Vaginal recurrence of endometrial cancer: MRI characteristics and correlation with patient outcome after salvage radiation therapy

Abstract

Purpose To evaluate MRI characteristics in vaginal recurrence of endometrial cancer (EC) including tumor volume shrinkage during salvage radiotherapy, and to identify imaging features associated with survival. Methods Patients with vaginal recurrence of EC treated with external beam radiotherapy (EBRT) followed by brachytherapy (BT), and with available pelvic MRI at two time points: baseline and/or before BT were retrospectively identified from 2004 to 2017. MRI features including recurrence location and tissue characteristics on T2-and T1-weighted images were evaluated at baseline only. Tumor volumes were measured both at baseline and pre-BT. Survival rates and associations were evaluated by Cox regression and Fisher's exact test, respectively. Results Sixty-two patients with 36 baseline and 50 pre-BT pelvic MRIs were included (24/62 with both MRIs). Vaginal recurrence of EC was most commonly located in the vaginal apex (27/36, 75%). Tumors with a post-contrast enhancing peripheral rim or low T2 signal rim at baseline showed longer recurrence-free survival (RFS) (HR 0.2, 95% CI 0.1-0.9, P < 0.05 adjusted for histology; HR 0.2, 95% CI 0.1-0.8, P < 0.05, respectively). The median tumor shrinkage at pre-BT was 69% (range 1-99%). Neither absolute tumor volumes nor volume regression at pre-BT were associated with RFS. Lymphovascular space invasion (LVSI) at hysterectomy and adjuvant RT were associated with recurrence involving the distal vagina (both P < 0.05). Conclusion Vaginal recurrences with rim enhancement at baseline MRI predicted improved RFS, while tumor volume shrinkage at pre-BT did not. Distal vaginal recurrence was more common in patients with LVSI and adjuvant RT at EC diagnosis.

Effect of Combination of Traditional Chinese Medicine with Western Medicine on Endometrial Carcinoma and Its Influence on Ultrasound, MRI, Tumor Markers HE4 and CA125

“…Transvaginal ultrasound can not only display two-dimensional ultrasound images but also further observe the nature of blood flow, speed, and other information, so as to sensitively and accurately reflect the pathological changes of the endometrium [ 28 , 29 ]. MRI has high tissue resolution and can accurately assess the degree and extent of lesion invasion in patients with endometrial cancer [ 30 , 31 ]. The two detection methods are not invasive and are more acceptable to patients.…”

Imaging to optimize gynecological radiation oncology

“…See Figure 4A–D for an example of pretreatment and post-treatment external beam radiation images. The degree of shrinkage has not been shown to correlate with overall recurrence-free survival, but pretreatment rim enhancement was associated with longer recurrence-free survival 37. Similar to cervical cancer, my group and others have also found it useful to perform a MRI with the interstitial needles in place to help guide brachytherapy target delineation.…”