterns of tumor shape and to compare tumor volume derived from simple diameter-based ellipsoid measurement with that derived from tracing the entire tumor contour using region of interest (ROI)-based 3D volumetry with respect to the prediction outcome in cervical cancer patients treated with concurrent chemotherapy and radiotherapy. MATERIALS AND METHODS Magnetic resonance imaging was performed in 98 patients with cervical cancer (stage IB-IIIB). The tumor shape was classified into two categories: ellipsoid and non-ellipsoid shape. ROI-based volumetry was derived from each magnetic resonance slice on the work station. For the diameter-based surrogate "ellipsoid volume," the three orthogonal diameters were measured to calculate volume as an ellipsoid. RESULTS The more than half of tumor (55.1%) had a non-ellipsoid configuration. The predictions for outcome were consistent between two volume groups, with overall survival of 93.6% and 87.7% for small tumor (<20 mL), 62.9% and 69.1% for intermediate-size tumor (20-39 mL), and 14.5% and 16.7% for large tumors (≥40 mL) using ROI and diameter based measurement, respectively. Disease-free survival was 93.8% and 90.6% for small tumor, 54.3% and 62.7% for intermediate-size tumor, and 13.7% and 10.3% for large tumor using ROI and diameter based method, respectively. Differences in outcome between size groups were statistically significant, and the differences in outcome predicted by the tumor volume by two different methods. CONCLUSION Our data suggested that large numbers of cervical cancers are not ellipsoid. However, simple diameter-based tumor volume measurement appears to be useful in comparison with ROI-based volumetry for predicting outcome in cervical cancer patients.
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Affiliation(s)
- Hun Jung Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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Toita T, Kato S, Niibe Y, Ohno T, Kazumoto T, Kodaira T, Kataoka M, Shikama N, Kenjo M, Tokumaru S, Yamauchi C, Suzuki O, Sakurai H, Numasaki H, Teshima T, Oguchi M, Kagami Y, Nakano T, Hiraoka M, Mitsuhashi N. Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2). Int J Radiat Oncol Biol Phys 2012; 82:e49-56. [DOI: 10.1016/j.ijrobp.2011.01.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 11/22/2010] [Accepted: 01/10/2011] [Indexed: 11/28/2022]
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Huang Z, Mayr NA, Lo SS, Grecula JC, Wang JZ, Jia G, Yuh WT. Characterizing at-Risk Voxels by Using Perfusion Magnetic Resonance Imaging for Cervical Cancer during Radiotherapy. ACTA ACUST UNITED AC 2012; 4:254-259. [PMID: 23638244 DOI: 10.4172/1948-5956.1000151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The number of voxels with low signal intensity (Low DCE voxels) might be potentially related to treatment failure, which might be associated with the tumor oxygenation status. Our goal was to investigate whether at-risk voxels can be used to predict treatment outcome during radiation therapy for cervical cancer. 80 patients with Stage IB2-IVB cervical cancer were included. Four sequential MRI scans were performed at pre-RT, every 2-2.5 weeks during RT, and post-radiotherapy. 3D volumetric data including tumor regression and tumor perfusion from dynamic contrast enhanced MRI (DCE-MRI) were analyzed. Based on the signal intensity (SI) curves of the DCE-MRI, the low-DCE tumor voxels was obtained for individual patients. The predictive power of low DCE voxels in predicting the treatment outcomes was evaluated by Kaplan-Meier survival analysis. Correlation of low DCE voxels with hemoglobin (Hgb) was checked by Pearson Correlation. The actuarial local control rate and survival rate in the patient group with a small number of low DCE voxels were 89.7% and 76.9%, compared with 75.6% and 51.2% in the patient group with a big number of low DCE voxels for the MRI study #1, and 94.1% and 80.4% compared with 62.1% and 34.5% for the MRI study #2, and 95.7% and 78.7% compared with 63.6% and 42.4% for the MRI study #3, respectively. Low DCE voxels were significantly correlated with Hgb. At-risk voxels can be used to predict the outcomes and help understand tumor heterogeneity of response to RT. The Hgb level and tumor perfusion during RT influence the radioresponsiveness and survival in cervical cancer patients.
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Affiliation(s)
- Zhibin Huang
- Department of Radiation Oncology, East Carolina University, Greenville, NC 27834, USA
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Kim YJ, Park SC, Kim DY, Moon SH, Chang HJ, Park JW, Oh JH, Kim MJ, Kim TH. No correlation between pretreatment serum CEA levels and tumor volume in locally advanced rectal cancer patients. Clin Chim Acta 2012; 413:511-5. [PMID: 22137981 DOI: 10.1016/j.cca.2011.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 11/18/2011] [Accepted: 11/18/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although serum carcinoembryonic antigen (CEA) levels reflect tumor volume in rectal cancer patients intrapersonally, it is unclear interpersonally. We determined the correlation between pretreatment serum CEA levels and tumor volume. METHODS A total of 489 patients with locally advanced primary rectal cancer who underwent preoperative chemoradiotherapy followed by surgery between October 2001 and April 2007 were retrospectively evaluated. CEA levels were measured by chemiluminescent microparticle immunoassay, and magnetic resonance (MR) volumetry was performed using MR data. The correlation between CEA levels and tumor volume was assessed using linear regression analysis and one-way analysis of variance. The prognostic values of CEA levels and tumor volume for survival were evaluated. RESULTS There was no significant correlation between CEA levels and tumor volume. The five-year overall survival and disease-free survival were 89.0%, 80.6% and 82.9%, and 72.0%, 70.0% and 60.3% in patients with CEA levels of ≤3 ng/ml, >3-10 ng/ml, and >10 ng/ml, respectively. Tumor volume had no prognostic value for either overall survival or disease-free survival CONCLUSIONS Pretreatment serum CEA levels were not correlated with tumor volume. While there was no correlation between tumor volume and survival, there was a positive correlation between CEA levels and survival.
