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Van Damme A, Tummers P, De Visschere P, Van Dorpe J, Van de Vijver K, Vercauteren T, De Gersem W, Denys H, Naert E, Makar A, De Neve W, Vandecasteele K. Exclusion of non-Involved uterus from the target volume (EXIT-trial): An individualized treatment for locally advanced cervical cancer using modern radiotherapy and imaging techniques followed by completion surgery. Clin Transl Radiat Oncol 2024; 47:100793. [PMID: 38798749 PMCID: PMC11126536 DOI: 10.1016/j.ctro.2024.100793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Background and purpose Chemoradiotherapy followed by brachytherapy is the standard of care for locally advanced cervical cancer (LACC). In this study, we postulate that omitting an iconographical unaffected uterus (+12 mm distance from the tumour) from the treatment volume is safe and that no tumour will be found in the non-targeted uterus (NTU) leading to reduction of high-dose volumes of surrounding organs at risk (OARs). Material and Methods In this single-arm phase 2 study, two sets of target volumes were delineated: one standard-volume (whole uterus) and an EXIT-volume (exclusion of non-tumour-bearing parts of the uterus with a minimum 12 mm margin from the tumour). All patients underwent chemoradiotherapy targeting the EXIT-volume, followed by completion hysterectomy. In 15 patients, a plan comparison between two treatment plans (PTV vs PTV_EXIT) was performed. The primary endpoint was the pathological absence of tumour involvement in the non-targeted uterus (NTU). Secondary endpoints included dosimetric impact of target volume reduction on OARs, acute and chronic toxicity, overall survival (OS), locoregional recurrence-free survival (LRFS), and progression-free survival (PFS). Results In all 21 (FIGO stage I: 2; II: 14;III: 3; IV: 2) patients the NTU was pathologically negative. Ssignificant reductions in Dmean in bladder, sigmoid and rectum; V15Gy in sigmoid and rectum, V30Gy in bladder, sigmoid and rectum; V40Gy and V45Gy in bladder, bowel bag, sigmoid and rectum; V50Gy in rectum were achieved. Median follow-up was 54 months (range 7-79 months). Acute toxicity was mainly grade 2 and 5 % grade 3 urinary. The 3y- OS, PFS and LRFS were respectively 76,2%, 64,9% and 81 %. Conclusion MRI-based exclusion of the non-tumour-bearing parts of the uterus at a minimum distance of 12 mm from the tumour out of the target volume in LACC can be done without risk of residual disease in the NTU, leading to a significant reduction of the volume of surrounding OARS treated to high doses.
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Affiliation(s)
- Axel Van Damme
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Philippe Tummers
- Department of Gynaecology, Ghent University Hospital, Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Pieter De Visschere
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Departement of Radiology and Nuclear Medicine, Ghent University Hospital, Belgium
| | - Jo Van Dorpe
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Koen Van de Vijver
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Tom Vercauteren
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Werner De Gersem
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hannelore Denys
- Department of Gynaecology, Ghent University Hospital, Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Gynaecology, Division of Gynecologic Oncology, ZNA Middelheim Antwerpen, Belgium
| | - Eline Naert
- Department of Gynaecology, Ghent University Hospital, Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Department of Gynaecology, Division of Gynecologic Oncology, ZNA Middelheim Antwerpen, Belgium
| | - Amin Makar
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Wilfried De Neve
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Katrien Vandecasteele
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Gynecological Pelvic Oncology Network (GYPON), Ghent University (Hospital), Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Shinagare AB, Burk KS, Kilcoyne A, Akin EA, Chuang L, Hindman NM, Huang C, Rauch GM, Small W, Stein EB, Venkatesan AM, Kang SK. ACR Appropriateness Criteria® Pretreatment Evaluation and Follow-Up of Invasive Cancer of the Cervix: 2023 Update. J Am Coll Radiol 2024; 21:S249-S267. [PMID: 38823948 DOI: 10.1016/j.jacr.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Cervical cancer is a common gynecological malignancy worldwide. Cervical cancer is staged based on the International Federation of Gynecology and Obstetrics (FIGO) classification system, which was revised in 2018 to incorporate radiologic and pathologic data. Imaging plays an important role in pretreatment assessment including initial staging and treatment response assessment of cervical cancer. Accurate determination of tumor size, local extension, and nodal and distant metastases is important for treatment selection and for prognostication. Although local recurrence can be diagnosed by physical examination, imaging plays a critical role in detection and follow-up of local and distant recurrence and subsequent treatment selection. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Atul B Shinagare
- Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Kristine S Burk
- Research Author, Brigham & Women's Hospital, Boston, Massachusetts
| | - Aoife Kilcoyne
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts
| | - Esma A Akin
- The George Washington University Medical Center, Washington, District of Columbia; Commission on Nuclear Medicine and Molecular Imaging
| | - Linus Chuang
- University of Vermont Larner College of Medicine Danbury Hospital, Burlington, Vermont; Gynecologic oncology expert
| | | | - Chenchan Huang
- New York University Langone Medical Center, New York, New York
| | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, Illinois; Commission on Radiation Oncology
| | - Erica B Stein
- University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Stella K Kang
- Specialty Chair, New York University Medical Center, New York, New York
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3
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Fischerova D, Smet C, Scovazzi U, Sousa DN, Hundarova K, Haldorsen IS. Staging by imaging in gynecologic cancer and the role of ultrasound: an update of European joint consensus statements. Int J Gynecol Cancer 2024; 34:363-378. [PMID: 38438175 PMCID: PMC10958454 DOI: 10.1136/ijgc-2023-004609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/05/2024] [Indexed: 03/06/2024] Open
Abstract
In recent years the role of diagnostic imaging by pelvic ultrasound in the diagnosis and staging of gynecological cancers has been growing exponentially. Evidence from recent prospective multicenter studies has demonstrated high accuracy for pre-operative locoregional ultrasound staging in gynecological cancers. Therefore, in many leading gynecologic oncology units, ultrasound is implemented next to pelvic MRI as the first-line imaging modality for gynecological cancer. The work herein is a consensus statement on the role of pre-operative imaging by ultrasound and other imaging modalities in gynecological cancer, following European Society guidelines.
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Affiliation(s)
- Daniela Fischerova
- Gynecologic Oncology Center, Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Carolina Smet
- Department of Obstetrics and Gynecology, São Francisco de Xavier Hospital in Lisbon, Lisbon, Portugal
| | - Umberto Scovazzi
- Department of Gynecology and Obstetrics, Ospedale Policlinico San Martino and University of Genoa, Genoa, Italy
| | | | - Kristina Hundarova
- Department of Gynecology and Obstetrics A, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Ingfrid Salvesen Haldorsen
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of Radiology and Department of Clinical Medicine, Haukeland University Hospital and the University of Bergen, Bergen, Norway
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4
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Fischerova D, Frühauf F, Burgetova A, Haldorsen IS, Gatti E, Cibula D. The Role of Imaging in Cervical Cancer Staging: ESGO/ESTRO/ESP Guidelines (Update 2023). Cancers (Basel) 2024; 16:775. [PMID: 38398166 PMCID: PMC10886638 DOI: 10.3390/cancers16040775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
Following the European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) joint guidelines (2018) for the management of patients with cervical cancer, treatment decisions should be guided by modern imaging techniques. After five years (2023), an update of the ESGO-ESTRO-ESP recommendations was performed, further confirming this statement. Transvaginal/transrectal ultrasound (TRS/TVS) or pelvic magnetic resonance (MRI) enables tumor delineation and precise assessment of its local extent, including the evaluation of the depth of infiltration in the bladder- or rectal wall. Additionally, both techniques have very high specificity to confirm the presence of metastatic pelvic lymph nodes but fail to exclude them due to insufficient sensitivity to detect small-volume metastases, as in any other currently available imaging modality. In early-stage disease (T1a to T2a1, except T1b3) with negative lymph nodes on TVS/TRS or MRI, surgicopathological staging should be performed. In all other situations, contrast-enhanced computed tomography (CECT) or 18F-fluorodeoxyglucose positron emission tomography combined with CT (PET-CT) is recommended to assess extrapelvic spread. This paper aims to review the evidence supporting the implementation of diagnostic imaging with a focus on ultrasound at primary diagnostic workup of cervical cancer.
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Affiliation(s)
- Daniela Fischerova
- Gynecologic Oncology Centre, Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic; (F.F.); (D.C.)
| | - Filip Frühauf
- Gynecologic Oncology Centre, Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic; (F.F.); (D.C.)
| | - Andrea Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic;
| | - Ingfrid S. Haldorsen
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of Radiology, Haukeland University Hospital, N-5021 Bergen, Norway;
- Section for Radiology, Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
| | - Elena Gatti
- Department of Biomedical Science for Health, University of Milan, 20133 Milan, Italy;
| | - David Cibula
- Gynecologic Oncology Centre, Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic; (F.F.); (D.C.)
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5
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Weykamp F, Meixner E, Arians N, Hoegen-Saßmannshausen P, Kim JY, Tawk B, Knoll M, Huber P, König L, Sander A, Mokry T, Meinzer C, Schlemmer HP, Jäkel O, Debus J, Hörner-Rieber J. Daily AI-Based Treatment Adaptation under Weekly Offline MR Guidance in Chemoradiotherapy for Cervical Cancer 1: The AIM-C1 Trial. J Clin Med 2024; 13:957. [PMID: 38398270 PMCID: PMC10889253 DOI: 10.3390/jcm13040957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/13/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: External beam radiotherapy (EBRT) and concurrent chemotherapy, followed by brachytherapy (BT), offer a standard of care for patients with locally advanced cervical carcinoma. Conventionally, large safety margins are required to compensate for organ movement, potentially increasing toxicity. Lately, daily high-quality cone beam CT (CBCT)-guided adaptive radiotherapy, aided by artificial intelligence (AI), became clinically available. Thus, online treatment plans can be adapted to the current position of the tumor and the adjacent organs at risk (OAR), while the patient is lying on the treatment couch. We sought to evaluate the potential of this new technology, including a weekly shuttle-based 3T-MRI scan in various treatment positions for tumor evaluation and for decreasing treatment-related side effects. (2) Methods: This is a prospective one-armed phase-II trial consisting of 40 patients with cervical carcinoma (FIGO IB-IIIC1) with an age ≥ 18 years and a Karnofsky performance score ≥ 70%. EBRT (45-50.4 Gy in 25-28 fractions with 55.0-58.8 Gy simultaneous integrated boosts to lymph node metastases) will be accompanied by weekly shuttle-based MRIs. Concurrent platinum-based chemotherapy will be given, followed by 28 Gy of BT (four fractions). The primary endpoint will be the occurrence of overall early bowel and bladder toxicity CTCAE grade 2 or higher (CTCAE v5.0). Secondary outcomes include clinical feasibility, quality of life, and imaging-based response assessment.
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Affiliation(s)
- Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Nathalie Arians
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Philipp Hoegen-Saßmannshausen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Ji-Young Kim
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Bouchra Tawk
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Maximilian Knoll
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Peter Huber
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Anja Sander
- Institute of Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany
| | - Theresa Mokry
- Department of Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Clara Meinzer
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Oliver Jäkel
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site, 69120 Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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Jin Y, Zhao C, Wang L, Su Y, Shang D, Li F, Wang J, Liu X, Li J, Wang W. Target volumes comparison between postoperative simulation magnetic resonance imaging and preoperative diagnostic magnetic resonance imaging for prone breast radiotherapy after breast-conserving surgery. Cancer Med 2024; 13:e6956. [PMID: 38247382 PMCID: PMC10905334 DOI: 10.1002/cam4.6956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/27/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND This study investigated the differences in target volumes between preoperative magnetic resonance imaging (MRIpre) and postoperative MRI (MRIpost) for breast radiotherapy after breast-conserving surgery (BCS) using deformable image registration (DIR). METHODS AND MATERIALS Seventeen eligible patients who underwent whole-breast irradiation in the prone position after BCS were enrolled. On MRIpre, the gross tumor volume (GTV) was delineated as GTVpre, which was then expanded by 10 mm to represent the preoperative lumpectomy cavity (LC), denoted as LCpre. The LC was expanded to the clinical target volume (CTV) and planning target volume (PTV) on the MRIpre and MRIpost, denoted as CTVpre, CTVpost, PTVpre, and PTVpost, respectively. The MIM software system was used to register the MRIpre and MRIpost using DIR. Differences were evaluated regarding target volume, distance between the centers of mass (dCOM), conformity index (CI), and degree of inclusion (DI). The relationship between CILC /CIPTV and the clinical factors was also assessed. RESULTS Significant differences were observed in LC and PTV volumes between MRIpre and MRIpost (p < 0.0001). LCpre was 0.85 cm3 larger than LCpost, while PTVpre was 29.38 cm3 smaller than PTVpost. The dCOM between LCpre and LCpost was 1.371 cm, while that between PTVpre and PTVpost reduced to 1.348 cm. There were statistically significant increases in CI and DI for LCpost-LCpre and PTVpost-PTVpre (CI = 0.221, 0.470; DI = 0.472, 0.635). No obvious linear correlations (p > 0.05) were found between CI and GTV, primary tumor volume-to-breast volume ratio, distance from the primary tumor to the nipple and chest wall, and body mass index. CONCLUSIONS Despite using DIR technology, the spatial correspondence of target volumes between MRIpre and MRIpost was suboptimal. Therefore, relying solely on preoperative diagnostic MRI with DIR for postoperative LC delineation is not recommended.
