Skip to main content

Advertisement

SpringerLink
Log in

MRI-based volumetric tumor parameters before and during chemoradiation predict tumor recurrence and patient survival in locally advanced cervical cancer: a subgroup analysis of a phase II prospective trial

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

This subgroup analysis of a prospective phase II trial aimed to identify valuable and accessible prognostic factors for overall survival (OS) and progression-free survival (PFS) of patients with locally advanced cervical cancer (LACC).

Methods

Patients with FIGO II to IVA cervical cancer were assessed in this study. All patients underwent concurrent chemoradiotherapy (CCRT) followed by brachytherapy. Tumor parameters based on MRI scans before and during CCRT were evaluated for Overall survival (OS) and Progression-free survival (PFS).

Results

A total of 86 patients were included in this analysis with a median follow-up period of 31.7 months. Three-year OS and PFS rates for all patients were 87.1% and 76.5%, respectively. Univariate Cox regression analysis showed that restaging tumor size (rTS) over 2.55 cm (p < 0.001), initial tumor volume (iTV) over 55.99 cc (p < 0.001), downstaging (p = 0.042), and restaging tumor volume (rTV) over 6.25 cc (p = 0.006) were significantly associated with OS. rTS (p < 0.001), iTV (p < 0.001), downstaging (p = 0.027), and rTV (p < 0.001) were identified as significant prognostic factors for PFS. In the stepwise multivariable analysis, only rTS > 2.55 cm showed statistically significant with OS (HR: 5.47, 95% CI 1.80–9.58, p = 0.035) and PFS (HR: 3.83, 95% CI 1.50–11.45; p = 0.025).

Conclusions

Initial tumor size and restaging tumor volume that are easily accessible during radiotherapy provide valuable prognostic information for cervical cancer. MRI-based measurable volumetric scoring system can be readily applied in real-world practice of cervical cancer.

Clinical trial information: This study is a subgroup analysis of prospective trial registered at ClinicalTrials.gov Identifier: NCT02993653.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

FIGO:

International Federation Gynecology Obstetrics

iTS:

Initial tumor size before therapy

rTS:

Restaging tumor size at early MRI during concurrent chemoradiation

TSRR:

Tumor size reduction rate

iTV:

Initial tumor volume before therapy

rTV:

Restaging tumor volume

TVRR:

Tumor volume reduction rate

iSCC:

Initial squamous cell cancer antigen level

rSCC:

Restaging squamous cell cancer antigen level

SCCRR:

Squamous cell cancer reduction rate

OS:

Overall survival

PFS:

Progression-free survival

References

  1. Siegel RL, Miller KD, Wagle NS et al (2023) Cancer statistics. CA A Cancer J Clin 73(1):17–48. https://doi.org/10.3322/caac.21763

    Article  Google Scholar 

  2. Singh D, Vignat J, Lorenzoni V et al (2023) Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health 11(2):e197–e206. https://doi.org/10.1016/s2214-109x(22)00501-0

    Article  CAS  PubMed  Google Scholar 

  3. Monk BJ, Tan DSP, Hernández Chagüi JD et al (2022) Proportions and incidence of locally advanced cervical cancer: a global systematic literature review. Int J Gynecol Cancer 32(12):1531–1539. https://doi.org/10.1136/ijgc-2022-003801

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kang S, Wu J, Li J et al (2022) Prognostic significance of clinicopathological factors influencing overall survival and event-free survival of patients with cervical cancer: a systematic review and meta-analysis. Med Sci Monit 28:e934588. https://doi.org/10.12659/msm.934588

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Aslan K, Meydanli MM, Oz M et al (2020) The prognostic value of lymph node ratio in stage IIIC cervical cancer patients triaged to primary treatment by radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy. J Gynecol Oncol 31(1):e1. https://doi.org/10.3802/jgo.2020.31.e1

    Article  PubMed  Google Scholar 

  6. Lee HC, Jeong JW, Lee JH et al (2023) High-dose (60 Gy) intensity-modulated radiotherapy with concurrent weekly cisplatin followed by intracavitary radiation in locally advanced cervical cancer: A phase II prospective clinical trial. Gynecol Oncol 177:142–149. https://doi.org/10.1016/j.ygyno.2023.08.018

    Article  CAS  PubMed  Google Scholar 

  7. Kodaira T, Fuwa N, Toita T et al (2003) Comparison of prognostic value of MRI and FIGO stage among patients with cervical carcinoma treated with radiotherapy. Int J Radiat Oncol Biol Phys 56(3):769–777. https://doi.org/10.1016/s0360-3016(03)00007-5

    Article  PubMed  Google Scholar 

  8. Lee JH, Lee SW, Kim JR et al (2017) Tumour size, volume, and marker expression during radiation therapy can predict survival of cervical cancer patients: a multi-institutional retrospective analysis of KROG 16–01. Gynecol Oncol 147(3):577–584. https://doi.org/10.1016/j.ygyno.2017.09.036

    Article  PubMed  Google Scholar 

  9. Sun C, Wang S, Ye W et al (2022) The prognostic value of tumor size, volume and tumor volume reduction rate during concurrent chemoradiotherapy in patients with cervical cancer. Front Oncol 12:934110. https://doi.org/10.3389/fonc.2022.934110