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Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. Outcomes after radical hysterectomy according to tumor size divided by 2-cm interval in patients with early cervical cancer. Ann Oncol 2011; 22:59-67. [DOI: 10.1093/annonc/mdq321] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Haynes-Outlaw ED, Grigsby PW. The Role of FDG-PET/CT in Cervical Cancer: Diagnosis, Staging, Radiation Treatment Planning and Follow-Up. PET Clin 2010; 5:435-46. [DOI: 10.1016/j.cpet.2010.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wang X, Liu R, Ma B, Yang K, Tian J, Jiang L, Bai ZG, Hao XY, Wang J, Li J, Sun SL, Yin H. High dose rate versus low dose rate intracavity brachytherapy for locally advanced uterine cervix cancer. Cochrane Database Syst Rev 2010:CD007563. [PMID: 20614461 DOI: 10.1002/14651858.cd007563.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Carcinoma of the uterine cervix is the second most common cancer and the third leading cause of cancer death among women. Radiotherapy has been used successfully to treat cervical cancer for nearly a century. The combination of external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT) has become a standard treatment modality for cervical cancer. Depending on the difference in dose rate on 'Point A' (located 2 cm above the cervical os and 2 cm lateral to the central axis of the uterus), the ICBT is divided into three modalities: low dose rate (LDR), high dose rate (HDR) and medium dose rate (MDR). Despite the practical advantages of HDR, it is necessary to investigate further the efficacy and safety of HDR brachytherapy compared to LDR brachytherapy. Questions arise as to whether HDR or LDR brachytherapy improves results for patients with cervical cancer in terms of local control rates, survival and complications related to treatment. OBJECTIVES To assess the efficacy and safety of HDR- versus LDR-ICBT for patients with uterine cervical cancer. SEARCH STRATEGY We searched the Cochrane Gynaecological Cancer Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 4), MEDLINE (1966 to November 2009), EMBASE (1974 to November 2009), Chinese Biomedical Literature Database (CBM) (1978 to November 2009) for relevant original, published trials. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs that compared HDR- with LDR-ICBT, combined with EBRT, for patients with locally advanced uterine cervical cancer. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data using standardised forms. Primary outcome measures included overall survival (OS), relapse-free survival (RFS) and pelvic control rate, while secondary outcomes included rates of recurrence and complications. MAIN RESULTS Four studies involving 1265 patients met the inclusion criteria. In our meta-analysis to compare HDR and LDR, the pooled RRs were 0.95 (95% CI 0.79 to 1.15), 0.93 (95% CI 0.84 to 1.04) and 0.79 (95% CI 0.52 to 1.20) for 3-, 5- and 10-year overall survival rates; and 0.95 (95% CI 0.84 to 1.07) and 1.02 (0.88 to 1.19) for 5- and 10-year disease-specific survival (DSS) rates. The RR for RFS was 1.04 (95% CI 0.71 to 1.52) and 0.96 (95% CI 0.81 to 1.14) at three and five years. For local control rates the RR was 0.95 (95% CI 0.86 to 1.05) and 0.95 (95% CI 0.87 to 1.05) at three and five years; with a RR of 1.09 (95% CI 0.83 to 1.43) for locoregional recurrence, 0.79 (95% CI 0.40 to 1.53) for local and distance recurrence, 2.23 (95% CI 0.78 to 6.34) for para-aortic lymph node metastasis and 0.99 (95% CI 0.72 to 1.35) for distance metastasis. For bladder, rectosigmoid and small bowel complications, the RR was 1.33 (95% CI 0.53 to 3.34), 1.00 (95% CI 0.52 to 1.91) and 3.37 (95% CI 1.06 to 10.72), respectively. These results indicate that there were no significant differences except for increased small bowel complications with HDR (P = 0.04). AUTHORS' CONCLUSIONS This review showed no significant differences between HDR- and LDR-ICBT when considering OS, DSS, RFS, local control rate, recurrence, metastasis and treatment related complications for women with cervical carcinoma. Due to some potential advantages of HDR-ICBT (rigid immobilization, outpatient treatment, patient convenience, accuracy of source and applicator positioning, individualized treatment) we recommend the use of HDR-ICBT for all clinical stages of cervix cancer.
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Affiliation(s)
- Xiaohu Wang
- Radiation Oncology Centre of Gan Su Tumour Hospital, Lanzhou University, 199 Dongang West Road, Lanzhou City, Gansu, China, 730000
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Mayr NA, Yuh WTC, Jajoura D, Wang JZ, Lo SS, Montebello JF, Porter K, Zhang D, McMeekin DS, Buatti JM. Ultra-early predictive assay for treatment failure using functional magnetic resonance imaging and clinical prognostic parameters in cervical cancer. Cancer 2010; 116:903-12. [PMID: 20052727 DOI: 10.1002/cncr.24822] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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.
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Affiliation(s)
- Nina A Mayr
- Department of Radiation Oncology, College for Public Health, Ohio State University, Columbus, OH 43210, USA.
