Clinical significance of tumor volume and lymph node involvement assessed by MRI in stage IIB cervical cancer patients treated with concurrent chemoradiation therapy

Abstract

Objective: The purpose of this study was to evaluate the prognostic significance of tumor volume assessed by pretreatment MRI in stage IIB cervical cancer patients with concurrent chemoradiation therapy. Methods: A retrospective chart review was performed on seventy five patients with cervical cancer who were treated with concurrent weekly cisplatin (40 mg/m 2 ) and radiotherapy between January 2000 and April 2007. Potential prognostic factors were age, chemotherapy numbers, histology, tumor diameter and volume, lymph node (LN) involvement and pretreatment squamous cell carcinoma antigen (SCC-Ag) levels. Results: The median follow-up time was 55 months (range, 8 to 104 months). The median tumor size and volume (range) were 4.5 cm (2 to 10) and 33.1 mL (4.2 to 392.7), respectively. Pelvic LN enlargement rate was 58.7%. Para-aortic LN enlargement rate was 14.7%. Using multivariate analysis, a tumor volume (＞33 mL, p=0.025), pelvic LN enlargement (p=0.044) revealed a significantly unfavorable outcome on overall survival. PFS was influenced by tumor histology (p＜0.001), pelvic LN enlargement (p=0.015) and pretreatment SCC-Ag levels (p=0.018). We found that 22 (29.3%) patients had recurrences and 14 (18.7%) patients died of disease. The 5-year overall survival rate was 80.6% (standard error, 4.9%) and 5-year PFS rate was 71.3% (standard error, 5.3%). Conclusion: Tumor volume and pelvic LN involvement showed possibility to predict overall survival in patient with stage ⅡB cervical cancer. Optimal tumor volume and pelvic LN assessment by pretreatment MRI might be helpful to predict treatment outcome.

Advanced Imaging Applications for Locally Advanced Cervical Cancer

“…Tumor size more than 8 cm in diameter or more than 35 cc volumes showed worse survival outcomes (Lee et al, 2010). Tumor size also predicted the risk of lymph node metastasis and ultimately the survival outcomes.…”

Raman Spectroscopic Study on Prediction of Treatment Response in Cervical Cancers

“…10 Imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), 18-°urodeoxyglucose-positron emission tomography ([ 18 F] FDG-PET) and singlephoton emission computed tomography (SPECT), which provides an indication of the metabolic and proliferative activity within tumors, have also been pursued for prediction of tumor response. Though these techniques have shown to be potential, wide variation in data collection and analysis are some of the known limitations.…”

Comparison of the prognostic value of F-18 PET metabolic parameters of primary tumors and regional lymph nodes in patients with locally advanced cervical cancer who are treated with concurrent chemoradiotherapy

“…Among the metabolic parameters of the primary tumor and the lymph nodes, the nodal SUVmax was the most powerful prognostic marker for the prediction of recurrence. Stage, tumor size, and lymph node status have been recognized as important predictors of the prognosis with respect to patient survival [2,3]. In addition, it has been well demonstrated that the survival rate of patients with cervical cancer with lymph node metastasis is significantly lower than that of patients without lymph node metastasis [14,15].…”

“…Advanced International Federation of Gynecology and Obstetrics (FIGO) stage, larger tumor size, and presence of lymph node metastasis have been reported as negative prognostic factors for patients with cervical cancer who are treated with concurrent chemoradiotherapy (CCRT) [2,3]. Pelvic and/or paraaortic lymph node status is a strong independent prognostic factor in cervical cancer [4,5].…”