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Affiliation(s)
- Ying Jin
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Changhui Zhao
- Department of Oncology, Jinan Third People's HospitalJinan Cancer HospitalJinanChina
| | - Lizhen Wang
- Department of Medical Physics, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Ya Su
- Department of Medical Physics, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Dongping Shang
- Department of Medical Physics, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Fengxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Jinzhi Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Xijun Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
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7
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Salzillo TC, Dresner MA, Way A, Wahid KA, McDonald BA, Mulder S, Naser MA, He R, Ding Y, Yoder A, Ahmed S, Corrigan KL, Manzar GS, Andring L, Pinnix C, Stafford RJ, Mohamed ASR, Christodouleas J, Wang J, Fuller CD. Development and implementation of optimized endogenous contrast sequences for delineation in adaptive radiotherapy on a 1.5T MR-linear-accelerator: a prospective R-IDEAL stage 0-2a quantitative/qualitative evaluation of in vivo site-specific quality-assurance using a 3D T2 fat-suppressed platform for head and neck cancer. J Med Imaging (Bellingham) 2023; 10:065501. [PMID: 37937259 PMCID: PMC10627232 DOI: 10.1117/1.jmi.10.6.065501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023] Open
Abstract
Purpose To improve segmentation accuracy in head and neck cancer (HNC) radiotherapy treatment planning for the 1.5T hybrid magnetic resonance imaging/linear accelerator (MR-Linac), three-dimensional (3D), T2-weighted, fat-suppressed magnetic resonance imaging sequences were developed and optimized. Approach After initial testing, spectral attenuated inversion recovery (SPAIR) was chosen as the fat suppression technique. Five candidate SPAIR sequences and a nonsuppressed, T2-weighted sequence were acquired for five HNC patients using a 1.5T MR-Linac. MR physicists identified persistent artifacts in two of the SPAIR sequences, so the remaining three SPAIR sequences were further analyzed. The gross primary tumor volume, metastatic lymph nodes, parotid glands, and pterygoid muscles were delineated using five segmentors. A robust image quality analysis platform was developed to objectively score the SPAIR sequences on the basis of qualitative and quantitative metrics. Results Sequences were analyzed for the signal-to-noise ratio and the contrast-to-noise ratio and compared with fat and muscle, conspicuity, pairwise distance metrics, and segmentor assessments. In this analysis, the nonsuppressed sequence was inferior to each of the SPAIR sequences for the primary tumor, lymph nodes, and parotid glands, but it was superior for the pterygoid muscles. The SPAIR sequence that received the highest combined score among the analysis categories was recommended to Unity MR-Linac users for HNC radiotherapy treatment planning. Conclusions Our study led to two developments: an optimized, 3D, T2-weighted, fat-suppressed sequence that can be disseminated to Unity MR-Linac users and a robust image quality analysis pathway that can be used to objectively score SPAIR sequences and can be customized and generalized to any image quality optimization protocol. Improved segmentation accuracy with the proposed SPAIR sequence will potentially lead to improved treatment outcomes and reduced toxicity for patients by maximizing the target coverage and minimizing the radiation exposure of organs at risk.
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Affiliation(s)
- Joint Head and Neck Radiotherapy-MRI Development Cooperative
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
- Philips Healthcare, Cleveland, Ohio, United States
- MD Anderson Cancer Center, Radiation Physics, Houston, Texas, United States
- MD Anderson Cancer Center, Imaging Physics, Houston, Texas, United States
- Elekta AB, Stockholm, Sweden
| | - Travis C. Salzillo
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
| | | | - Ashley Way
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
| | - Kareem A. Wahid
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
| | - Brigid A. McDonald
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
| | - Sam Mulder
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
| | - Mohamed A. Naser
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
| | - Renjie He
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
| | - Yao Ding
- MD Anderson Cancer Center, Radiation Physics, Houston, Texas, United States
| | - Alison Yoder
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
| | - Sara Ahmed
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
| | - Kelsey L. Corrigan
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
| | - Gohar S. Manzar
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
| | - Lauren Andring
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
| | - Chelsea Pinnix
- MD Anderson Cancer Center, Radiation Oncology, Houston, Texas, United States
| | - R. Jason Stafford
- MD Anderson Cancer Center, Imaging Physics, Houston, Texas, United States
| | | | | | - Jihong Wang
- MD Anderson Cancer Center, Radiation Physics, Houston, Texas, United States
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8
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Lakhman Y, Aherne EA, Jayaprakasam VS, Nougaret S, Reinhold C. Staging of Cervical Cancer: A Practical Approach Using MRI and FDG PET. AJR Am J Roentgenol 2023; 221:633-648. [PMID: 37459457 DOI: 10.2214/ajr.23.29003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
This review provides a practical approach to the imaging evaluation of patients with cervical cancer (CC), from initial diagnosis to restaging of recurrence, focusing on MRI and FDG PET. The primary updates to the International Federation of Gynecology and Obstetrics (FIGO) CC staging system, as well as these updates' relevance to clinical management, are discussed. The recent literature investigating the role of MRI and FDG PET in CC staging and image-guided brachytherapy is summarized. The utility of MRI and FDG PET in response assessment and posttreatment surveillance is described. Important findings on MRI and FDG PET that interpreting radiologists should recognize and report are illustrated. The essential elements of structured reports during various phases of CC management are outlined. Special considerations, including the role of imaging in patients desiring fertility-sparing management, differentiation of CC and endometrial cancer, and unusual CC histologies, are also described. Finally, future research directions including PET/MRI, novel PET tracers, and artificial intelligence applications are highlighted.
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Affiliation(s)
- Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Emily A Aherne
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Vetri Sudar Jayaprakasam
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, Montpellier, France
- Pinkcc Lab, IRCM, Montpellier, France
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, QC, Canada
- Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, QC, Canada
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9
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Lupinelli M, Sbarra M, Kilcoyne A, Venkatesan AM, Nougaret S. MR Imaging of Gynecologic Tumors: Pearls, Pitfalls, and Tumor Mimics. Radiol Clin North Am 2023; 61:687-711. [PMID: 37169432 DOI: 10.1016/j.rcl.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
MR imaging is the modality of choice for the pre-treatment evaluation of patients with gynecologic malignancies, given its excellent soft tissue contrast and multi-planar capability. However, it is not without pitfalls. Challenges can be encountered in the assessment of the infiltration of myometrium, vagina, cervical stroma, and parametria, which are crucial prognostic factors for endometrial and cervical cancers. Other challenges can be encountered in the distinction between solid and non-solid tissue and in the identification of peritoneal carcinomatosis for the sonographically indeterminate adnexal mass.
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Affiliation(s)
- Michela Lupinelli
- Department of Radiology, Morgagni-Pierantoni Hospital, Via Carlo Forlanini 34, 47121, Forlì, Italy.
| | - Martina Sbarra
- Unit of Diagnostic Imaging, Fondazione Policlinico Universitario Campus Bio-medico, Via Alvaro Del Portillo, 200, Roma 00128, Italy
| | - Aoife Kilcoyne
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Aradhana M Venkatesan
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Stephanie Nougaret
- Department of Radiology, IRCM, Montpellier Cancer Research Institute, Montpellier 34090, France; INSERM, U1194, University of Montpellier, Montpellier 34295, France
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10
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Kim NR, Kim SI, Suh DH, Kim HS, Kim K, Chung HH, No JH, Kim YB, Kim JW, Park NH, Song YS, Choi CH, Lee M. Survival outcomes of laparoscopic versus open radical hysterectomy in early cervical cancer with incidentally identified high-risk factors. Gynecol Oncol 2023; 174:224-230. [PMID: 37229880 DOI: 10.1016/j.ygyno.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Previously, we suggested that patients with cervical cancer (CC) with tumors ≤2 cm on preoperative magnetic resonance imaging (MRI) are safe candidates for laparoscopic radical hysterectomy (LRH). Here, we aim to investigate whether LRH deteriorates the prognosis of patients with incidentally identified high-risk factors; lymph node metastasis (LNM) or parametrial invasion (PMI). METHODS We identified patients with 2009 FIGO stage IB1 CC who underwent Type C LRH or open radical hysterectomy (ORH) at three tertiary hospitals between 2000 and 2019. Those with a tumor ≤2 cm on preoperative MRI who were not suspicious of LNM or PMI preoperatively were included, while those who were indicated to receive adjuvant treatment but did not actually receive it were excluded. Survival outcomes were compared between the LRH and ORH groups in the overall population, then narrowed down to those with LNM, and then to those with PMI. RESULTS In total, 498 patients were included: 299 in the LRH group and 199 in the ORH group. The LRH and ORH groups showed similar 3-year progression-free survival (PFS) (94.0% vs. 93.6%; P = 0.615) and 5-year overall survival (OS) rates (97.2% vs. 96.8%; P = 0.439). On pathologic examination, 49 (9.8%) and 16 (3.2%) patients had LNM and PMI, respectively, and 10 (2.0%) had both. In the LNM subgroup, 5-year PFS rate was not significantly different between the LRH and ORH groups (73.2% vs. 91.7%; P = 0.169). In the PMI subgroup, no difference in PFS was observed between the two groups (P = 0.893). CONCLUSIONS LRH might not deteriorate recurrence and mortality rates in CC patients with tumors ≤2 cm when adjuvant treatment is appropriately administered, even if pathologic LNM and PMI are incidentally identified.
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Affiliation(s)
- Nae Ry Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Noh Hyun Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong-Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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11
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Zhang Z, Zhang N, Cheng G. Application of three-dimensional multi-imaging combination in brachytherapy of cervical cancer. LA RADIOLOGIA MEDICA 2023; 128:588-600. [PMID: 37138200 DOI: 10.1007/s11547-023-01632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Three-dimensional (3D) imaging has an important role in brachytherapy and the treatment of cervical cancer. The main imaging methods used in the cervical cancer brachytherapy include magnetic resonance imaging (MRI), computer tomography (CT), ultrasound (US), and positron emission tomography (PET). However, single-imaging methods have certain limitations compared to multi-imaging. The application of multi-imaging can make up for the shortcomings and provide a more suitable imaging selection for brachytherapy. PURPOSE This review details the situation and scope of existing multi-imaging combination methods in cervical cancer brachytherapy and provides a reference for medical institutions. MATERIALS AND METHODS Searched the literature related to application of three-dimensional multi-imaging combination in brachytherapy of cervical cancer in PubMed/Medline and Web of Science electronic databases. Summarized the existing combined imaging methods and the application of each method in cervical cancer brachytherapy. CONCLUSION The current imaging combination methods mainly include MRI/CT, US/CT, MRI/US, and MRI/PET. The combination of two imaging tools can be used for applicator implantation guidance, applicator reconstruction, target and organs at risk (OAR) contouring, dose optimization, prognosis evaluation, etc., which provides a more suitable imaging choice for brachytherapy.
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Affiliation(s)
- Zhaoming Zhang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China
| | - Ning Zhang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China
| | - Guanghui Cheng
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China.