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Abstract
The goal of radiation therapy is to deliver a high-dose of radiation to the tumour or target region to improve local control of disease and a low-dose to normal soft tissues to limit side effects. Conformal radiation therapy, intensity modulated radiotherapy (IMRT), brachytherapy and stereotactic radiosurgery have been developed to achieve the desired dose distribution. They require precise imaging of internal anatomy so that it is well adapted to the tumour and organs at risk. Indeed, morphological imaging such as computed tomography is already recommended for radiotherapy planning. But radiation oncologists are also considering other imaging modalities for treatment planning and imaging tools capable of controlling patient motion during treatment. The aim of this article is to present and illustrate the place of imaging during treatment planning and delivery via techniques such as: 4D computed tomography, morphological and functional MRI, positron emission tomography, and imaging devices mounted on accelerators.
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Huang Z, Mayr NA, Yuh WTC, Lo SS, Montebello JF, Grecula JC, Lu L, Li K, Zhang H, Gupta N, Wang JZ. Predicting outcomes in cervical cancer: a kinetic model of tumor regression during radiation therapy. Cancer Res 2010; 70:463-70. [PMID: 20068180 DOI: 10.1158/0008-5472.can-09-2501] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Applications of mathematical modeling can improve outcome predictions of cancer therapy. Here we present a kinetic model incorporating effects of radiosensitivity, tumor repopulation, and dead-cell resolving on the analysis of tumor volume regression data of 80 cervical cancer patients (stages 1B2-IVA) who underwent radiation therapy. Regression rates and derived model parameters correlated significantly with clinical outcome (P < 0.001; median follow-up: 6.2 years). The 6-year local tumor control rate was 87% versus 54% using radiosensitivity (2-Gy surviving fraction S(2) < 0.70 vs. S(2) > or = 0.70) as a predictor (P = 0.001) and 89% vs. 57% using dead-cell resolving time (T(1/2) < 22 days versus T(1/2) > or = 22 days, P < 0.001). The 6-year disease-specific survival was 73% versus 41% with S(2) < 0.70 versus S(2) > or = 0.70 (P = 0.025), and 87% vs. 52% with T(1/2) < 22 days versus T(1/2) > or = 22 days (P = 0.002). Our approach illustrates the promise of volume-based tumor response modeling to improve early outcome predictions that can be used to enable personalized adaptive therapy.
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Affiliation(s)
- Zhibin Huang
- Department of Radiation Medicine, The Ohio State University, Columbus, Ohio 43210, USA
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SAIDA T, TANAKA YOISHI, OHARA K, OKI A, SATO T, YOSHIKAWA H, MINAMI M. Can MRI Predict Local Control Rate of Uterine Cervical Cancer Immediately after Radiation Therapy? Magn Reson Med Sci 2010; 9:141-8. [DOI: 10.2463/mrms.9.141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Haie-Meder C, Mazeron R, Verezesan O, Dumas I, Monnier L, Vieillot S, Lhommé C, Morice P, Barillot I. Apport des techniques de curiethérapie optimisée grâce à l’imagerie tridimensionnelle dans la prise en charge des patientes atteintes d’un cancer du col utérin. Cancer Radiother 2009; 13:520-4. [DOI: 10.1016/j.canrad.2009.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 06/16/2009] [Accepted: 06/17/2009] [Indexed: 12/18/2022]
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Mayr NA, Wang JZ, Lo SS, Zhang D, Grecula JC, Lu L, Montebello JF, Fowler JM, Yuh WTC. Translating response during therapy into ultimate treatment outcome: a personalized 4-dimensional MRI tumor volumetric regression approach in cervical cancer. Int J Radiat Oncol Biol Phys 2009; 76:719-27. [PMID: 19632061 DOI: 10.1016/j.ijrobp.2009.02.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 01/11/2009] [Accepted: 02/09/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess individual volumetric tumor regression pattern in cervical cancer during therapy using serial four-dimensional MRI and to define the regression parameters' prognostic value validated with local control and survival correlation. METHODS AND MATERIALS One hundred and fifteen patients with Stage IB(2)-IVA cervical cancer treated with radiation therapy (RT) underwent serial MRI before (MRI 1) and during RT, at 2-2.5 weeks (MRI 2, at 20-25 Gy), and at 4-5 weeks (MRI 3, at 40-50 Gy). Eighty patients had a fourth MRI 1-2 months post-RT. Mean follow-up was 5.3 years. Tumor volume was measured by MRI-based three-dimensional volumetry, and plotted as dose(time)/volume regression curves. Volume regression parameters were correlated with local control, disease-specific, and overall survival. RESULTS Residual tumor volume, slope, and area under the regression curve correlated significantly with local control and survival. Residual volumes >or=20% at 40-50 Gy were independently associated with inferior 5-year local control (53% vs. 97%, p <0.001) and disease-specific survival rates (50% vs. 72%, p = 0.009) than smaller volumes. Patients with post-RT residual volumes >or=10% had 0% local control and 17% disease-specific survival, compared with 91% and 72% for <10% volume (p <0.001). CONCLUSION Using more accurate four-dimensional volumetric regression analysis, tumor response can now be directly translated into individual patients' outcome for clinical application. Our results define two temporal thresholds critically influencing local control and survival. In patients with >or=20% residual volume at 40-50 Gy and >or=10% post-RT, the risk for local failure and death are so high that aggressive intervention may be warranted.
