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Early diffusion weighted magnetic resonance imaging can predict survival in women with locally advanced cancer of the cervix treated with combined chemo-radiation

  • Magnetic Resonance
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European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess the predictive value of diffusion weighted imaging (DWI) for survival in women treated for advanced cancer of the cervix with concurrent chemo-radiotherapy.

Methods

Twenty women treated for advanced cancer of the cervix were recruited and followed up for a median of 26 (range <1 to 43) months. They each had DWI performed before treatment, 2 weeks after beginning therapy (midtreatment) and at the end of treatment. Apparent diffusion coefficient (ADC) values were calculated from regions of interest (ROI). All participants were reviewed for follow-up data. ADC values were compared with mortality status (Mann–Whitney test). Time to progression and overall survival were assessed (Kaplan–Meier survival graphs).

Results

There were 14 survivors. The median midtreatment ADC was statistically significantly higher in those alive compared to the non-survivors, 1.55 and 1.36 (×10−3/mm2/s), respectively, P = 0.02. The median change in ADC 14 days after treatment commencement was significantly higher in the alive group compared to non-survivors, 0.28 and 0.14 (×10−3/mm2/s), respectively, P = 0.02. There was no evidence of a difference between survivors and non-survivors for pretreatment baseline or post-therapy ADC values.

Conclusion

Functional DWI early in the treatment of advanced cancer of the cervix may provide useful information in predicting survival.

Key Points

Diffusion weighted magnetic resonance imaging (DWI) is increasingly used in cervical cancer.

Functional DWI early in treatment of cervical cancer may help predict survival.

DWI may help clinicians to tailor or individualise treatment appropriately.

This may limit toxicity from ineffective treatment and allow early alternative therapy.

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Abbreviations

ADC:

apparent diffusion coefficient

DWI:

diffusion weighted imaging

EUA:

examination under anaesthesia

LDR:

low dose rate

ROI:

regions of interest

SIGN:

Scottish Intercollegiate Guidelines Network

References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM, GLOBOCAN (2008) Cancer incidence and mortality worldwide: IARC CancerBase no. 10. International Agency for Research on Cancer, Lyon. Available via http://www.globocan.iarc.fr. Accessed 11 Jan 2011

  2. Cancer Research UK (2010) Cervical cancer: survival statistics. Available via http://info.cancerresearchuk.org/cancerstats. Accessed 5 Nov 2010

  3. Green JA, Kirwan JM, Tierney JF et al (2001) Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet 358:781–786

    Article  PubMed  CAS  Google Scholar 

  4. Balleyguier C, Sala E, Da Cunha T et al (2011) Staging of uterine cervical cancer with MRI: guidelines of the European Society of Urogenital Radiology. Eur Radiol 21:1102–1110

    Article  PubMed  Google Scholar 

  5. Lee DW, Kim YT, Kim JH et al (2010) Clinical significance of tumor volume and lymph node involvement assessed by MRI in stage IIB cervical cancer patients treated with concurrent chemoradiation therapy. J Gynecol Oncol 1:18–23

    Article  Google Scholar 

  6. Amano M, Kato T, Amano Y, Kumazaki T (1998) Using MR imaging to predict and evaluate the response of invasive cervical carcinoma to systemic chemotherapy. AJR Am J Roentgenol 171:1335–1339

    PubMed  CAS  Google Scholar 

  7. Padhani AR, Liu G, Kohl DM et al (2009) Diffusion weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia 11:102–125

    PubMed  CAS  Google Scholar 

  8. Koh DM, Collins DJ (2007) Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 188:1622–1635

    Article  PubMed  Google Scholar 

  9. Harry VN, Semple SI, Gilbert FJ, Parkin DE (2008) Diffusion-weighted magnetic resonance imaging in the early detection of response to chemoradiation in cervical cancer. Gynecol Oncol 111:213–220

    Article  PubMed  Google Scholar 

  10. Theilmann RJ, Borders R, Trouard TP et al (2004) Changes in water mobility measured by diffusion MRI predict response of metastatic breast cancer to chemotherapy. Neoplasia 6:831–837

    Article  PubMed  Google Scholar 

  11. Liapi E, Geschwind JF, Vossen JA et al (2008) Functional MRI evaluation of tumor response in patients with neuroendocrine hepatic metastasis treated with transcatheter arterial chemoembolization. AJR Am J Roentgenol 190:67–73