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12
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Wenzel HHB, Hardie AN, Moncada-Torres A, Høgdall CK, Bekkers RLM, Falconer H, Jensen PT, Nijman HW, van der Aa MA, Martin F, van Gestel AJ, Lemmens VEPP, Dahm-Kähler P, Alfonzo E, Persson J, Ekdahl L, Salehi S, Frøding LP, Markauskas A, Fuglsang K, Schnack TH. A federated approach to identify women with early-stage cervical cancer at low risk of lymph node metastases. Eur J Cancer 2023; 185:61-68. [PMID: 36965329 DOI: 10.1016/j.ejca.2023.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE Lymph node metastases (pN+) in presumed early-stage cervical cancer negatively impact prognosis. Using federated learning, we aimed to develop a tool to identify a group of women at low risk of pN+, to guide the shared decision-making process concerning the extent of lymph node dissection. METHODS Women with cervical cancer between 2005 and 2020 were identified retrospectively from population-based registries: the Danish Gynaecological Cancer Database, Swedish Quality Registry for Gynaecologic Cancer and Netherlands Cancer Registry. Inclusion criteria were: squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma; The International Federation of Gynecology and Obstetrics 2009 IA2, IB1 and IIA1; treatment with radical hysterectomy and pelvic lymph node assessment. We applied privacy-preserving federated logistic regression to identify risk factors of pN+. Significant factors were used to stratify the risk of pN+. RESULTS We included 3606 women (pN+ 11%). The most important risk factors of pN+ were lymphovascular space invasion (LVSI) (odds ratio [OR] 5.16, 95% confidence interval [CI], 4.59-5.79), tumour size 21-40 mm (OR 2.14, 95% CI, 1.89-2.43) and depth of invasion>10 mm (OR 1.81, 95% CI, 1.59-2.08). A group of 1469 women (41%)-with tumours without LVSI, tumour size ≤20 mm, and depth of invasion ≤10 mm-had a very low risk of pN+ (2.4%, 95% CI, 1.7-3.3%). CONCLUSION Early-stage cervical cancer without LVSI, a tumour size ≤20 mm and depth of invasion ≤10 mm, confers a low risk of pN+. Based on an international privacy-preserving analysis, we developed a useful tool to guide the shared decision-making process regarding lymph node dissection.
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Affiliation(s)
- Hans H B Wenzel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
| | - Anna N Hardie
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Arturo Moncada-Torres
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Claus K Høgdall
- Department of Gynaecology, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ruud L M Bekkers
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Henrik Falconer
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Pernille T Jensen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hans W Nijman
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Maaike A van der Aa
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Frank Martin
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Anna J van Gestel
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Valery E P P Lemmens
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital and Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emilia Alfonzo
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital and Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital and Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden
| | - Linnea Ekdahl
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital and Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, Lund, Sweden
| | - Sahar Salehi
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ligita P Frøding
- Department of Gynaecology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Katrine Fuglsang
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Tine H Schnack
- Department of Gynaecology, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Gynaecology, Odense University Hospital, Odense, Denmark
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Mao P, Zhang C, Wang X, Yang H. Copious vaginal discharge finally diagnosed as cervical adenocarcinoma: A case report. Medicine (Baltimore) 2023; 102:e33614. [PMID: 37083792 PMCID: PMC10118343 DOI: 10.1097/md.0000000000033614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
RATIONALE Copious vaginal discharge is a frequent manifestation of reproductive tract infections. However, when little effect can obtain treated as vaginitis, cervical disease should be highly suspected. PATIENT CONCERNS A 41-year-old woman had suffering from abnormally increased vaginal discharge without any other signs of discomfort for the past 4 years. A lot of medical examinations and treatment of vaginosis were administered, resulting in unclear diagnosis and little effect. DIAGNOSES Cervical adenocarcinoma. INTERVENTIONS Gynecological examination, vaginal microbiome culture, and primary cervical cancer screening were negative, and a positron emission tomography revealed an increased 18F-fluorodeoxyglucose metabolism in the local cervix. After a thorough description, the patient demanded a hysterectomy and bilateral salpingo-oophorectomy. OUTCOMES Histopathological evaluation confirmed adenocarcinoma in situ of the uterine cervix. LESSONS The correct diagnosis of symptomatic patients with increased vaginal discharge is challenging. Human papillomavirus-negative patients presenting profuse watery vaginal discharge with an abnormal signal of cervix lesion on positron emission tomography or magnetic resonance imaging should be alert to cervical adenocarcinoma. Deep-seated cervical biopsy, conization, or even hysterectomy is conducive to early diagnosis, treatment and improvement of prognosis.
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Affiliation(s)
- Peiyu Mao
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chen Zhang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xinyan Wang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huadi Yang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Shang F, Tan Z, Gong T, Tang X, Sun H, Liu S. Evaluation of parametrial infiltration in patients with IB-IIB cervical cancer by a radiomics model integrating features from tumoral and peritumoral regions in 18 F-fluorodeoxy glucose positron emission tomography/MR images. NMR IN BIOMEDICINE 2023:e4945. [PMID: 37012600 DOI: 10.1002/nbm.4945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/03/2023] [Accepted: 03/26/2023] [Indexed: 06/19/2023]
Abstract
Parametrial infiltration (PMI) is an essential factor in staging and planning treatment of cervical cancer. The purpose of this study was to develop a radiomics model for accessing PMI in patients with IB-IIB cervical cancer using features from 18 F-fluorodeoxy glucose (18 F-FDG) positron emission tomography (PET)/MR images. In this retrospective study, 66 patients with International Federation of Gynecology and Obstetrics stage IB-IIB cervical cancer (22 with PMI and 44 without PMI) who underwent 18 F-FDG PET/MRI were divided into a training dataset (n = 46) and a testing dataset (n = 20). Features were extracted from both the tumoral and peritumoral regions in 18 F-FDG PET/MR images. Single-modality and multimodality radiomics models were developed with random forest to predict PMI. The performance of the models was evaluated with F1 score, accuracy, and area under the curve (AUC). The Kappa test was used to observe the differences between PMI evaluated by radiomics-based models and pathological results. The intraclass correlation coefficient for features extracted from each region of interest (ROI) was measured. Three-fold crossvalidation was conducted to confirm the diagnostic ability of the features. The radiomics models developed by features from the tumoral region in T2 -weighted images (F1 score = 0.400, accuracy = 0.700, AUC = 0.708, Kappa = 0.211, p = 0.329) and the peritumoral region in PET images (F1 score = 0.533, accuracy = 0.650, AUC = 0.714, Kappa = 0.271, p = 0.202) achieved the best performances in the testing dataset among the four single-ROI radiomics models. The combined model using features from the tumoral region in T2 -weighted images and the peritumoral region in PET images achieved the best performance (F1 score = 0.727, accuracy = 0.850, AUC = 0.774, Kappa = 0.625, p < 0.05). The results suggest that 18 F-FDG PET/MRI can provide complementary information regarding cervical cancer. The radiomics-based method integrating features from the tumoral and peritumoral regions in 18 F-FDG PET/MR images gave a superior performance for evaluating PMI.
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Affiliation(s)
- Fei Shang
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Zheng Tan
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Tan Gong
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Xiaoying Tang
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Hongzan Sun
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuai Liu
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, China
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Gashu C, Tasfa B, Alemu C, Kassa Y. Assessing survival time of outpatients with cervical cancer: at the university of Gondar referral hospital using the Bayesian approach. BMC Womens Health 2023; 23:59. [PMID: 36765315 PMCID: PMC9921662 DOI: 10.1186/s12905-023-02202-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Cervical cancer is the 4th most common cancer in women worldwide. as well as the 4th most common cause of cancer-related death. The main objective of this study was to identify factors that affect the survival time of outpatients with cervical cancer. METHODS A retrolective study including outpatients with cervical cancer was carried out in a hospital. To achieve the aim, 322 outpatients with cervical cancer were included in the study based on the data taken from the medical records of patients enrolled from May 15, 2018, to May 15, 2022, at the University of Gondar referral hospital, Gondar, Ethiopia. The Kaplan-Meier plots and log-rank test were used for the comparison of survival functions; the Cox-PH model and Bayesian parametric survival models were used to analyze the survival times of outpatients with cervical cancer. Integrated nested Laplace approximation methods have been applied. RESULTS Out of a total of 322 patients, 118 (36.6%) died as outpatients. The estimated median survival time for patients was 42 months. Using model selection criteria, the Bayesian log-normal accelerated failure time model was found to be appropriate. According to the results of this model, oral contraceptive use, HIV, stage, grade, co-morbid disease, history of abortion, weight, histology type, FIGO stage, radiation, chemotherapy, LVSI, metastatic number, regional nodes examined, and tumor size all have a significant impact on the survival time of outpatients with cervical cancer. The Bayesian log-normal accelerated failure time model accurately predicted the survival time of cervical cancer outpatients. CONCLUSIONS The findings of this study suggested that reductions in weight, treatment, the presence of comorbid disease, the presence of HIV, squamous cell histology type, having a history of abortion, oral contraceptive use, a large tumor size, an increase in the International Federation of Gynecologists and Obstetricians stage, an increase in metastasis number, an increase in grade, positive regional nodes, lymphatic vascular space invasion, and late stages of cancer all shortened the survival time of cervical cancer outpatients.
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Affiliation(s)
- Chalachew Gashu
- Department of Statistics, College of Natural and Computational Science, Oda Bultum University, Chiro, Ethiopia.
| | - Buzuneh Tasfa
- Department of Epidemiology, Faculty of Public Health, Jima University, Jima, Ethiopia
| | - Chekol Alemu
- Department of Statistics, College of Natural and Computational Science, Gambella University, Gambella, Ethiopia
| | - Yoseph Kassa
- Department of Statistics, College of Natural and Computational Science, Oda Bultum University, Chiro, Ethiopia
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Smits A, Steins M, van Koeverden S, Rundle S, Dekker H, Zusterzeel P. Can MRI Be Used as a Sole Diagnostic Modality in Determining Clinical Stage in Cervical Cancer? Oncologist 2022; 28:e19-e25. [PMID: 36250801 PMCID: PMC9847530 DOI: 10.1093/oncolo/oyac210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/15/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The objective of this study was to compare staging by MRI to clinical staging in patients with cervical cancer and to determine the histological accuracy of staging by MRI and examination under anesthesia (EUA) in early stage disease. METHODS This was a retrospective cohort study of patients diagnosed with cervical cancer between 2010 and 2020 at the Radboud University Medical Centre, the Netherlands. Pretreatment stage (FIGO 2009) by MRI was compared with staging by EUA. Diagnostic accuracy in terms of sensitivity, specificity, positive, and negative predictive value was calculated for MRI and EUA in patients undergoing surgery (early stage disease) with histological results as a reference standard. RESULTS A total of 358 patients were included in the study and MRI-based stage differed from EUA stage in 30.7%. In 12.3% this meant a discrepancy in treatment assignment between MRI and EUA. Diagnostic accuracy of MRI in terms of sensitivity and specificity for detecting early stage disease was comparable to EUA in surgical patients. Further analyses showed that premenopausal status, early stage disease and a tumor diameter of <2 cm were associated with improved comparability of MRI and EUA (98%). CONCLUSION There is still a large discrepancy between MRI and EUA. In patients with suspected early stage disease, diagnostic accuracy of MRI is similar to EUA, especially for premenopausal women with early stage disease and a tumor diameter of <2 cm.
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Affiliation(s)
- Anke Smits
- Corresponding author: Anke Smits, PhD, Department Gynecological Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. Tel: +31243614726; E-mail:
| | - Maud Steins
- Department of Gynecological Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Stuart Rundle
- Department of Gynecological Oncology, Queen Elizabeth Hospital, Gateshead, United Kingdom
| | - Heleen Dekker
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petra Zusterzeel
- Department of Gynecological Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
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17
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Sertic M, Kilcoyne A, Catalano OA, Lee SI. Quantitative imaging of uterine cancers with diffusion-weighted MRI and 18-fluorodeoxyglucose PET/CT. Abdom Radiol (NY) 2022; 47:3174-3188. [PMID: 34302185 DOI: 10.1007/s00261-021-03218-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 01/18/2023]
Abstract
Imaging plays an important role in the diagnosis and treatment of women with uterine cervical and endometrial cancers. Quantitative imaging, through MRI, PET/CT, and hybrid PET/MRI, allows for characterization of primary tumors beyond anatomic and qualitative descriptors. MRI diffusion-weighted imaging (DWI) yields an apparent diffusion coefficient (ADC), which can be applied in both the pre-and post-treatment assessment of uterine tumors. PET/CT assesses metabolic activity, and measurement of tumor standardized uptake value (SUV) is a useful metric in the staging of uterine malignancies. Hybrid PET/MRI is an emerging modality that combines the soft tissue contrast of MRI with the molecular imaging capability of PET. This review provides an overview of these quantitative imaging modalities, and their current and potential roles in the assessment of uterine cervical and cancer.