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Affiliation(s)
- Nina A Mayr
- Department of Radiation Medicine, Ohio State University, Columbus, OH 43210, USA.
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LEBIODA A, MAKAREWICZ R, ŻYROMSKA A, SZYMAŃSKI M, SOKOLSKA E. Measurement of tumour volume by MRI to evaluate risk of pelvic nodal metastases in early cervical carcinoma patients. Rep Pract Oncol Radiother 2009. [DOI: 10.1016/s1507-1367(10)60029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Dimopoulos JCA, Schirl G, Baldinger A, Helbich TH, Pötter R. MRI assessment of cervical cancer for adaptive radiotherapy. Strahlenther Onkol 2009; 185:282-7. [PMID: 19440666 DOI: 10.1007/s00066-009-1918-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 02/12/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the importance of the information obtained from MRI for adaptive cervix cancer radiotherapy. PATIENTS AND METHODS 49 patients with cervix cancer, treated by external-beam radiotherapy (EBRT) and MRI-assisted high-dose-rate brachytherapy +/- concomitant cisplatin, underwent MRI at diagnosis and at the time of brachytherapy fractions. 190 MRI examinations were performed. Pretreatment scans were correlated with clinical examination (CE) findings. Measurements in 3-D of the tumor extension and also of the distance from the tumor to the pelvic side wall were performed using both MRI and CE. The tumor volume regression induced initially by EBRT and the subsequent regression after each brachytherapy fraction were assessed. RESULTS MRI and CE showed 92% agreement in overall parametrial staging and 73% agreement in terms of vaginal involvement. There was, however, disagreement in parametrial side (right/left) classification in 25% of the parametria examined. These were patients with unilateral displacement of the cervix and contralateral invasion of the parametrium. The mean tumor volume on the pretreatment MRI scan (GTVD) was 61 cm(3). At the time of the four brachytherapy fractions the mean was 16 cm(3), 10 cm(3), 9 cm(3), and 8 cm(3), defined as the GTVBT plus the gray zones in the parametria. CONCLUSION CE and MRI findings agree well in terms of overall staging. The clinical assessment of side-specific parametrial invasion improved when having access to the additional knowledge obtained from MRI. The greatest decrease in tumor volume occurs during EBRT, whereas tumor regression between the first and subsequent brachytherapy fractions is minor.
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Suzuki Y, Oka K, Ohno T, Kato S, Tsujii H, Nakano T. Prognostic impact of mitotic index of proliferating cell populations in cervical cancer patients treated with carbon ion beam. Cancer 2009; 115:1875-82. [DOI: 10.1002/cncr.24189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Eifel PJ, Jhingran A, Levenback CF, Tucker S. Predictive value of a proposed subclassification of stages I and II cervical cancer based on clinical tumor diameter. Int J Gynecol Cancer 2009; 19:2-7. [PMID: 19258933 DOI: 10.1111/igc.0b013e318197f185] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Hospital records of 4490 patients treated for International Federation of Gynecology and Obstetrics (FIGO) stage IB, IIA, or IIB carcinoma of the cervix between 1960 and 2001 at 1 institution were reviewed. Outcomes were estimated using the Kaplan-Meier method and compared using the log-rank method. A proportional hazards regression model was used to evaluate the relative importance of predictive factors. The rates of disease-specific survival and pelvic disease control were strongly correlated with tumor diameter, FIGO stage, histological subtype, and clinical node status. Regression analysis demonstrated that a diameter of greater than 4 cm, a diameter of greater than 6 cm, FIGO stage II (vs IB), the presence and level of lymph node involvement, and histological subtype were all highly significant independent predictors of poor disease-specific survival. Intermediate tumor-diameter categories (>5 cm or >7 cm) and FIGO stage IIB (vs IB or IIA) did not contribute significant additional information to the model. Only a tumor diameter of greater than 4 cm, a diameter of greater than 6 cm, the presence of lymph node involvement, and histological subtype were independent predictors of pelvic disease control. On the basis of these results, we propose dividing each of the FIGO categories IB, IIA, and IIB into 3 groups according to clinical tumor diameter: (1) less than or equal to 4 cm, (2) 4.1 to 6 cm, and (3) greater than 6 cm. The proposed modified system would provide more accurate prognostic information, facilitate comparisons, and maintain continuity with the current staging system.
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Affiliation(s)
- Patricia J Eifel
- Division of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Ohara K, Tanaka YO, Oki A, Okamoto Y, Satoh T, Matsumoto K, Yoshikawa H. Comparison of tumor regression rate of uterine cervical squamous cell carcinoma during external beam and intracavitary radiotherapy. ACTA ACUST UNITED AC 2008; 26:526-32. [PMID: 19030960 DOI: 10.1007/s11604-008-0268-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 06/26/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE We compared the radioresponse of cervical carcinoma that was closely related to local disease control by the tumor regression rate (RR) during intracavitary radiotherapy (ICRT) and external beam radiotherapy (EBRT) on the presumption that ICRT has a stronger treatment impact than EBRT because of its specific dose distribution. MATERIALS AND METHODS A total of 37 patients were treated by EBRT at 45.0 Gy over 5 weeks, followed by high-dose-rate ICRT at 6.0 Gy per weekly insertion at point A three to five times and by boost EBRT. RR was defined as the slope (day(-1)) of the tumor-volume shrinkage curve fit to an exponential regression equation. Assuming that the tumors were ellipsoid, the tumor volume was estimated using magnetic resonance (MR) images obtained before treatment, after 45.0 Gy of EBRT, and after the third ICRT insertion. RRs were compared based on the radiotherapy method. RESULTS RR ranged between -0.008 to 0.093 day(-1) (median 0.021 day(-1)) during EBRT and -0.001 to 0.097 day(-1) (median 0.018 day(-1)) during ICRT, showing no significant difference or correlation between treatments. CONCLUSION Contrary to expectations, RR did not directly relate to the impact of physical treatment. RR could be related to biological factors, such as the amount of tumor clearance and changes in tumor consistency during treatment.