    Article  PubMed  Google Scholar 

  12. Vossen JA, Kamel IR, Buijs M et al (2008) Role of functional magnetic resonance imaging in assessing metastatic leiomyosarcoma response to chemoembolization. J Comput Assist Tomogr 32:347–352

    Article  PubMed  Google Scholar 

  13. Lee KC, Moffat BA, Schott AF et al (2007) Prospective early response imaging biomarker for neoadjuvant breast cancer chemotherapy. Clin Cancer Res 13:443–450

    Article  PubMed  CAS  Google Scholar 

  14. Galbán CJ, Mukherji SK, Chenevert TL et al (2009) A feasibility study of parametric response map analysis of diffusion-weighted magnetic resonance imaging scans of head and neck cancer patients for providing early detection of therapeutic efficacy. Transl Oncol 2:184–190

    PubMed  Google Scholar 

  15. Pickles MD, Gibbs P, Lowry M, Turnbull LW (2006) Diffusion changes precede size reduction in neoadjuvant treatment of breast cancer. Magn Reson Imaging 24:843–847

    Article  PubMed  Google Scholar 

  16. Kim SH, Lee JM, Hong SH et al (2009) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumour response to neoadjuvant chemo and radiation therapy. Radiology 253:116–125

    Article  PubMed  Google Scholar 

  17. Bodurka-Bevers D, Morris M, Eifel PJ et al (2000) Post therapy surveillance of women with cervical cancer: an outcomes analysis. Gynecol Oncol 78:187–193

    Article  PubMed  CAS  Google Scholar 

  18. Hong JH, Tsai CS, Lai CH et al (2004) Recurrent squamous cell carcinoma of cervix after definitive radiotherapy. Int J Radiat Oncol Biol Phys 60:249–257

    Article  PubMed  Google Scholar 

  19. Chen J, Zhang Y, Liang B, Yang Z (2010) The utility of diffusion-weighted MR imaging in cervical cancer. Eur J Radiol 74:101–106

    Article  Google Scholar 

  20. McVeigh PZ, Syed AM, Milosevic M, Fyles A, Haider MA (2008) Diffusion-weighted MRI in cervical cancer. Eur Radiol 18:1058–1064

    Article  PubMed  Google Scholar 

  21. Naganawa S, Sato C, Kumada H, Ishigaki T, Miura S, Takizawa O (2005) Apparent diffusion coefficient in cervical cancer of the uterus: comparison with the normal uterine cervix. Eur Radiol 15:71–78

    Article  PubMed  Google Scholar 

  22. Zhao M, Pipe JG, Bonnett J, Evelhoch JL (1996) Early detection of treatment response by diffusion-weighted 1H-NMR spectroscopy in a murine tumour in vivo. Br J Cancer 73:61–64

    Article  PubMed  CAS  Google Scholar 

  23. Lemaire L, Howe FA, Rodrigues LM, Griffiths JR (1999) Assessment of induced rat mammary tumour response to chemotherapy using the apparent diffusion coefficient of tissue water as determined by diffusion-weighted 1H-NMR spectroscopy in vivo. MAGMA 8:20–26

    PubMed  CAS  Google Scholar 

  24. Vandecaveye V, Dirix P, De Keyzer F et al (2010) Predictive value of diffusion-weighted magnetic resonance during chemoradiotherapy for head and neck squamous cell carcinoma. Eur Radiol 20:1703–1714

    Article  PubMed  Google Scholar 

  25. DeVries A, Kremser C, Hein P et al (2003) Tumor microcirculation and diffusion predict therapy outcome for primary rectal carcinoma. Int J Radiat Oncol Biol Phys 56:958–965

    Article  PubMed  Google Scholar 

  26. Lee KC, Bradley DA, Hussain M et al (2007) A feasibility study evaluating the functional diffusion map as a predictive imaging biomarker for detection of treatment response in a patient with metastatic prostate cancer to the bone. Neoplasia 9:1003–1011

    Article  PubMed  Google Scholar 

  27. Mardor Y, Roth Y, Ochershvilli A et al (2004) Pretreatment prediction of brain tumors response to radiation therapy using high b-value diffusion-weighted MRI. Neoplasia 6:136–142

    Article  PubMed  Google Scholar 

  28. Koh DM, Scurr E, Collins D et al (2007) Predicting response of colorectal hepatic metastasis: value of pretreatment apparent diffusion coefficients. AJR Am J Roentgenol 188:1001–1008