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Affiliation(s)
- Madeleine Sertic
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Aoife Kilcoyne
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Onofrio Antonio Catalano
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Gou S, Xu Y, Yang H, Tong N, Zhang X, Wei L, Zhao L, Zheng M, Liu W. Automated cervical tumor segmentation on MR images using multi-view feature attention network. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Zabihollahy F, Viswanathan AN, Schmidt EJ, Lee J. Fully automated segmentation of clinical target volume in cervical cancer from magnetic resonance imaging with convolutional neural network. J Appl Clin Med Phys 2022; 23:e13725. [PMID: 35894782 PMCID: PMC9512359 DOI: 10.1002/acm2.13725] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/25/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Contouring clinical target volume (CTV) from medical images is an essential step for radiotherapy (RT) planning. Magnetic resonance imaging (MRI) is used as a standard imaging modality for CTV segmentation in cervical cancer due to its superior soft-tissue contrast. However, the delineation of CTV is challenging as CTV contains microscopic extensions that are not clearly visible even in MR images, resulting in significant contour variability among radiation oncologists depending on their knowledge and experience. In this study, we propose a fully automated deep learning-based method to segment CTV from MR images. METHODS Our method begins with the bladder segmentation, from which the CTV position is estimated in the axial view. The superior-inferior CTV span is then detected using an Attention U-Net. A CTV-specific region of interest (ROI) is determined, and three-dimensional (3-D) blocks are extracted from the ROI volume. Finally, a CTV segmentation map is computed using a 3-D U-Net from the extracted 3-D blocks. RESULTS We developed and evaluated our method using 213 MRI scans obtained from 125 patients (183 for training, 30 for test). Our method achieved (mean ± SD) Dice similarity coefficient of 0.85 ± 0.03 and the 95th percentile Hausdorff distance of 3.70 ± 0.35 mm on test cases, outperforming other state-of-the-art methods significantly (p-value < 0.05). Our method also produces an uncertainty map along with the CTV segmentation by employing the Monte Carlo dropout technique to draw physician's attention to the regions with high uncertainty, where careful review and manual correction may be needed. CONCLUSIONS Experimental results show that the developed method is accurate, fast, and reproducible for contouring CTV from MRI, demonstrating its potential to assist radiation oncologists in alleviating the burden of tedious contouring for RT planning in cervical cancer.
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Affiliation(s)
- Fatemeh Zabihollahy
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Akila N. Viswanathan
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Ehud J. Schmidt
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Junghoon Lee
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Jacobsen MC, Beriwal S, Dyer BA, Klopp AH, Lee SI, McGinnis GJ, Robbins JB, Rauch GM, Sadowski EA, Simiele SJ, Stafford RJ, Taunk NK, Yashar CM, Venkatesan AM. Contemporary image-guided cervical cancer brachytherapy: Consensus imaging recommendations from the Society of Abdominal Radiology and the American Brachytherapy Society. Brachytherapy 2022; 21:369-388. [PMID: 35725550 DOI: 10.1016/j.brachy.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/15/2022] [Accepted: 04/24/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To present recommendations for the use of imaging for evaluation and procedural guidance of brachytherapy for cervical cancer patients. METHODS An expert panel comprised of members of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease Focused Panel and the American Brachytherapy Society jointly assessed the existing literature and provide data-driven guidance on imaging protocol development, interpretation, and reporting. RESULTS Image-guidance during applicator implantation reduces rates of uterine perforation by the tandem. Postimplant images may be acquired with radiography, computed tomography (CT), or magnetic resonance imaging (MRI), and CT or MRI are preferred due to a decrease in severe complications. Pre-brachytherapy T2-weighted MRI may be used as a reference for contouring the high-risk clinical target volume (HR-CTV) when CT is used for treatment planning. Reference CT and MRI protocols are provided for reference. CONCLUSIONS Image-guided brachytherapy in locally advanced cervical cancer is essential for optimal patient management. Various imaging modalities, including orthogonal radiographs, ultrasound, computed tomography, and magnetic resonance imaging, remain integral to the successful execution of image-guided brachytherapy.
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Affiliation(s)
- Megan C Jacobsen
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX
| | - Sushil Beriwal
- Allegheny Health Network, Department of Radiation Oncology, Pittsburgh, PA; Varian Medical Systems, Palo Alto, CA
| | - Brandon A Dyer
- Legacy Health, Department of Radiation Oncology, Portland, OR
| | - Ann H Klopp
- The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX
| | - Susanna I Lee
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | - Gwendolyn J McGinnis
- The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX
| | | | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Department of Abdominal Imaging, Houston, TX
| | | | - Samantha J Simiele
- The University of Texas MD Anderson Cancer Center, Department of Radiation Physics, Houston, TX
| | - R Jason Stafford
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX
| | - Neil K Taunk
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA
| | - Catheryn M Yashar
- University of California San Diego, Department of Radiation Oncology, San Diego, CA
| | - Aradhana M Venkatesan
- The University of Texas MD Anderson Cancer Center, Department of Abdominal Imaging, Houston, TX.
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21
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Predicting the rate of adjuvant postoperative chemo/radiation in cervical cancer with tumor size ≥2 cm and <4 cm: An Israeli Gynecologic Oncology Group study. Surg Oncol 2022; 42:101777. [DOI: 10.1016/j.suronc.2022.101777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/02/2022] [Accepted: 04/18/2022] [Indexed: 11/23/2022]
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22
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Pang SS, Murphy M, Markham MJ. Current Management of Locally Advanced and Metastatic Cervical Cancer in the United States. JCO Oncol Pract 2022; 18:417-422. [PMID: 35286157 DOI: 10.1200/op.21.00795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite decreases in incidence in the twentieth century, cervical cancer continues to be a highly morbid disease in the United States. For those diagnosed with locally advanced disease, single-agent cisplatin-based chemotherapy concurrent with radiation remains the mainstay of treatment. For patients with metastatic, progressive, and recurrent disease, treatment typically consists of combination chemotherapy and incorporation of bevacizumab, and recent data show benefits with the addition of upfront immunotherapy in women whose cancer expresses programmed death ligand-1. The physical sequelae of locally advanced cervical cancer treatments stem largely from irradiation of the pelvis, and treatment of these is aimed at identifying reversible or treatable causes of symptoms and palliating those with irreversible causes. From a psychologic standpoint, patients with cervical cancer face the stigma of having a preventable cancer caused by a sexually transmitted infection and the ramifications of sexual dysfunction. Clinicians must invite honest dialogue to be able to address specific survivorship issues.
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Affiliation(s)
- Shiyi Sarah Pang
- Division of Hematology & Oncology, University of Florida College of Medicine, Gainesville, FL
| | - Martina Murphy
- Division of Hematology & Oncology, University of Florida College of Medicine, Gainesville, FL
| | - Merry J Markham
- Division of Hematology & Oncology, University of Florida College of Medicine, Gainesville, FL
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Cao Y, Vassantachart A, Ragab O, Bian S, Mitra P, Xu Z, Gallogly AZ, Cui J, Shen ZL, Balik S, Gribble M, Chang EL, Fan Z, Yang W. Automatic segmentation of high-risk clinical target volume for tandem-and-ovoids brachytherapy patients using an asymmetric dual-path convolutional neural network. Med Phys 2022; 49:1712-1722. [PMID: 35080018 PMCID: PMC9170543 DOI: 10.1002/mp.15490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSES Preimplant diagnostic magnetic resonance imaging is the gold standard for image-guided tandem-and-ovoids (T&O) brachytherapy for cervical cancer. However, high dose rate brachytherapy planning is typically done on postimplant CT-based high-risk clinical target volume (HR-CTVCT ) because the transfer of preimplant Magnetic resonance (MR)-based HR-CTV (HR-CTVMR ) to the postimplant planning CT is difficult due to anatomical changes caused by applicator insertion, vaginal packing, and the filling status of the bladder and rectum. This study aims to train a dual-path convolutional neural network (CNN) for automatic segmentation of HR-CTVCT on postimplant planning CT with guidance from preimplant diagnostic MR. METHODS Preimplant T2-weighted MR and postimplant CT images for 65 (48 for training, eight for validation, and nine for testing) patients were retrospectively solicited from our institutional database. MR was aligned to the corresponding CT using rigid registration. HR-CTVCT and HR-CTVMR were manually contoured on CT and MR by an experienced radiation oncologist. All images were then resampled to a spatial resolution of 0.5 × 0.5 × 1.25 mm. A dual-path 3D asymmetric CNN architecture with two encoding paths was built to extract CT and MR image features. The MR was masked by HR-CTVMR contour while the entire CT volume was included. The network put an asymmetric weighting of 18:6 for CT: MR. Voxel-based dice similarity coefficient (DSCV ), sensitivity, precision, and 95% Hausdorff distance (95-HD) were used to evaluate model performance. Cross-validation was performed to assess model stability. The study cohort was divided into a small tumor group (<20 cc), medium tumor group (20-40 cc), and large tumor group (>40 cc) based on the HR-CTVCT for model evaluation. Single-path CNN models were trained with the same parameters as those in dual-path models. RESULTS For this patient cohort, the dual-path CNN model improved each of our objective findings, including DSCV , sensitivity, and precision, with an average improvement of 8%, 7%, and 12%, respectively. The 95-HD was improved by an average of 1.65 mm compared to the single-path model with only CT images as input. In addition, the area under the curve for different networks was 0.86 (dual-path with CT and MR) and 0.80 (single-path with CT), respectively. The dual-path CNN model with asymmetric weighting achieved the best performance with DSCV of 0.65 ± 0.03 (0.61-0.70), 0.79 ± 0.02 (0.74-0.85), and 0.75 ± 0.04 (0.68-0.79) for small, medium, and large group. 95-HD were 7.34 (5.35-10.45) mm, 5.48 (3.21-8.43) mm, and 6.21 (5.34-9.32) mm for the three size groups, respectively. CONCLUSIONS An asymmetric CNN model with two encoding paths from preimplant MR (masked by HR-CTVMR ) and postimplant CT images was successfully developed for automatic segmentation of HR-CTVCT for T&O brachytherapy patients.
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Affiliation(s)
- Yufeng Cao
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - April Vassantachart
- Department of Radiation Oncology, LAC+USC Medical Center, Los Angeles, California, USA
| | - Omar Ragab
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Shelly Bian
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Priya Mitra
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Zhengzheng Xu
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Audrey Zhuang Gallogly
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jing Cui
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Zhilei Liu Shen
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Salim Balik
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael Gribble
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Eric L. Chang
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Zhaoyang Fan
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Wensha Yang
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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3D-Image-Guided Multi-Catheter Interstitial Brachytherapy for Bulky and High-Risk Stage IIB-IVB Cervical Cancer. Cancers (Basel) 2022; 14:cancers14051257. [PMID: 35267565 PMCID: PMC8909688 DOI: 10.3390/cancers14051257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The prognosis of locally advanced cervical cancer still remains poor. Recently, image-guided brachytherapy ameliorated local control and pelvic control in these patients. Additionally, concurrent chemoradiotherapy with interstitial brachytherapy (ISBT) demonstrated more favorable outcomes than that with intracavity brachytherapy. The purpose of our study was to evaluate the efficacy and safety of CT-MRI-guided multi-catheter ISBT for bulky (≥4 cm) and high-risk stage IIB-IVB cervical cancer. Total of 18 patients with squamous cell carcinoma received concurrent chemoradiotherapy with ISBT were assessed. Four (22.2%), seven (38.9%), and seven (38.9%) patients were diagnosed with stage II, III, and IV cervical cancer, respectively. The four-year local control, pelvic control, disease-free survival, and overall survival rates were 100%, 100%, 81.6%, and 87.8%, respectively. Although three (16.7%) patients experienced grade 3 late adverse events, no one had procedure-related complications. CT-MRI-guided multi-catheter ISBT could be a promising treatment strategy for locally advanced cervical cancer. Abstract This study aimed to evaluate the efficacy and safety of computed tomography-magnetic resonance imaging (CT-MRI)-guided multi-catheter interstitial brachytherapy for patients with bulky (≥4 cm) and high-risk, stage IIB–IVB advanced cervical cancer. Eighteen patients who underwent concurrent chemoradiotherapy with multi-catheter interstitial brachytherapy between September 2014 and August 2020 were enrolled. The prescribed dose of external beam radiotherapy was 45–50.4 Gy, and the brachytherapy high-dose-rate aim was 25–30 Gy per 5 fractions. The endpoints were four-year local and pelvic control rates, four-year disease-free and overall survival rates, and the adverse events rate. The median follow-up period was 48.4 months (9.1–87.5 months). Fifteen patients received concurrent cisplatin therapy (40 mg/m2, q1week). Four (22.2%), seven (38.9%), and seven (38.9%) patients had stage II, III, and IV cervical cancer, respectively. Pelvic and para-aortic lymph node metastases were observed in 11 (61.1%) and 2 (11.1%) patients, respectively. The median pre-treatment volume was 87.5 cm3. The four-year local control, pelvic control, disease-free survival, and overall survival rates were 100%, 100%, 81.6%, and 87.8%, respectively. Three (16.7%) patients experienced grade 3 adverse events, and none experienced grade 4–5 adverse events. CT-MRI-guided multi-catheter interstitial brachytherapy could be a promising treatment strategy for locally advanced cervical cancer.