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Affiliation(s)
- Kiyoshi Ohara
- Department of Radiation Oncology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan.
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Haie-Meder C, Dumas I, Paumier A, Lessard N, Kanoun S, Morice P, Lhommé C. [Implementation of GEC-ESTRO recommendations on 3-D based image brachytherapy]. Cancer Radiother 2008; 12:522-6. [PMID: 18951823 DOI: 10.1016/j.canrad.2008.08.277] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 08/20/2008] [Indexed: 01/21/2023]
Abstract
Even if the prognosis of patients with cervical cancer has been dramatically improved with concomitant chemoradiation, brachytherapy still plays fundamental role in the therapeutic approach of patients with Figo stage I-IV cervical carcinoma. The development of imaging with three-dimensional dosimetry has contributed to the improvement in target and organs at risk knowledge. In 2005 and 2006, GEC-ESTRO recommendations on 3-D based image brachytherapy have defined the different volumes of interest. These recommendations have been validated with intercomparison delineation studies. Data on dose to normal tissues are better known with dose volume-histograms analysis. Dose limits to the bladder are high in the range of 90 Gy to the 2 cm3 while 2 cm3 limits to the rectum do not differ from ICRU point. The sigmoid is currently under study as this organ was not extensively studied before the era of imaging. Doses to the tumour (HR-CTV or IR-CTV) are not clearly stated and will likely depend on tumour extension.
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Plataniotis GA, Dale RG. Use of concept of chemotherapy-equivalent biologically effective dose to provide quantitative evaluation of contribution of chemotherapy to local tumor control in chemoradiotherapy cervical cancer trials. Int J Radiat Oncol Biol Phys 2008; 72:1538-43. [PMID: 18786779 DOI: 10.1016/j.ijrobp.2008.06.1911] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 06/08/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE To express the magnitude of the contribution of chemotherapy to local tumor control in chemoradiotherapy cervical cancer trials in terms of the concept of the biologically effective dose. METHODS AND MATERIALS The local control rates of both arms of each study (radiotherapy vs. radiotherapy plus chemotherapy) reported from randomized controlled trials of concurrent chemoradiotherapy for cervical cancer were reviewed and expressed using the Poisson model for tumor control probability (TCP) as TCP = exp(-exp E), where E is the logarithm of cell kill. By combining the two TCP values from each study, we calculated the chemotherapy-related log cell kill as Ec = ln[(lnTCP(Radiotherapy))/(lnTCP(Chemoradiotherapy))]. Assuming a range of radiosensitivities (alpha = 0.1-0.5 Gy(-1)) and taking the calculated log cell kill, we calculated the chemotherapy-BED, and using the linear quadratic model, the number of 2-Gy fractions corresponding to each BED. The effect of a range of tumor volumes and radiosensitivities (alpha Gy(-1)) on the TCP was also explored. RESULTS The chemotherapy-equivalent number of 2-Gy fractions range was 0.2-4 and was greater in tumors with lower radiosensitivity. In those tumors with intermediate radiosensitivity (alpha = 0.3 Gy(-1)), the equivalent number of 2-Gy fractions was 0.6-1.3, corresponding to 120-260 cGy of extra dose. The opportunities for clinically detectable improvement are only available in tumors with intermediate radiosensitivity with alpha = 0.22-0.28 Gy(-1). The dependence of TCP on the tumor volume decreases as the radiosensitivity increases. CONCLUSION The results of our study have shown that the contribution of chemotherapy to the TCP in cervical cancer is expected to be clinically detectable in larger and less-radiosensitive tumors.
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Kim HJ, Kim WC. Pretreatment tumor diameter/volume and pelvic lymph node status assessed by magnetic resonance imaging for uterine cervical carcinoma treated with concurrent chemotherapy and radiotherapy. J Obstet Gynaecol Res 2008; 34:529-37. [DOI: 10.1111/j.1447-0756.2008.00733.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee YK, Han SS, Kim JW, Park NH, Song YS, Kang SB. Value of pelvic examination and imaging modality for the evaluation of tumor size in cervical cancer. J Gynecol Oncol 2008; 19:108-12. [PMID: 19471556 DOI: 10.3802/jgo.2008.19.2.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 05/21/2008] [Accepted: 05/26/2008] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare the accuracy of pelvic examination versus imaging modality such as computed tomography (CT) or magnetic resonance imaging (MRI) in the measurement of the tumor size of invasive cervical carcinoma based on pathologic findings. METHODS Patients with stage Ib-II cervical cancer who underwent primary surgical treatment between January 2003 and December 2005 were evaluated retrospectively. One hundred three consecutive patients aged 24 to 81 years (mean age, 50.6 years), who had not received any treatment previously were included in this study. Accuracy of preoperative CT or MRI versus pelvic examination in the measurement of tumor size was compared based on pathologic findings. All patients were examined and staged clinically by the gynecologic oncologist. Surgery was performed within 2 weeks after imaging studies. The data were analyzed using descriptive statistics. RESULTS The largest diameter of the tumor measured by pathologic findings was 2.76+/-1.76 cm. Based on pathologic findings, accuracy was estimated by the degree of agreement with a difference of <0.5 or 1.0 cm between the measurements of tumor size obtained by pelvic examination and imaging modality. Pelvic examination and imaging modality had an accuracy of 46.6% and 39.8%, respectively, with a difference of <0.5 cm, and an accuracy of 72.8% and 55.3%, respectively, with a difference of <1.0 cm. Correlation with pathologic findings was higher for pelvic examination (r(s)=0.680) than for imaging modality (r(s)=0.410). In determining the size of tumor mass differentiating >4.0 cm from </=4.0 cm, imaging modality showed higher accuracy than pelvic examination. CONCLUSION For the patients with stage Ib to II cervical cancer, pelvic examination is superior to imaging modality with regard to evaluation of the tumor size. However, imaging modality may be accurate for evaluating bulky tumors of cervical cancer.
