Can MRI Predict Local Control Rate of Uterine Cervical Cancer Immediately after Radiation Therapy?

Abstract

Purpose: To evaluate the utility of measuring the volumes of areas of high signal intensity on T 2 -weighted magnetic resonance (MR) images immediately after irradiation for predicting the local control rate of uterine cervical cancer.Materials and Methods: From our departmental database, we identiˆed 109 patients with cervical cancer who underwent MR imaging before irradiation and just before or just after completion of radiation therapy from 1994 to 2007. We included 46 of the 109 patients in this study, 5 patients with local recurrence and 41 patients who were free of disease for more than 2 years. Fifteen received radiation therapy alone, and 28 patients received concurrent chemoradiation therapy. We measured the volumes of areas of high signal intensity involving the uterine cervix on T 2 -weighted MR images before radiation therapy and just before or just after its completion. We measured the 3 orthogonal diameters to calculate the volume as an ellipsoid and evaluated proportional tumor volume and the rate of reduction. We analyzed statistics with Student's t-test.Results: In patients with local recurrence, the mean volume of the areas of high signal intensity on T 2 -weighted MR images just before completion of irradiation therapy or just after was 19.70 cm 3 , which was signiˆcantly larger than that in patients without recurrence (1.77 cm 3 , Pº0.05). The proportional tumor volume was also signiˆcantly larger (Pº 0.05).Conclusions: Although areas of high signal intensity on T 2 -weighted MR images include acute radiation change, their volume and the proportional tumor volume after irradiation can be useful clues in predicting the local control rate of uterine cervical cancer.

Consecutive magnetic resonance imaging during brachytherapy for cervical carcinoma: predictive value of volume measurements with respect to persistent disease and prognosis

“…Several groups have performed semi-objective volumetric tumor measurements for the assessment of treatment responses [ 10 – 13 , 20 , 21 ]. Most of these studies were performed retrospectively with small study populations, the imaging protocols employed differed from study to study, and volume evaluations were obtained using ellipsoid based volume measurements, which are inferior to those obtained by manual and freehand delineation of regions of interest [ 18 ].…”

Correlation between clinical findings and magnetic resonance imaging for the assessment of local response after standard treatment in cervical cancer

“…Despite the promising results as a predictor of response, larger studies are needed because their series only included 25 cases. In this sense, Saida et al [24] studied a series of 46 cases measuring the volume of the areas of high signal intensity in T2 immediately after finishing the treatment. They concluded that local control depends more on the diminishment of volume registered than the initial volume.…”

Advanced MRI in malignant neoplasms of the uterus

“…Hricak et al (80) reported that the finding of reconstitution of the normal zonal anatomy of the cervix and the presence of homogenous low‐signal‐intensity cervical stroma are reliable indicators that the cervix is normal after 3–6 months of radiation therapy (RT). Saida et al (81) evaluated the local recurrence rate by measuring the volumes of areas of high signal intensity on T2‐weighted images just before/after RT. The patients with local recurrence had larger areas of high signal intensity on T2‐WI just before/after RT than those without recurrence (81).…”

“…Saida et al (81) evaluated the local recurrence rate by measuring the volumes of areas of high signal intensity on T2‐weighted images just before/after RT. The patients with local recurrence had larger areas of high signal intensity on T2‐WI just before/after RT than those without recurrence (81). However, these findings were not satisfactory for predicting the patient's prognosis.…”