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Seifu B, Fikru C, Yilma D, Tessema F. Predictors of time to death among cervical cancer patients at Tikur Anbesa specialized hospital from 2014 to 2019: A survival analysis. PLoS One 2022; 17:e0264369. [PMID: 35202442 PMCID: PMC8870501 DOI: 10.1371/journal.pone.0264369] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Cervical cancer (CC) is the 4th most prevalent cancer among females globally. In Ethiopia, around 7,095 new CC cases are diagnosed every year and it is the second common cause of cancer deaths in women. There is limited evidence on survival status as well as about predictors of time to death among CC patients in Ethiopia. Thus, this study investigated the five-year survival status and predictors of time to death among CC patients who had been admitted at Tikur Anbesa specialized Hospital (TASH) from 2014–2019.
Methods
Facility-based, retrospective-cohort study was conducted at Tikur Anbesa specialized Hospital among 348 patients from June 2014 to June 2019. A systematic random sampling method was employed to select the study participants. Data were extracted from the patient card, and through phone calls. The data was collected using the android version CS-Entry tool. Data was analyzed by SPSS version 23. Kaplan and Meier’s method was used to estimate survival functions and Cox-proportional hazard regression analysis was carried out in order to identify the independent predictors of time to death.
Results
The overall incidence of death was 31 per 100 person-years of follow up. The median (IQR) follow-up time of the entire cohorts was 18.55 (8.96–49.65) months. The independent predictors for time to death included; age older than 50 years [AHR: 1.4; 95% CI: 1.1–1.9], late stage of CC at diagnosis [AHR: 2.2; 95% CI: 1.7–2.9], No CC treatment [AHR: 2.1; 95% CI: 1.5–3.1] and HIV positive [AHR: 2.3; 95% CI: 1.4–3.8].
Conclusion and recommendation
The death rate of CC patients was high. The significant predictors associated with shorten time to death of CC patients were older age, advanced cancer stage at diagnosis, HIV infection and not receiving cancer treatment. Therefore, improving early detection and initiation of treatment for all CC patients is necessary in order to improve patient’s survival status. The government needs to strengthen the routine CC screening programs to address high-risk women such as elderly and HIV positive women in Ethiopia.
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Affiliation(s)
- Benyam Seifu
- Collage of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
- * E-mail:
| | - Chaltu Fikru
- Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Delelegn Yilma
- College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Fasil Tessema
- Faculty of Public Health, Jimma University, Jimma, Ethiopia
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The Fusion of MRI and CT in the Planning of Brachytherapy for Cancer of the Uterine Cervix. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: tumors of the uterine cervix are among the most common carcinomas in women. Intracervical brachytherapy is an indispensable part of curative treatment. Although the tumor is significantly more recognizable in MRI than in CT, the practical application of MRI in brachytherapy planning is still difficult. The present study examines the technical possibilities of merging CT and MRI. Materials and Methods: the treatment files and imaging of all 53 patients who had been irradiated by image-guided adaptive brachytherapy (IGABT) between January 2019 and August 2021 at the Department of Radiotherapy of the Hannover Medical School were evaluated, retrospectively. Patients were treated first with an external beam radiotherapy (EBRT) combined with simultaneous chemotherapy. After an average of 4.2 weeks, the preparation for IGABT began. The clinical target volume (CTV) for brachytherapy was contoured first in an MRI acquired before starting EBRT (MRI 1) and once more in a second MRI just before starting IGABT (MRI 2). Then, after inserting the intravaginal applicator, a CT-scan was acquired, and the CTV was contoured in the CT. Finally, the recordings of MRI 1, MRI 2, and the CT were merged, and the congruence of CTVs was quantitatively evaluated. Results: the CTV delineated in MRI 2 was, on average, 28% smaller than that in MRI 1 after an average applied radiation dose of 42 Gy. The CTV delineated in the CT covered an average of no more than 80.8% of the CTV delineated in MRI 2. The congruence of CTVs was not superior in patients with a smit sleeve in the cervical channel, with a 3D-volumetric MRI or with a contrast-enhanced sequence for MRI. Conclusion: the anatomical shape and position of the uterus is significantly changed by introducing a vaginal applicator. Despite the superior delimitability of the tumor in MRI, brachytherapy cannot be reliably planned by the image fusion of an MRI without a vaginal applicator.
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Nawapun S, Aphinives C, Srisitthiprapha W, Thamronganantasakul K, Temtanakitpaisan A. Correlation of clinical staging and MRI staging for cervical cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00544-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Background
Cervical cancer is a major public health problem for women. Accurate staging may lead to proper management of cervical cancer. We retrospectively reviewed all patients with cervical cancer who underwent pre-treatment MRI between January 2009 and December 2018 and analyzed the correlation between the clinical staging and MRI staging.
Results
Correlation of overall clinical and MRI staging by percent agreement is moderate (73.9%), but the kappa coefficient showed a slight correlation. The correlation of clinical and MRI findings in the vaginal invasion, pelvic sidewall invasion, adjacent pelvic organ invasion, and spreading to distant organ also showed moderate-to-strong correlation by percent agreement (ranging from 67.6 to 91.9%) but slight correlation between clinical and MRI examinations by kappa or weighted kappa coefficient (K = 0.000–0.128w).
Conclusion
In patients with cervical cancer, pretreatment MRI provides higher spatial soft tissue resolution which can define pelvic tumor extent, including a more accurate assessment of tumor size (due to multiplanar evaluation), parametrial invasion, pelvic sidewall invasion, and adjacent pelvic organ invasion. This could potentially lead to a reduction in staging morbidity by invasive investigation such as cystoscopy and proctoscopy.
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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] [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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Diagnostic Accuracy of Magnetic Resonance Imaging for International Federation of Gynecology and Obstetrics 2018 IB to IIB Cervical Cancer Staging: Comparison Among Magnetic Resonance Sequences and Pathologies. J Comput Assist Tomogr 2021; 45:829-836. [PMID: 34407060 DOI: 10.1097/rct.0000000000001210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate the most accurate magnetic resonance (MR) sequence for tumor detection, maximal tumor diameter, and parametrial invasion compared with histopathologic diagnoses. METHODS Fifty-one patients with International Federation of Gynecology and Obstetrics 2018 IB1 to IIB cervical cancer underwent preoperative MR imaging and surgical resection. Two radiologists independently evaluated the tumor detection, parametrial invasion, and tumor size in each of T2-weighted image, diffusion-weighted image, and contrast-enhanced T1-weighted image. Results obtained for squamous cell carcinoma (SCC) and adenocarcinoma were also compared. RESULTS Neither the tumor detection rate nor parametrial invasion was found to be significantly different among sequences. Tumor size assessment using MR imaging with pathology showed good correlation: r = 0.63-0.72. The adenocarcinoma size tended to be more underestimated than SCC in comparison with the pathologic specimen. CONCLUSIONS Cervical cancer staging by MR images showed no significant difference among T2-weighted image, diffusion-weighted image, and contrast-enhanced T1-weighted image. Adenocarcinoma was prone to be measured as smaller than the pathologic specimen compared with SCC.
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Park BK, Kim TJ. Useful MRI Findings for Minimally Invasive Surgery for Early Cervical Cancer. Cancers (Basel) 2021; 13:cancers13164078. [PMID: 34439231 PMCID: PMC8391577 DOI: 10.3390/cancers13164078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary Radical hysterectomy and lymph node dissection are extensive procedures with severe post-operative morbidities and should be avoided on patients with low risk of recurrence. Still, due to lack of good prognostic tools, radical surgery is performed on most patients with early stage cervical cancer, leading to overtreatment and unnecessary morbidities. The recent International Federation of Gynecology and Obstetrics (FIGO) staging system accepts the use of magnetic resonance imaging (MRI) in addition to physical examination. Currently, 3 Tesla (3T) MRI is available widely and, due to its high soft tissue contrast, can provide more useful information on precise estimation of tumor size and metastasis than can physical examination in patients with cervical cancer. Therefore, this imaging modality can help gynecologic oncologists to determine whether minimally invasive surgery is necessary and can be used for early detection of small recurrent cancers. Abstract According to the recent International Federation of Gynecology and Obstetrics (FIGO) staging system, Stage III cervical cancer indicates pelvic or paraaortic lymph node metastasis. Accordingly, the new FIGO stage accepts imaging modalities, such as MRI, as part of the FIGO 2018 updated staging. Magnetic resonance imaging (MRI) is the best imaging modality to estimate the size or volume of uterine cancer because of its excellent soft tissue contrast. As a result, MRI is being used increasingly to determine treatment options and follow-up for cervical cancer patients. Increasing availability of cancer screening and vaccination have improved early detection of cervical cancer. However, the incidence of early cervical cancers has increased compared to that of advanced cervical cancer. A few studies have investigated if MRI findings are useful in management of early cervical cancer. MRI can precisely predict tumor burden, allowing conization, trachelectomy, and simple hysterectomy to be considered as minimally invasive treatment options for early cervical cancer. This imaging modality also can be used to determine whether there is recurrent cancer following minimally invasive treatments. The purpose of this review is to highlight useful MRI features for managing women with early cervical cancer.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Korea
- Correspondence: (B.K.P.); (T.-J.K.); Tel.: +82-2-3410-6457 (B.K.P.); +82-2-3410-0630 (T.-J.K.)
| | - Tae-Joong Kim
- Department of Obstetrics & Gynecology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Korea
- Correspondence: (B.K.P.); (T.-J.K.); Tel.: +82-2-3410-6457 (B.K.P.); +82-2-3410-0630 (T.-J.K.)
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Musunuru HB, Pifer PM, Mohindra P, Albuquerque K, Beriwal S. Advances in management of locally advanced cervical cancer. Indian J Med Res 2021; 154:248-261. [PMID: 35142642 PMCID: PMC9131769 DOI: 10.4103/ijmr.ijmr_1047_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Globally, cervical cancer has the fourth highest cancer incidence and mortality in women. Cervical cancer is unique because it has effective prevention, screening, and treatment options. This review discusses the current cervical cancer advances with a focus on locally advanced cervical cancer. Topics discussed include diagnostic imaging principles, surgical management with adjuvant therapy and definitive concurrent chemoradiotherapy. Emphasis is given on current advances and future research directions in radiation therapy (RT) with an emphasis on three-dimensional brachytherapy, intensity-modulated RT, image-guided RT, proton RT and hyperthermia.