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Affiliation(s)
- Yoo-Kyung Lee
- Department of Obstetrics and Gynecology, Seoul National University, College of Medicine, Seoul, Korea
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Haie-meder C, Balleyguier C, Dumas I, Morice P, Lhommé C, Duvillard P. IRM en curiethérapie gynécologique : impact sur la dosimétrie et sur le contrôle local des patientes porteuses d’un cancer du col utérin. Imagerie de la Femme 2008; 18:30-34. [DOI: 10.1016/s1776-9817(08)71697-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lim K, Chan P, Dinniwell R, Fyles A, Haider M, Cho YB, Jaffray D, Manchul L, Levin W, Hill RP, Milosevic M. Cervical Cancer Regression Measured Using Weekly Magnetic Resonance Imaging During Fractionated Radiotherapy: Radiobiologic Modeling and Correlation With Tumor Hypoxia. Int J Radiat Oncol Biol Phys 2008; 70:126-33. [PMID: 17768016 DOI: 10.1016/j.ijrobp.2007.06.033] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 04/21/2007] [Accepted: 06/06/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE To measure regression of cancer of the uterine cervix during external beam radiotherapy using magnetic resonance imaging, derive radiobiologic parameters from a mathematical model of tumor regression, and compare these parameters with the pretreatment measurements of tumor hypoxia. METHODS AND MATERIALS A total of 27 eligible patients undergoing external beam radiotherapy for cervical cancer underwent weekly magnetic resonance imaging scans. The tumor volume was assessed on each of these scans and the rate of regression plotted. A radiobiologic model was formulated to simulate the effect on tumor regression of the surviving proportion of cells after 2 Gy (SP(2)), the cell clearance constant (clearance of irreparably damaged cells from the tumor [T(c)]), and accelerated repopulation. Nonlinear regression analysis was used to fit the radiobiologic model to the magnetic resonance imaging-derived tumor volumes and to derive the estimates of SP(2) and T(c) for each patient. These were compared to the pretreatment hypoxia measurements. RESULTS The initial tumor volume was 8-209 cm(3). The relative reduction in volume during treatment was 0.02-0.79. The simulations using representative values of the independent biologic variables derived from published data showed SP(2) and T(c) to strongly influence the shape of the volume-response curves. Nonlinear regression analysis yielded a median SP(2) of 0.71 and median T(c) of 10 days. Tumors with a high SP(2) >0.71 were significantly more hypoxic at diagnosis (p = 0.02). CONCLUSION The results of our study have shown that cervical cancer regresses during external beam radiotherapy, although marked variability is present among patients and is influenced by underlying biologic processes, including cellular sensitivity to radiotherapy and proliferation. Better understanding of the biologic mechanisms might facilitate novel adaptive treatment strategies in future studies.
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Affiliation(s)
- Karen Lim
- Radiation Medicine Program, Princess Margaret Hospital/Ontario Cancer Institute, University Health Network, Toronto, ON, Canada
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Abstract
BACKGROUND Tongue cancers are staged by the American Joint Committee on Cancer and the Union Internationale Contre le Cancer TNM staging systems. Cancer, however, evolves in a 3-D plane. Hence, using the largest tumour diameter will not reflect total cancer volume. We aim to evaluate the use of tongue cancer tumour volume (Tv) as a prognostic predictor of disease recurrence and survival. METHODS The study is a retrospective analysis of patients in Singapore General Hospital who underwent complete resection for histologically proven tongue carcinoma from 2000 to 2002. The Tv was measured on staging T(2)-weighted magnetic resonance imaging datasets by semiautomated methods. RESULTS Seventeen patients with a median follow-up duration of 57.9 months were studied. A wide range of volumes was noted in each T stage. The median time to relapse was 8.6 months for those with Tv > or = 13 cc but was not achieved for those with Tv < 13 cc. The hazard ratio comparing Tv > or = 13 cc versus <13 cc is 9.02 (95% confidence interval (CI) 1.70-47.94, P = 0.014). Of the seven deaths reported, five patients had Tv > or = 13 cc. The median overall survival was 15.8 months for those with Tv > or = 13 cc but was not achieved for those with Tv < 13 cc. The hazards of death for Tv > or = 13 cc was 3.91 times that of Tv < 13 cc (95% CI 0.86-17.86, P = 0.078). CONCLUSION Tongue cancer Tv measurement allows a more refined and accurate assessment of tumour status. This can be a possible prognostic indicator and be used in a novel staging method for the future.