    Article  PubMed  Google Scholar 

  29. Byun WM, Shin SO, Chang Y, Lee SJ, Finsterbusch J, Frahm J (2002) Diffusion-weighted MR imaging of metastatic disease of the spine: assessment of response to therapy. AJNR Am J Neuroradiol 23:906–912

    PubMed  Google Scholar 

  30. Moffat BA, Chenevert TL, Lawrence TS et al (2005) Functional diffusion map: a noninvasive MRI biomarker for early stratification of clinical brain tumor response. Proc Natl Acad Sci U S A 102:5524–5529

    Article  PubMed  CAS  Google Scholar 

  31. Park SH, Moon WK, Cho N et al (2010) Diffusion-weighted MR imaging: pretreatment prediction of response to neoadjuvant chemotherapy in patients with breast cancer. Radiology 257:56–63

    Article  PubMed  Google Scholar 

  32. Sun YS, Zhang XP, Tang L et al (2010) Locally advanced rectal carcinoma treated with preoperative chemotherapy and radiation therapy: preliminary analysis of diffusion-weighted MR imaging for early detection of tumor histopathologic downstaging. Radiology 254:170–178

    Article  PubMed  Google Scholar 

  33. Hamstra DA, Galbán CJ, Meyer CR et al (2008) Functional diffusion map as an early imaging biomarker for high-grade glioma: correlation with conventional radiologic response and overall survival. J Clin Oncol 26:3387–3394

    Article  PubMed  Google Scholar 

  34. Hamstra DA, Chenevert TL, Moffat BA et al (2005) Evaluation of the functional diffusion map as an early biomarker of time-to-progression and overall survival in high-grade glioma. Proc Natl Acad Sci U S A 102:16759–16764

    Article  PubMed  CAS  Google Scholar 

  35. Barajas RF Jr, Rubenstein JL, Chang JS, Hwang J, Cha S (2010) Diffusion-weighted MR imaging derived apparent diffusion coefficient is predictive of clinical outcome in primary central nervous system lymphoma. AJNR Am J Neuroradiol 31:60–66

    Article  PubMed  Google Scholar 

  36. Yokoyama Y, Takano T, Nakahara K et al (2008) A phase II multicenter trial of concurrent chemoradiotherapy with weekly nedaplatin in advanced uterine cervical carcinoma: Tohoku Gynecologic Cancer Unit Study. Oncol Rep 19:1551–1556

    PubMed  Google Scholar 

  37. Niibe Y, Tsunoda S, Jobo T et al (2008) Phase II study of radiation therapy combined with weekly nedaplatin in locally advanced uterine cervical carcinoma (LAUCC): Kitasato Gynecologic Radiation Oncology Group (KGROG 0501) initial analysis. Eur J Gynaecol Oncol 29:222–224

    PubMed  CAS  Google Scholar 

  38. Franckena M, Lutgens LC, Koper PC (2009) Radiotherapy and hyperthermia for treatment of primary locally advanced cervix cancer: results in 378 patients. Int J Radiat Oncol Biol Phys 73:242–250

    Article  PubMed  Google Scholar 

  39. Plataniotis G, Dale RG (2009) Use of the concept of equivalent biologically effective dose (BED) to quantify the contribution of hyperthermia to local tumor control in radiohyperthermia cervical cancer trials, and comparison with radiochemotherapy results. Int J Radiat Oncol Biol Phys 73:1538–1544

    Article  PubMed  Google Scholar 

  40. Scottish Intercollegiate Guidelines Network (2008) 99 Management of cervical cancer. A national clinical guideline. NHS Quality Improvement Scotland. Available via http://www.sign.ac.uk. Accessed 24 Mar 2011

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Acknowledgments

DP conceived the study concept, contributed to the writing of the paper and is guarantor. GS collected and analysed the survival data and wrote the first draft. VH, SS and FJG designed the MRI DWI protocol, undertook the initial study and revised the paper. GP collected the clinical response data and revised the paper. NS performed statistical analyses on the data.

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Correspondence to Gbolahan Somoye.

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Somoye, G., Harry, V., Semple, S. et al. Early diffusion weighted magnetic resonance imaging can predict survival in women with locally advanced cancer of the cervix treated with combined chemo-radiation. Eur Radiol 22, 2319–2327 (2012). https://doi.org/10.1007/s00330-012-2496-0

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