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Affiliation(s)
- Hima Bindu Musunuru
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Phillip M Pifer
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Maryland Proton Treatment Center, Baltimore, Maryland, USA
| | - Kevin Albuquerque
- Department of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
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Machine Learning Models to Predict Survival Outcomes According to the Surgical Approach of Primary Radical Hysterectomy in Patients with Early Cervical Cancer. Cancers (Basel) 2021; 13:cancers13153709. [PMID: 34359610 PMCID: PMC8345043 DOI: 10.3390/cancers13153709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 01/23/2023] Open
Abstract
Simple Summary An increased risk of relapse and death from minimally invasive radical hysterectomy has been reported in some patients with early cervical cancer. Thus, the development of an intuitive and precise decision-aid tool, which estimates recurrence and mortality rates by surgical approach, is necessary. To develop models predicting survival outcomes according to the surgical approach, we collected clinicopathologic and survival data of patients with 2009 FIGO stage IB cervical cancer who underwent a radical hysterectomy. Using only variables that could be obtained preoperatively, we developed various models predicting the probability of 5-year progression-free survival and overall survival. Among them, hybrid ensemble models, combined with logistic regression and multiple machine learning models, achieved the best predictive performance. The developed models are expected to help physicians’ and patients’ decision making related to the surgical approach for primary radical hysterectomy. Abstract We purposed to develop machine learning models predicting survival outcomes according to the surgical approach for radical hysterectomy (RH) in early cervical cancer. In total, 1056 patients with 2009 FIGO stage IB cervical cancer who underwent primary type C RH by either open or laparoscopic surgery were included in this multicenter retrospective study. The whole dataset consisting of patients’ clinicopathologic data was split into training and test sets with a 4:1 ratio. Using the training set, we developed models predicting the probability of 5-year progression-free survival (PFS) and overall survival (OS) with tenfold cross validation. The developed models were validated in the test set. In terms of predictive performance, we measured the area under the receiver operating characteristic curve (AUC) values. The logistic regression models comprised of preoperative variables yielded AUCs of 0.679 and 0.715 for predicting 5-year PFS and OS rates, respectively. Combining both logistic regression and multiple machine learning models, we constructed hybrid ensemble models, and these models showed much improved predictive performance, with 0.741 and 0.759 AUCs for predicting 5-year PFS and OS rates, respectively. We successfully developed models predicting disease recurrence and mortality after primary RH in patients with early cervical cancer. As the predicted value is calculated based on the preoperative factors, such as the surgical approach, these ensemble models would be useful for making decisions when choosing between open or laparoscopic RH.
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Inter-observer variations of the tumor bed delineation for patients after breast conserving surgery in preoperative magnetic resonance and computed tomography scan fusion. BMC Cancer 2021; 21:838. [PMID: 34284752 PMCID: PMC8293511 DOI: 10.1186/s12885-021-08546-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Tumor bed (TB) delineation based on preoperative magnetic resonance imaging (pre-MRI) fused with postoperative computed tomography (post-CT) were compared to post-CT only to define pre-MRI may aid in improving the accuracy of delineation. Methods and materials The pre-MRI imaging of 10 patients underwent radiotherapy (RT) after breast conserving surgery (BCS) were reviewed. Post-CT scans were acquired in the same prone position as pre-MRI. Pre-MRI and post-CT automatically match and then manual alignment was given to enhance fusion consistency. Three radiation oncologists and 2 radiologists delineated the clinical target volume (CTV) for CT-based. The gross target volume (GTV) of pre-MRI-based was determined by the volume of tumor acquired with 6 sequences: T1, T2, T2W-SPAIR, DWI, dyn-eTHRIVE and sdyn-eTHRIVE, expended 10 mm to form the CTV-pre-MRI. Planning target volume (PTV) for each sequence was determined by CTV extended 15 mm, trimmed to 3 mm from skin and the breast-chest wall interface. The variability of the TB delineation were developed as follows: the mean volume, conformity index (CI) and dice coefficient (DC). Results The mean volumes of CTV and PTV delineated with CT were all larger than those with pre-MRI. The lower inter-observer variability was observed from PTV, especially in sdyn-eTHRIVE in all sequences. For each sequence of pre-MRI, all DCs were larger than post-CT, and the largest DC was observed by sdyn-eTHRIVE sequence fusion to post-CT. The overlap for PTV was significantly improved in the pre-MRI-based compared with the CT-based. Conclusions TB volumes based on pre-MRI were smaller than post-CT with CVS increased. Pre-MRI provided a more precise definition of the TB with observers performed a smaller inter-observer variability than CT. Pre-MRI, especially in sdyn-eTHRIVE sequence, should help in reducing treatment volumes with the improved accuracy of TB delineation of adjuvant RT of breast cancer.
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Williamson CW, Liu HC, Mayadev J, Mell LK. Advances in External Beam Radiation Therapy and Brachytherapy for Cervical Cancer. Clin Oncol (R Coll Radiol) 2021; 33:567-578. [PMID: 34266728 DOI: 10.1016/j.clon.2021.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/04/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022]
Abstract
The standard of care for the definitive treatment of locoregionally advanced cervical cancer is external beam radiation therapy (EBRT) with concurrent chemotherapy followed by a brachytherapy boost. Historically, EBRT was delivered via a two-dimensional technique based primarily on bony landmarks. This gave way to three-dimensional conformal radiation therapy, which allows for dose calculation and adjustment based on individual tumour and patient anatomy. Further technological advances have established intensity-modulated radiation therapy (IMRT) as a standard treatment modality, given the ability to maintain tumoricidal doses to target volumes while reducing unwanted radiation dose to nearby critical structures, thereby reducing toxicity. Routine image guidance allows for increased confidence in patient alignment prior to treatment, and the ability to visualise the daily position of the targets and organs at risk has been instrumental in allowing safe reductions in treated volumes. Additional EBRT technologies, including proton therapy and stereotactic body radiation therapy, may further improve the therapeutic index. In the realm of brachytherapy, a shift from point-based dose planning to image-guided brachytherapy has been associated with improved local control and reduced toxicity, with additional refinement ongoing. Here we will discuss these advances, the supporting data and future directions.
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Affiliation(s)
- C W Williamson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - H C Liu
- La Jolla Center for Precision Radiation Medicine, La Jolla, California, USA
| | - J Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - L K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA; La Jolla Center for Precision Radiation Medicine, La Jolla, California, USA.
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Rosa C, Pizzi AD, Augurio A, Caravatta L, DI Tommaso M, Mincuzzi E, Cinalli S, Basilico R, Porreca A, DI Nicola M, Genovesi D. Volume Delineation in Cervical Cancer With T2 and Diffusion-weighted MRI: Agreement on Volumes Between Observers. In Vivo 2021; 34:1981-1986. [PMID: 32606170 DOI: 10.21873/invivo.11995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 01/25/2023]
Abstract
AIM To delineate cervical cancer gross tumor volume (GTV) on T2-magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) maps, assessing volumes and inter-observer agreement between two observers. PATIENTS AND METHODS A radiologist and a radiation oncologist delineated GTV on T2 (T2GTV) and ADC (ADCGTV) sequences. Dice similarity index (DICE) and Bland-Altman analysis were used to estimated concordance. RESULTS Mean T2GTV and ADCGTV volumes were 43.84±71.47 cc and 37.28±68.92 cc according to the radiologist, and 43.4±70.44 cc and 36.65±69.21 cc according to the radiation oncologist. ADC led to statistically significantly smaller volumes compared to T2. The mean DICE index was 0.86 for T2GTV and 0.84 for ADCGTV The Bland-Altman plots globally showed concordance. CONCLUSION GTV delineation was smaller in the ADC maps compared to T2-MRI, reaching an almost perfect agreement between observers. Thanks to this acceptable variability, adding functional imaging might provide more information for tumor delineation, improving reproducibility for image-guided adaptive radiotherapy.
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Affiliation(s)
- Consuelo Rosa
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy .,Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
| | - Andrea Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy.,Department of Radiology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Antonietta Augurio
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Luciana Caravatta
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Monica DI Tommaso
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Erica Mincuzzi
- Department of Radiology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | | | - Raffaella Basilico
- Department of Radiology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | | | - Marta DI Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy
| | - Domenico Genovesi
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
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Wassie M, Fentie B, Asefa T. Determinants of Mortality among Cervical Cancer Patients Attending in Tikur Anbessa Specialized Hospital, Ethiopia: Institutional-Based Retrospective Study. JOURNAL OF ONCOLOGY 2021; 2021:9916050. [PMID: 34239565 PMCID: PMC8233077 DOI: 10.1155/2021/9916050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Globally, about 570,000 cases and 311,000 deaths of cervical cancer occurred in 2018. It was the leading cause of cancer-related deaths among women in Africa. The global mean age at death of cervical cancer was about 59 years. This study aimed to assess the determinants of cervical cancer mortality among cervical cancer patients attending in Tikur Anbessa Specialized Hospital (TASH). METHODS Institutional-based retrospective cohort study was conducted in the oncology center of TASH, Ethiopia, from March to April 2019. Data were extracted from patients' chart using structured checklist and analyzed using Stata 14.2. Cox regression was used to identify variables that affect the outcome variable. RESULT From the total of 2045 reviewed medical records of cervical cancer patients, 1057 medical records were found to be complete and included in this study. The incidence of mortality among cervical cancer patients was 15.6/100/years. Mortality was significantly increased with advanced age (adjusted hazard ratio (AHR) = 1.02, 95% CI (1.01-1.03)), comorbidity (AHR = 1.8, 95% CI (1.39-1.89)), being anemic (AHR = 1.42, 95% CI (1.07-1.89)), advanced stage (AHR = 1.63, 95% CI (1.24-2.13)), and being substance user (AHR = 2.71, 95% CI (2.08-3.53)). CONCLUSION The study revealed that the incidence of mortality within the cohort was 15.6/100/years. Mortality was significantly increased with advanced age, anemia, advanced stage, comorbidity, and using substances. It is better to give special attention to patients with anemia, advanced age, advanced stage, comorbidity, and substance usage. In addition, expanding cervical cancer early screening will decrease the mortality of patients.
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Affiliation(s)
- Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beletech Fentie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tseganesh Asefa
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Brodeur MN, Dejean R, Beauchemin MC, Samouëlian V, Cormier B, Bacha OM, Warkus T, Barkati M. Oncologic outcomes in the era of modern radiation therapy using FIGO 2018 staging system for cervical cancer. Gynecol Oncol 2021; 162:277-283. [PMID: 34059350 DOI: 10.1016/j.ygyno.2021.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The recently published ASTRO cervical cancer guidelines recommend the use of modern radiotherapy. Imaging is now incorporated in the updated FIGO 2018 staging with a new stage IIIC. This study aims to evaluate the oncologic outcomes and predictors of survival using FIGO 2018 staging in a cohort of patients treated in an era of high-precision image-guided radiotherapy. METHODS We performed a retrospective cohort study of 216 adult cervical cancer patients treated with definitive chemoradiotherapy between 2010 and 2018. Eligible patients had non-metastatic cervical cancer treated at a single academic institution. All patients had pre-treatment MRI and CT/PET. Treatment protocol consisted of external beam intensity-modulated radiotherapy and 3D image-guided brachytherapy. Kaplan-Meier curves were used for survival analysis. Multivariate cox proportional-hazards model was performed to identify potential prognostic factors. RESULTS Median age at diagnosis was 50 and median BMI was 26.4 kg/m2. Median follow-up time was 44.3 months. Five-year overall survival (OS), disease-free survival and loco-regional disease-free survival rates were 76.8%, 68.5% and 82.6%, respectively. FIGO 2018 showed better OS discrimination compared to FIGO 2009 classification. OS was increasingly worse with positive pelvic and para-aortic nodes (p < 0.001). In a multivariate prediction model, performance status (p = 0.044) and FIGO 2018 classification (stage III p = 0.016; stage IVA p = 0.010) were predictors of mortality; FIGO 2018 classification (stage III p = 0.003; stage IVA p = 0.001) was a predictor of any recurrence; MRI tumor diameter (p ≤ 0.001) and nodal metastases (p = 0.024) were predictors of loco-regional recurrence. CONCLUSIONS Integration of state-of-the-art imaging in cervical cancer staging and in radiotherapy planning leads to good loco-regional control rates, however distant recurrence remains an important issue. FIGO 2018 staging better reflects patient prognosis, highlighting the need for new treatment strategies for stage IIIC cervical cancer.
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Affiliation(s)
| | - Romain Dejean
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Marie-Claude Beauchemin
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Vanessa Samouëlian
- Division of Gynecologic Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Béatrice Cormier
- Division of Gynecologic Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Omar Moreira Bacha
- Division of Gynecologic Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Thomas Warkus
- Division of Gynecologic Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Maroie Barkati
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.