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Affiliation(s)
- Min H Chew
- Department of General Surgery, Singapore General Hospital, Singapore
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Atahan IL, Onal C, Ozyar E, Yiliz F, Selek U, Kose F. Long-term outcome and prognostic factors in patients with cervical carcinoma: a retrospective study. Int J Gynecol Cancer 2007; 17:833-42. [PMID: 17367320 DOI: 10.1111/j.1525-1438.2007.00895.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This study evaluates treatment outcomes and possible prognostic factors of inoperable cervical cancer patients treated with external beam radiotherapy (EBRT) and high-dose rate brachytherapy (HDR BRT). Between 1993 and 2000, 183 patients with cervical cancer were treated at our institute. Radiotherapy was the sole treatment modality until January 1997; after the announcement of National Cancer Institute in 1999, 40 mg/m(2) of cisplatin (49%) was routinely applied every week. Median age was 54 years (32-92 years). Most patients (88%) had advanced-stage disease (IIB-IIIB). With a median follow-up time of 45 months (6-121 months), the 5-year overall survival (OS), local recurrence-free survival, disease-free survival (DFS), and distant metastasis-free survival (DMFS) rates were 55%, 71%, 51%, and 77%, respectively. Univariate analysis revealed that age, tumor size, lymph node status, and concomitant cisplatin were prognostic factors for OS. The DFS rates were lower in young age group. Patients with tumor greater than 4 cm and age greater than 40 were at greater risk for local recurrence. Distant metastases were more frequent in patients with adenocarcinoma. Concurrent cisplatin use increases DMFS rates (91% vs 78%; P= 0.05). In multivariate analysis, extensive stage, parametrial infiltration, young age, adenocarcinoma histopathology, and lymph node metastasis were negative prognostic factors for OS while concomitant cisplatin increases OS. Likewise, patients with extensive stage, adenocarcinoma, and without concurrent cisplatin administration had more risk for distant metastasis. There was no treatment-related mortality. Grade 3-4 morbidity rates were seen only in eight patients (4%). The combination of EBRT and HDR BRT together with concomitant chemotherapy in the treatment of locally advanced carcinoma of cervix is safe and well tolerated with acceptable morbidity.
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Affiliation(s)
- I L Atahan
- Department of Radiation Oncology, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey
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Mitchell DG, Snyder B, Coakley F, Reinhold C, Thomas G, Amendola M, Schwartz LH, Woodward P, Pannu H, Hricak H. Early invasive cervical cancer: tumor delineation by magnetic resonance imaging, computed tomography, and clinical examination, verified by pathologic results, in the ACRIN 6651/GOG 183 Intergroup Study. J Clin Oncol 2007; 24:5687-94. [PMID: 17179104 DOI: 10.1200/jco.2006.07.4799] [Citation(s) in RCA: 216] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To compare magnetic resonance imaging (MRI), computed tomography (CT), and clinical examination for delineating early cervical cancer and for measuring tumor size. PATIENTS AND METHODS A 25-center study enrolled 208 patients with biopsy-proven invasive cervical cancer for MRI and CT before attempted curative radical hysterectomy. Each imaging study was interpreted prospectively by one onsite radiologist and retrospectively by four independent offsite radiologists, who were all blinded to surgical, histopathologic, and other imaging findings. Likelihood of cervical stromal and uterine body involvement was rated on a 5-point scale. Tumor size measurements were attempted in three axes. Surgical pathology was the standard of reference. RESULTS Neither MRI nor CT was accurate for evaluating cervical stroma. For uterine body involvement, the area under the receiver operating characteristic curve was higher for MRI than for CT for both prospective (0.80 v 0.66, respectively; P = .01) and retrospective (0.68 v 0.57, respectively; P = .02) readings. Retrospective readers could measure diameter by CT in 35% to 73% of patients and by MRI in 79% to 94% of patients. Prospective readers had the highest Spearman correlation coefficient with pathologic measurement for MRI (r(s) = 0.54), followed by CT (r(s) = 0.45) and clinical examination (r(s) = 0.37; P < .0001 for all). Spearman correlation of multiobserver diameter measurements for MRI (r(s) = 0.58; P < .0001) was double that for CT (r(s) = 0.27; P = .03). CONCLUSION In patients with cervical cancer, MRI is superior to CT and clinical examination for evaluating uterine body involvement and measuring tumor size, but no method was accurate for evaluating cervical stroma.
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Affiliation(s)
- Donald G Mitchell
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.
