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Residual tumour volumes and grey zones after external beam radiotherapy (with or without chemotherapy) in cervical cancer patients

A low-field MRI study

Residuale Tumorvolumen und Grauzonen nach externer Strahlentherapie (mit und ohne Chemotherapie) bei Zervixkarzinompatientinnen

Eine Niederfeld-MRT-Studie

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Abstract

Background

Grey zones, which are defined as tissue with intermediate signal intensity in the area of primary hyperintense tumour extension, can be seen during radiation with or without chemotherapy on the T2-weighted MRI in patients with cervical cancer. The purpose of this study was to systematically measure the tumour volume at the time of diagnosis and the residual tumour volume at the time of brachytherapy without and with consideration of the grey zones and to estimate tumour regression during external beam radiotherapy (EBRT).

Material and methods

T2-weighted MRI datasets of 175 patients with locally advanced cervical cancer (FIGO stage IB–IVA), who underwent combined external beam radiotherapy and brachytherapy with or without concomitant chemotherapy were available for this study. The gross tumour volume at the time of diagnosis (GTVinit) and at the time of first brachytherapy without (GTVres) and with (GTVres+ GZ) consideration of grey zones were measured for each patient. A descriptive statistical analysis was performed and tumour regression rates without (R) and with consideration of grey zones (RGZ) were calculated. Further, the role of prognostic factors on GTVinit, GTVres, GTVres+ GZ and tumour regression rates was investigated.

Results

The median GTVinit, GTVres, GTVres+ GZ in all patients were 44.4 cm3, 8.2 cm3, 20.3 cm3, respectively. The median R was 78.5% and the median RGZ was 50.1%. The histology and FIGO staging showed a significant impact on GTVinit, GTVres and GTVres+ GZ.

Conclusion

Grey zones represent a substantial proportion of the residual tumour volume at the time of brachytherapy. Differentiation of high signal intensity mass and surrounding intermediate signal intensity grey zones may be reasonable.

Zusammenfassung

Hintergrund

Sogenannte Grauzonen können im Verlauf der Radiochemotherapie auf der T2-gewichteten MRT bei Patientinnen mit Zervixkarzinomen als Areal mit intermediärer Signalintensität im Gebiet des initialen hyperintensen Tumors beobachtet werden. Das Ziel dieser Studie war es, das Tumorvolumen zum Zeitpunkt der Diagnose und zum Zeitpunkt der Brachytherapie mit und ohne Berücksichtigung der Grauzonen zu erfassen und die daraus resultierende Tumorregression während der externen Strahlentherapie (EBRT) zu berechnen.

Material und Methode

T2-gewichtete MRT-Datensätze von 175 Patientinnen mit lokal fortgeschrittenem Zervixkarzinom (FIGO-Stadien IB–IVA), die mittels kombinierter EBRT und Brachytherapie mit und ohne konkomittante Chemotherapie behandelt worden waren, waren für diese Studie verfügbar. Für jede Patientin wurden das „Gross Tumor Volume“ (GTV) zum Zeitpunkt der Diagnose (GTVinit) sowie zum Zeitpunkt der Brachytherapie mit (GTVres+ GZ) und ohne Berücksichtigung der Grauzonen (GTVres) erfasst. Eine deskriptive statistische Analyse wurde durchgeführt und die Tumorregression mit (R) und ohne Berücksichtigung der Grauzonen (RGZ) berechnet. Desweiteren wurden der Einfluss prognostischer Faktoren auf GTVinit, GTVres, GTVres+ GZ und Tumorregressionsraten untersucht.

Ergebnisse

Das mediane GTVinit, GTVres und GTVres+ GZ aller Patientinnen betrug jeweils 44,4 cm3, 8,2 cm3 und 20,3 cm3. Die mediane R lag bei 78,5% und die mediane RGZ bei 50,1%. Die Histologie und das FIGO-Stadium hatten einen signifikanten Einfluss auf GTVinit, GTVres und GTVres+ GZ.

Schlussfolgerung

Grauzonen scheinen als Folge der Tumorregression zu entstehen und haben einen wesentlichen Anteil am Tumorvolumen zum Zeitpunkt der Brachytherapie. Eine MR-tomographische Unterscheidung des Resttumors zum Zeitpunkt der Brachytherapie in hohe und intermediäre Signalintensität erscheint sinnvoll.

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Fig. 1

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Acknowledgement

This study was granted by the Medical Scientific Fund of the Mayor of the City of Vienna: Project No. 07063.

Conflict of interest

On behalf of all authors, the corresponding author states the following: the Department of Radiotherapy at the Medical University of Vienna receives/received financial and/or equipment support for research and educational purposes from Nucletron B.V., Varian Medical Systems, Inc., and Isodose Control B.V.

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Authors and Affiliations

  1. Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, 18-20 Währinger Gürtel, 1090, Vienna, Austria

    M.P. Schmid MD, B. Mansmann, M. Federico, P. Georg, E. Fidarova, W. Dörr & R. Pötter

  2. Department of Radiation Oncology, Metropolitan Hospital, Ethnarhou Makariou & El. Venizelou1, Athens, Greece

    J.C.A. Dimopoulous

  3. Department of Radiotherapy and Radiation Oncology, Medical Faculty Carl Gustav Carus, University of Technology, Dresden, Germany

    W. Dörr

  4. Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria

    W. Dörr & R. Pötter

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  1. M.P. Schmid MD
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  2. B. Mansmann
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  3. M. Federico
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  5. P. Georg
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Correspondence to M.P. Schmid MD.

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Schmid, M., Mansmann, B., Federico, M. et al. Residual tumour volumes and grey zones after external beam radiotherapy (with or without chemotherapy) in cervical cancer patients. Strahlenther Onkol 189, 238–245 (2013). https://doi.org/10.1007/s00066-012-0260-7

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  • DOI: https://doi.org/10.1007/s00066-012-0260-7

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