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39
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Kido A, Nakamoto Y. Implications of the new FIGO staging and the role of imaging in cervical cancer. Br J Radiol 2021; 94:20201342. [PMID: 33989030 DOI: 10.1259/bjr.20201342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
International Federation of Gynecology and Obstetrics (FIGO) staging, which is the fundamentally important cancer staging system for cervical cancer, has changed in 2018. New FIGO staging includes considerable progress in the incorporation of imaging findings for tumour size measurement and evaluating lymph node (LN) metastasis in addition to tumour extent evaluation. MRI with high spatial resolution is expected for tumour size measurements and the high accuracy of positron emmision tomography/CT for LN evaluation. The purpose of this review is firstly review the diagnostic ability of each imaging modality with the clinical background of those two factors newly added and the current state for LN evaluation. Secondly, we overview the fundamental imaging findings with characteristics of modalities and sequences in MRI for accurate diagnosis depending on the focus to be evaluated and for early detection of recurrent tumour. In addition, the role of images in treatment response and prognosis prediction is given with the development of recent technique of image analysis including radiomics and deep learning.
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Affiliation(s)
- Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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40
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Feng Y, Wang Y, Xie Y, Wu S, Li Y, Li M. Nomograms predicting the overall survival and cancer-specific survival of patients with stage IIIC1 cervical cancer. BMC Cancer 2021; 21:450. [PMID: 33892663 PMCID: PMC8063429 DOI: 10.1186/s12885-021-08209-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/16/2021] [Indexed: 01/21/2023] Open
Abstract
Background To explore the factors that affect the prognosis of overall survival (OS) and cancer-specific survival (CSS) of patients with stage IIIC1 cervical cancer and establish nomogram models to predict this prognosis. Methods Data from patients in the Surveil-lance, Epidemiology, and End Results (SEER) programme meeting the inclusion criteria were classified into a training group, and validation data were obtained from the First Affiliated Hospital of Anhui Medical University from 2010 to 2019. The incidence, Kaplan-Meier curves, OS and CSS of patients with stage IIIC1 cervical cancer in the training group were evaluated. Nomograms were established according to the results of univariate and multivariate Cox regression models. Harrell’s C-index, calibration plots, receiver operating characteristic (ROC) curves and decision-curve analysis (DCA) were calculated to validate the prediction models. Results The incidence of pelvic lymph node metastasis, a high-risk factor for the prognosis of cervical cancer, decreased slightly over time. Eight independent prognostic variables were identified for OS, including age, race, marriage status, histology, extension range, tumour size, radiotherapy and surgery, but only seven were identified for CSS, with marriage status excluded. Nomograms of OS and CSS were established based on the results. The C-indexes for the nomograms of OS and CSS were 0.687 and 0.692, respectively, using random sampling of SEER data sets and 0.701 and 0.735, respectively, using random sampling of external data sets. The AUCs for the nomogram of OS were 0.708 and 0.705 for the SEER data sets and 0.750 and 0.750 for the external data sets, respectively. In addition, AUCs of 0.707 and 0.709 were obtained for the nomogram of CSS when validated using SEER data sets, and 0.788 and 0.785 when validated using external data sets. Calibration plots for the nomograms were almost identical to the actual observations. The DCA also indicated the value of the two models. Conclusions Eight independent prognostic variables were identified for OS. The same factors predicted CSS, with the exception of the marriage status. Both OS and CSS nomograms had good predictive and clinical application value after validation. Notably, tumour size had the largest contribution to the OS and CSS nomograms.
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Affiliation(s)
- Yifan Feng
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Ye Wang
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Yangqin Xie
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Shuwei Wu
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Yuyang Li
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Min Li
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
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Abstract
Volatolomics allows us to elucidate cell metabolic processes in real time. In particular, a volatile organic compound (VOC) excreted from our bodies may be specific for a certain disease, such that measuring this VOC may afford a simple, fast, accessible and safe diagnostic approach. Yet, finding the optimal endogenous volatile marker specific to a pathology is non-trivial because of interlaboratory disparities in sample preparation and analysis, as well as high interindividual variability. These limit the sensitivity and specificity of volatolomics and its applications in biological and clinical fields but have motivated the development of induced volatolomics. This approach aims to overcome issues by measuring VOCs that result not from an endogenous metabolite but, rather, from the pathogen-specific or metabolic-specific enzymatic metabolism of an exogenous biological or chemical probe. In this Review, we introduce volatile-compound-based probes and discuss how they can be exploited to detect and discriminate pathogenic infections, to assess organ function and to diagnose and monitor cancers in real time. We focus on cases in which labelled probes have informed us about metabolic processes and consider the potential and drawbacks of the probes for clinical trials. Beyond diagnostics, VOC-based probes may also be effective tools to explore biological processes more generally.
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Steiner A, Narva S, Rinta-Kiikka I, Hietanen S, Hynninen J, Virtanen J. Diagnostic efficiency of whole-body 18F-FDG PET/MRI, MRI alone, and SUV and ADC values in staging of primary uterine cervical cancer. Cancer Imaging 2021; 21:16. [PMID: 33482909 PMCID: PMC7821517 DOI: 10.1186/s40644-020-00372-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background The use of PET/MRI for gynecological cancers is emerging. The purpose of this study was to assess the additional diagnostic value of PET over MRI alone in local and whole-body staging of cervical cancer, and to evaluate the benefit of standardized uptake value (SUV) and apparent diffusion coefficient (ADC) in staging. Methods Patients with histopathologically-proven cervical cancer and whole-body 18F-FDG PET/MRI obtained before definitive treatment were retrospectively registered. Local tumor spread, nodal involvement, and distant metastases were evaluated using PET/MRI or MRI dataset alone. Histopathology or clinical consensus with follow-up imaging were used as reference standard. Tumor SUVmax and ADC were measured and SUVmax/ADC ratio calculated. Area under the curve (AUC) was determined to predict diagnostic performance and Mann-Whitney U test was applied for group comparisons. Results In total, 33 patients who underwent surgery (n = 23) or first-line chemoradiation (n = 10) were included. PET/MRI resulted in higher AUC compared with MRI alone in detecting parametrial (0.89 versus 0.73), vaginal (0.85 versus 0.74), and deep cervical stromal invasion (0.96 versus 0.74), respectively. PET/MRI had higher diagnostic confidence than MRI in identifying patients with radical cone biopsy and no residual at hysterectomy (sensitivity 89% versus 44%). PET/MRI and MRI showed equal AUC for pelvic nodal staging (both 0.73), whereas AUC for distant metastases was higher using PET/MRI (0.80 versus 0.67). Tumor SUVmax/ADC ratio, but not SUVmax or ADC alone, was significantly higher in the presence of metastatic pelvic lymph nodes (P < 0.05). Conclusions PET/MRI shows higher accuracy than MRI alone for determining local tumor spread and distant metastasis emphasizing the added value of PET over MRI alone in staging of cervical cancer. Tumor SUVmax/ADC ratio may predict pelvic nodal involvement. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-020-00372-5.
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Affiliation(s)
- Aida Steiner
- Department of Radiology, Turku University Hospital and University of Turku, PO Box 52, 20521, Turku, Finland. .,Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - Sara Narva
- Department of Obstetrics and Gynecology, Turku University Hospital, PO Box 52, 20521, Turku, Finland
| | - Irina Rinta-Kiikka
- Department of Radiology, Tampere University Hospital, PO Box 2000, 33521, Tampere, Finland
| | - Sakari Hietanen
- Department of Obstetrics and Gynecology, Turku University Hospital, PO Box 52, 20521, Turku, Finland
| | - Johanna Hynninen
- Department of Obstetrics and Gynecology, Turku University Hospital, PO Box 52, 20521, Turku, Finland
| | - Johanna Virtanen
- Department of Radiology, Turku University Hospital and University of Turku, PO Box 52, 20521, Turku, Finland
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Ingle M, Lalondrelle S. Current Status of Anatomical Magnetic Resonance Imaging in Brachytherapy and External Beam Radiotherapy Planning and Delivery. Clin Oncol (R Coll Radiol) 2020; 32:817-827. [PMID: 33169690 DOI: 10.1016/j.clon.2020.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Abstract
Radiotherapy planning and delivery have dramatically improved in recent times. Imaging is key to a successful three-dimensional and increasingly four-dimensional based pathway with computed tomography embedded as the backbone modality. Computed tomography has significant limitations for many tumour sites where soft-tissue discrimination is suboptimal, and where magnetic resonance imaging (MRI) has largely superseded in the diagnostic arena. MRI is increasingly used together with computed tomography in the radiotherapy planning pathway and is now established as a prerequisite for several tumours. With the advent of combined MRI and linear accelerator (MR-linac) systems, a transition to MRI-based radiotherapy planning is becoming reality, with increasing experience and research involving these new platforms. In this overview, we aim to highlight how magnetic resonance-guided imaging has improved radiotherapy, using gynaecological malignancies to illustrate, in both external beam radiotherapy and image-guided brachytherapy, and will assess the early evidence for magnetic resonance-guided radiotherapy using combined MR-linac systems.
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Affiliation(s)
- M Ingle
- Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK
| | - S Lalondrelle
- Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK.
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Staley SA, Tucker KR, Gehrig PA, Clark LH. Accuracy of preoperative cross-sectional imaging in cervical cancer patients undergoing primary radical surgery. Gynecol Oncol 2020; 160:384-388. [PMID: 33213900 DOI: 10.1016/j.ygyno.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 11/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We aim to describe the false negative (FN) and false positive (FP) rates of preoperative cross-sectional imaging (PCI) prior to radical surgery for cervical cancer. METHODS A retrospective cohort study of patients who underwent radical hysterectomy for early-stage cervical cancer from January 2010 until December 2017 at a single tertiary care center was performed. Patients were included if they underwent preoperative PCI and radical surgery. Patient demographics and clinicopathologic information were recorded from medical record review. Descriptive statistics were used. RESULTS Overall, 106 patients met inclusion criteria. Eighty-four percent (89/106) of patients had no suspicion for metastatic disease on PCI, while 16% (17/106) had suspicion for metastatic disease. Of the 89 without suspicion for metastatic disease on PCI, 16% (14/89) had a false negative study with metastatic disease identified on final surgical pathology. False negative rates by modality were 16% (11/70) for PET/CT and 6% (2/33) for diagnostic CT. Of the 17 cases with suspicion for metastatic disease on imaging, 53% (9/17) were false positive studies with no metastatic disease identified histologically. False positive rates by modality were 7% (5/70) for PET/CT and 12% (4/33) for diagnostic CT. CONCLUSION PCI is a tool to help identify patients who are optimal candidates for radical surgery. In this sample, the false negative rate was 16%, and false positive rate was 53% for PCI among women who underwent primary radical surgery. Further study is needed to explore preoperative testing that may more accurately identify optimal surgical candidates.
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Affiliation(s)
- S Allison Staley
- Gynecologic Oncologist, Rocky Mountain Gynecologic Oncology, Swedish Medical Center, Denver, CO, United States of America.
| | - Katherine R Tucker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States of America
| | - Paola A Gehrig
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States of America
| | - Leslie H Clark
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, United States of America
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Prognosis impact of posttreatment pelvic MRI in patients treated for stage IB2-IIB cervical cancer with chemoradiation therapy. Eur J Surg Oncol 2020; 47:1103-1110. [PMID: 33160780 DOI: 10.1016/j.ejso.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the performances of systematic posttreatment pelvic magnetic resonance imaging (PPMRI) in predicting prognosis of patients treated with chemoradiation therapy (CRT) for locally advanced cervical cancer (LACC). MATERIALS AND METHODS Multi-institutional data from 216 patients presenting FIGO IB2-IIB cervical cancer for which PPMRI was performed following CRT were retrospectively reviewed. Incomplete response was defined as the identification of persistent lesion on PPMRI. Primary endpoints were patients' 5-year recurrence free (RFS) and overall (OS) survivals. Secondary endpoint was the identification of residual histologic disease on hysterectomy specimens when completion surgery was performed. RESULTS PPMRI identified an incomplete response in 102 (47.2%) cases. A 70% or more reduction in tumor size on PPMRI was identified as the best predictive cut-off for recurrence (37.7% sensitivity and 78.7% specificity) and death (50% sensitivity and 77.9% specificity) with significant impact on those risks (HRa: 0.42; 95%CI: 0.23-0.77 and HRa: 0.18; 95%CI: 0.06-0.50, respectively). Completion hysterectomy was performed in 117 (54.4%) cases, with histologic residual disease in 55 (47.4%). PPMRI demonstrated 74.5% sensitivity and 50.8% specificity in predicting residual disease. Although survival of patients with complete response at PPMRI was not impacted by completion hysterectomy, it significantly increased 5-year RFS and OS of those with incomplete response: 38.7% vs. 65.3% (p < 0.001) and 63% vs. 82.9% (p = 0.038), respectively. CONCLUSION A 70% or more reduction of in tumor size on PPMRI following CRT in patients with LACC is predictive of RFS and OS. PPMRI could help triaging patients who could benefit from completion hysterectomy.