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Ozden H, Ak G, Metintas S, Metintas M, Sahin B, Erginel S, Civi K. Relationship between tumorsize of malignant pleural mesothelioma and its response to chemotherapy. ACTA ACUST UNITED AC 2007. [DOI: 10.1248/jhs.53.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hilmi Ozden
- Department of Anatomy, Eskisehir Osmangazi University Medical School
| | - Güntülü Ak
- Department of Chest Disease, Eskisehir Osmangazi University Medical School
| | - Selma Metintas
- Department of Public Health, Eskisehir Osmangazi University Medical School
| | - Muzaffer Metintas
- Department of Chest Disease, Eskisehir Osmangazi University Medical School
| | - Bünyamin Sahin
- Department of Anatomy, Ondokuz Mayis University Medical School
| | - Sinan Erginel
- Department of Chest Disease, Eskisehir Osmangazi University Medical School
| | - Kismet Civi
- Department of Pathology, Dumlupinar University, Education and Training Haspital
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Baghi M, Mack MG, Hambek M, Bisdas S, Muerthel R, Wagenblast J, Gstoettner W, Vogl T, Knecht R. Usefulness of MRI volumetric evaluation in patients with squamous cell cancer of the head and neck treated with neoadjuvant chemotherapy. Head Neck 2007; 29:104-8. [PMID: 17111434 DOI: 10.1002/hed.20488] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose was to evaluate the efficacy of tumor volumetry on MRI as predictive of response to treatment with induction chemotherapy, comparing the results with endoscopy. METHODS Fifty patients with advanced squamous cell carcinoma of the head and neck (SSCHN) who underwent MRI volumetry before and after neoadjuvant chemotherapy consisting of docetaxel, cisplatin, and 5-fluorouracil (TPF) were included in this study. The tumor volume was calculated by a slice-by-slice evaluation. With the standard software of a workstation, the area of the tumor was measured slice by slice using manual segmentation. To evaluate the efficacy of MRI volumetry, pretreatment volume was compared with pretreatment remission status as evaluated with endoscopy. RESULTS Forty-five (90%) patients demonstrated a tumor downstaging after chemotherapy. Fourteen (28%) patients showed a complete histologic remission (CR), 31 (62%) patients showed a partial remission (PR). Pretreatment tumor volume was significantly different between patients whose tumor completely responded (CR) and those whose tumor did not completely respond or whose disease was stable or was progressive (p = .00023). We defined a threshold for the pretreatment tumor volume in patients with CR, which was equal to 29.71 cc. CONCLUSION We propose that MRI tumor volume analyses can be a useful parameter to predict the response to neoadjuvant chemotherapy in SCCHN.
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Affiliation(s)
- Mehran Baghi
- Department for ENT-Surgery, University of Frankfurt/Main, Theodor-Stern-Kai, 60590 Frankfurt am Main, Germany
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Abstract
Magnetic Resonance Imaging (MRI) is the criterion standard in the assessment and staging of uterine cancer because of the high tissue contrast between glandular lining and inner and outer muscle layers of the uterine corpus and cervix on T2-weighted scans. It is also an essential tool in monitoring treatment response and in assessing disease recurrence in these patients. The key to a successful examination lies in good patient preparation, use of antiperistaltic agents, and a meticulous scanning technique. Endometrial carcinomas are the most common uterine malignancy, occurring in a primarily postmenopausal population. Dynamic contrast-enhanced scans may be required in addition to T2-weighted images to assess the presence of myometrial invasion in this age group. Cervical cancers occur in a younger population and are readily assessed with T2-weighted imaging. Use of an endovaginal receiver coil allows high spatial resolution imaging of the cervix, which is particularly useful when assessing patients for fertility-sparing procedures such as trachelectomy. Uterine sarcomas are 1% to 3% of all uterine malignancies and usually arise from a mixture of homologous and heterologous elements. Rarely, lymphoma, small cell carcinoma and metastatic deposits involve the uterus. This review summarizes the optimal scanning techniques for demonstrating uterine malignancy and discusses the role of imaging and the MRI appearances of uterine tumors.
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Affiliation(s)
- Camilla R Whitten
- Department of Radiology, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Haie-Meder C, Peiffert D. Nouveautés en curiethérapie gynécologique : nouvelles technologies, curiethérapie pulsée, imagerie, définitions de nouveaux volumes d'intérêt et leur impact sur la dosimétrie : applications dans le cadre d'un STIC. Cancer Radiother 2006; 10:402-9. [PMID: 16884941 DOI: 10.1016/j.canrad.2006.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2006] [Indexed: 11/28/2022]
Abstract
Brachytherapy plays a fundamental role in the therapeutic approach of patients with stage I-IV cervical carcinoma. Technical modalities have evolved during the last decades: stepping source technology, imaging modalities development, specially IMN, treatment planning system integrating 3D images. Images from CT-Scan and MRI have contributed to a better knowledge of tumoral extension and critical organs. CT and/or MRI compatible applicators allow a sectional image based approach with a better definition of tumour volume compared to traditional approaches. The introduction of 3D image based approach for GTV and CTV requires new definitions and a common language. In 2000, a working group within GEC-ESTRO was created to support 3D image based 3D treatment planning approach in cervix cancer BT. The task was to determine a common terminology enabling various groups to use a common language. Recommendations were described and proposed based on clinical experience and dosimetric concepts of different institutions. Two CTVs were described en relation to the risk for recurrence: high-risk CTV and intermediate risk CTV. In order to better define the role of such definitions and their potential impact on the complication incidence in patients with cervical cancer, a special French programme was developed. The aim of this programme is to study the incidence of the severe 2-year complication rate in two comparable patient populations: one population is treated using PDR brachytherapy with CT-Scan or MRI with the applicators in place allowing a 3D dosimetry with optimization, the second population is treated using standard X-rays radiographs without any delineation of the target nor optimisation. Each population arm includes 425 patients. A medicoeconomic assessment is performed, allowing a real cost of the most sophisticated approach compared to a historical dosimetric system.
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Affiliation(s)
- C Haie-Meder
- Service de Curiethérapie, Institut Gustave-Roussy, 39, Rue Camille-Desmoulins, 94805 Villejuif, France.
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