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tseng JY, Yen MS, Twu NF et al (2010) Prognostic nomogram for overall survival in stage IIB-IVA cervical cancer patients treated with concurrent chemoradiotherapy. Am J Obstet Gynecol 202(2):174.e171-177. https://doi.org/10.1016/j.ajog.2009.09.028

    Article  Google Scholar 

  11. Wan Q, Yan W, Liu Y et al (2020) Prognostic value of post-radiation serum squamous cell carcinoma antigen and primary tumor regression for cervical squamous cell carcinoma. Cancer Biomark 29(3):327–335. https://doi.org/10.3233/cbm-190934

    Article  CAS  PubMed  Google Scholar 

  12. Wang W, Liu X, Hou X et al (2019) Posttreatment squamous cell carcinoma antigen predicts treatment failure in patients with cervical squamous cell carcinoma treated with concurrent chemoradiotherapy. Gynecol Oncol 155(2):224–228. https://doi.org/10.1016/j.ygyno.2019.09.003

    Article  CAS  PubMed  Google Scholar 

  13. Kapp KS, Stuecklschweiger GF, Kapp DS et al (1998) Prognostic factors in patients with carcinoma of the uterine cervix treated with external beam irradiation and IR-192 high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 42(3):531–540. https://doi.org/10.1016/s0360-3016(98)00255-7

    Article  CAS  PubMed  Google Scholar 

  14. Mayr NA, Taoka T, Yuh WT et al (2002) Method and timing of tumor volume measurement for outcome prediction in cervical cancer using magnetic resonance imaging. Int J Radiat Oncol Biol Phys 52(1):14–22. https://doi.org/10.1016/s0360-3016(01)01808-9

    Article  PubMed  Google Scholar 

  15. Devi BC, Tang TS, Corbex M (2007) Reducing by half the percentage of late-stage presentation for breast and cervix cancer over 4 years: a pilot study of clinical downstaging in Sarawak. Malaysia Ann Oncol 18(7):1172–1176. https://doi.org/10.1093/annonc/mdm105

    Article  CAS  PubMed  Google Scholar 

  16. He F, Li W, Liu P et al (2020) Influence of uterine corpus invasion on prognosis in stage IA2-IIB cervical cancer: a multicenter retrospective cohort study. Gynecol Oncol 158(2):273–281. https://doi.org/10.1016/j.ygyno.2020.05.005

    Article  PubMed  Google Scholar 

  17. Lee HJ, Kim JM, Chin YJ et al (2020) Prognostic value of hematological parameters in locally advanced cervical cancer patients treated with concurrent chemoradiotherapy. Anticancer Res 40(1):451–458. https://doi.org/10.21873/anticanres.13973

    Article  PubMed  Google Scholar 

  18. Zong L, Zhang Q, Kong Y et al (2020) The tumor-stroma ratio is an independent predictor of survival in patients with 2018 FIGO stage IIIC squamous cell carcinoma of the cervix following primary radical surgery. Gynecol Oncol 156(3):676–681. https://doi.org/10.1016/j.ygyno.2019.12.022

    Article  CAS  PubMed  Google Scholar 

  19. Wu J, Chen M, Liang C et al (2017) Prognostic value of the pretreatment neutrophil-to-lymphocyte ratio in cervical cancer: a meta-analysis and systematic review. Oncotarget 8(8):13400–13412. https://doi.org/10.18632/oncotarget.14541

    Article  PubMed  PubMed Central  Google Scholar 

  20. Khan AA, Vijay A, Wani SQ et al (2022) Dosimetric analysis of intracavitary brachytherapy applicators: a practical study. Radiat Oncol J 40(3):180–191. https://doi.org/10.3857/roj.2022.00199

    Article  PubMed  PubMed Central  Google Scholar 

  21. Huang YT, Wang CC, Tsai CS et al (2011) Long-term outcome and prognostic factors for adenocarcinoma/adenosquamous carcinoma of cervix after definitive radiotherapy. Int J Radiat Oncol Biol Phys 80(2):429–436. https://doi.org/10.1016/j.ijrobp.2010.02.009

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Statistical analyses performed in this article were advised by Catholic Medical Center Clinical Research Coordinating Center.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Han Byul Kang, Sung Hwan Kim, Joo Hwan Lee, Hyo Chun Lee, Nam Kyu Kang & Jong Hoon Lee

Authors
  1. Han Byul Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sung Hwan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joo Hwan Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hyo Chun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nam Kyu Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jong Hoon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Analysis design, Data collection, performing data analysis, data interpretation and wrote the paper is solely the responsibility of the authors.

Corresponding author

Correspondence to Jong Hoon Lee.

Ethics declarations

Conflict of interests

The authors declare no financial or other interest that is relevant to this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kang, H.B., Kim, S.H., Lee, J.H. et al. MRI-based volumetric tumor parameters before and during chemoradiation predict tumor recurrence and patient survival in locally advanced cervical cancer: a subgroup analysis of a phase II prospective trial. Int J Clin Oncol 29, 620–628 (2024). https://doi.org/10.1007/s10147-024-02490-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-024-02490-7

Keywords

Search

Navigation