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Knoth J, Pötter R, Jürgenliemk-Schulz IM, Haie-Meder C, Fokdal L, Sturdza A, Hoskin P, Mahantshetty U, Segedin B, Bruheim K, Wiebe E, Rai B, Cooper R, van der Steen-Banasik E, van Limbergen E, Pieters BR, Sundset M, Tan LT, Nout RA, Tanderup K, Kirisits C, Nesvacil N, Lindegaard JC, Schmid MP. Clinical and imaging findings in cervical cancer and their impact on FIGO and TNM staging - An analysis from the EMBRACE study. Gynecol Oncol 2020; 159:136-141. [PMID: 32798000 DOI: 10.1016/j.ygyno.2020.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/05/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate differences in local tumour staging between clinical examination and MRI and differences between FIGO 2009, FIGO 2018 and TNM in patients with primary cervical cancer undergoing definitive radio-chemotherapy. METHODS Patients from the prospective observational multi-centre study "EMBRACE" were considered for analysis. All patients had gynaecological examination and pelvic MRI before treatment. Nodal status was assessed by MRI, CT, PET-CT or lymphadenectomy. For this analysis, patients were restaged according to the FIGO 2009, FIGO 2018 and TNM staging system. The local tumour stage was evaluated for MRI and clinical examination separately. Descriptive statistics were used to compare local tumour stages and different staging systems. RESULTS Data was available from 1338 patients. For local tumour staging, differences between MRI and clinical examination were found in 364 patients (27.2%). Affected lymph nodes were detected in 52%. The two most frequent stages with FIGO 2009 are IIB (54%) and IIIB (16%), with FIGO 2018 IIIC1 (43%) and IIB (27%) and with TNM T2b N0 M0 (27%) and T2b N1 M0 (23%) in this cohort. CONCLUSIONS MRI and clinical examination resulted in a different local tumour staging in approximately one quarter of patients. Comprehensive knowledge of the differential value of clinical examination and MRI is necessary to define one final local stage, especially when a decision about treatment options is to be taken. The use of FIGO 2009, FIGO 2018 and TNM staging system leads to differences in stage distributions complicating comparability of treatment results. TNM provides the most differentiated stage allocation.
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Affiliation(s)
- J Knoth
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | - R Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | | | - C Haie-Meder
- Department of Radiotherapy, Gustave-Roussy, France
| | - L Fokdal
- Department of Oncology, Aarhus University Hospital, Denmark
| | - A Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - U Mahantshetty
- Department of Radiation Oncology, Tata Memorial Hospital, India
| | - B Segedin
- Department of Oncology, Institute of Oncology Ljubljana, Slovenia
| | - K Bruheim
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Norway
| | - E Wiebe
- Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, Canada
| | - B Rai
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Cooper
- Leeds Cancer Centre, St James's University Hospital, United Kingdom
| | | | - E van Limbergen
- Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - B R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - M Sundset
- Clinic of Oncology and Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - L T Tan
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - R A Nout
- Department of Radiation Oncology, Erasmus MC, Erasmus University Rotterdam, The Netherlands
| | - K Tanderup
- Department of Oncology, Aarhus University Hospital, Denmark
| | - C Kirisits
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | - N Nesvacil
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | - J C Lindegaard
- Department of Oncology, Aarhus University Hospital, Denmark
| | - M P Schmid
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria.
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Reed N, Balega J, Barwick T, Buckley L, Burton K, Eminowicz G, Forrest J, Ganesan R, Harrand R, Holland C, Howe T, Ind T, Iyer R, Kaushik S, Music R, Sadozye A, Shanbhag S, Siddiqui N, Syed S, Percival N, Whitham NL, Nordin A, Fotopoulou C. British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2020; 256:433-465. [PMID: 33143928 DOI: 10.1016/j.ejogrb.2020.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 01/20/2023]
Abstract
Cervix cancer in many countries is declining and screening programmes and immunisation will reduce the incidence in the next few decades. This guideline attempts to cover management of invasive disease reflecting diagnosis and imaging including new imaging and sentinel lymph node biopsies. Smaller volume disease is usually managed surgically whereas advanced disease is treated with (chemo)- radiation. It also includes discussion of fertility sparing procedures. Practices are changing frequently for all aspects of care usually in attempts to reduce complications and improve quality of life. The management of advanced disease is treated by chemotherapy and the use of newer agents is also discussed. Other sections discuss specialist situations such as cancer in pregnancy, rare cervical tumours, late effects and supportive measures and fertility preserving approaches.
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Affiliation(s)
- Nick Reed
- Beatson Oncology Centre, Glasgow, United Kingdom.
| | | | | | - Lynn Buckley
- Clinical Nurse Specialist, Hull University Teaching Hospitals NHS Trust, United Kingdom
| | | | | | | | | | | | | | | | - Thomas Ind
- Royal Marsden Hospital, London, United Kingdom
| | - Rema Iyer
- East Kent Hospitals University Foundation NHS Trust, United Kingdom
| | | | - Robert Music
- Jo's Cervical Cancer Trustt, London, United Kingdom
| | | | - Smruta Shanbhag
- University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom
| | | | - Sheeba Syed
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Natasha Lauren Whitham
- Lancashire Teaching Hospitals (Royal Preston Hospital, Fulwood, Lancashire), United Kingdom
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, East Kent Hospitals University Foundation Nhs Trust, Queen Elizabeth The Queen Mother Hospital, Margate, United Kingdom
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Qin M, Siyi L, Huang HF, Li Y, Gu Y, Wang W, Shan Y, Yin J, Wang YX, Cai Y, Chen JY, Jin Y, Pan LY. A Comparison of Laparoscopies and Laparotomies for Radical Hysterectomy in Stage IA1-IB1 Cervical Cancer Patients: A Single Team With 18 Years of Experience. Front Oncol 2020; 10:1738. [PMID: 32984056 PMCID: PMC7485394 DOI: 10.3389/fonc.2020.01738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
Objective To investigate the safety and efficacy of abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) in managing early-stage cervical cancer. Methods This retrospective study comprised patients with FIGO stage IA1 with lymphovascular space invasion (LVSI), IA2, and IB1 cervical cancer who underwent radical hysterectomy performed by a single gynecologic oncology team at Peking Union Medical College Hospital from 2000–2018. The clinicopathological characteristics, surgical outcomes, and survival outcomes were compared between the two groups. Results The ARH and LRH groups consisted of 84 and 172 patients, respectively. The 5-year progression-free survival (PFS) rates were 89.3 and 95.9% in the ARH and LRH groups (P = 0.122, adjusted HR = 0.449, 95% CI: 0.162–1.239), respectively, while the 5-year overall survival (OS) rates were 95.2 and 98.8%, respectively (P = 0.578, adjusted HR = 0.650, 95% CI: 0.143–2.961). The presence of more than two comorbidities led to poor OS (P = 0.011). For patients with a BMI greater than 24 kg/m2, LRH was associated with better PFS (P = 0.039). Compared with ARH, LRH was associated with a shorter operation time (248.8 vs. 176.9 min, P < 0.001), less blood loss (670.2 vs. 200.9 ml, P < 0.001), and lower postoperative ileus rates (2.4% vs. 0%, P = 0.042). No significant differences were observed in PFS and OS between 2006–2012, 2013–2015, and 2016–2018 in the LRH group (P = 0.126 and P = 0.583). Conclusion Compared with ARH, LRH yields similar survival and improved surgical outcomes in patients with early-stage cervical cancer. LRH is not inferior to ARH for select cervical cancer patients treated by a single team with adequate laparoscopy experience.
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Affiliation(s)
- Meng Qin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Siyi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Fang Huang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Gu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Shan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Yin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Xue Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Cai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia-Yu Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Jin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ling-Ya Pan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Comparison of computed tomography- and magnetic resonance imaging-based target delineation for cervical cancer brachytherapy. J Contemp Brachytherapy 2020; 12:367-374. [PMID: 33293976 PMCID: PMC7690230 DOI: 10.5114/jcb.2020.98117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/08/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose The objective of this study was to compare and assess the accuracy of computed tomography (CT)-based target delineation with that of magnetic resonance imaging (MRI)-based on high-dose-rate brachytherapy (HDR-BT) for patients with cervical cancer. Material and methods Data of 20 patients with locally advanced cervical cancer were collected and evaluated. Dimensions, conformity, and dose parameters of high-risk clinical target volume (CTVHR) as well as D0.1cc, D1cc, and D2cc of organs at risk (OARs) based on MRI were compared with those based on CT. Results Average age of 20 patients included was 57.8 years. Width, thickness, and volumes of CT-based CTVHR (CTVHR-CT) were significantly overestimated compared with those of MRI-based CTVHR (CTVHR-MR). Mean values of dice similarity coefficient (DSC), Hausdorff distance (HD), and centroid distance (ΔV) of CTVHR were 0.82 cm, 0.96 cm, and 0.35 cm, respectively. Dose values of CTVHR-CT were significantly lower compared with those of CTVHR-MR. Concerning OARs, geometrical and dosimetric values on CT were comparable to those on MRI. Conclusions The delineated ranges of CTVHR were significantly over-estimated on CT compared with MRI. D98 and D90 of CTVHR-CT were lower than CTVHR-MR. DSC and ΔV of CTVHR and CTVIR were similar to each other; however, there was a difference in terms of HD. CT images regarding pre-BT MR images for delineating were not enough and MRI fusion is still required.
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Comparison of postoperative CT- and preoperative MRI-based breast tumor bed contours in prone position for radiotherapy after breast-conserving surgery. Eur Radiol 2020; 31:345-355. [PMID: 32740818 PMCID: PMC7755637 DOI: 10.1007/s00330-020-07085-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/15/2020] [Accepted: 07/20/2020] [Indexed: 02/05/2023]
Abstract
Objectives To compare the target volume of tumor bed defined by postoperative computed tomography (post-CT) in prone position registered with or without preoperative magnetic resonance imaging (pre-MRI). Methods A total of 22 patients were included with early-stage breast invasive ductal cancer, who have undergone breast-conservative surgery and received the pre-MRI and post-CT in prone position. The MRI sequences (T1W, T2W, T2W-SPAIR, DWI, dyn-eTHRIVE, sdyn-eTHRIVE) were delineated and manually registered to CT, respectively. The clinical target volumes (CTVs) and planning target volumes (PTVs) were contoured on CT and different MRI sequences, respectively. Differences were measured in terms of consistence index (CI), dice coefficient (DC), geographical miss index (GMI), and normal tissue index (NTI). Results The differences of delineation volumes among CT and MRIs were significant, both in the CTVs (p = 0.035) and PTVs (p < 0.001). The values of CI and DC for sdyn-eTHRIVE registration to CT were the largest among all MRI sequences, but GMI and NTI were the smallest. No obvious linear correlation (p > 0.05) between the CI derived from the registration of CT and sdyn-eTHRIVE of CTV with the breast volume, the cavity visualization score (CVS) of CT, time interval from surgery to CT simulation, the maximum diameter of the intraoperative mass, and the number of titanium clips, respectively. Conclusions The CTVs and PTVs in MRI sequences were all smaller than those in CT. The pre-MRI, especially the sdyn-eTHRIVE, could be used to optimize the post-CT-based target delineation of breast cancer. Key Points • Registered pre-MRI to post-CT in order to improve the accuracy of target volume delineation of breast cancer. • The CTVs and PTVs in MRI sequences were all smaller than those in CT. • The sdyn-eTHRIVE of pre-MRIs may be a better choice to improve the delineation of CT-based CTV and PTV. Electronic supplementary material The online version of this article (10.1007/s00330-020-07085-0) contains supplementary material, which is available to authorized users.
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