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Recurrent uterine cancer after surgery: magnetic resonance imaging patterns and their changes after concomitant chemoradiation

Recidive di neoplasia uterine dopo trattamento chirurgico: caratteristiche alla risonanza magnetica e loro modificazioni dopo radio-chemioterapia concomitante

  • Uro-Genital Radiology/Radiologia Uro-Genitale
  • Published:
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Abstract

Purpose

Our primary objective was to describe the magnetic resonance (MR) imaging patterns of recurrent uterine cancer after surgery and their changes following concurrent chemoradiation. The secondary objective was to identify MR imaging predictors of outcome.

Materials and methods

Twenty-two consecutive women with biopsy-proven recurrent uterine cancer after surgery (cervix 13 patients, endometrium nine patients) were enrolled in this prospective study. Inclusion criteria were MR imaging at diagnosis and during follow-up and eligibility for concurrent chemoradiation. MR images were assessed for signal intensity of the pelvic relapse on T2-weighted images, site of relapse and infiltration of adjacent organs. Pre- and posttreatment MR images were compared on the basis of the same criteria. The 3D volume of relapses after treatment was calculated, and tumour response to treatment was evaluated as complete, partial, no change or disease progression.

Results

Recurrences appeared hyperintense on T2-weighted images in 22/22 (100%) patients. Pelvic relapse site was vagina in 5/22 (23%), vaginal vault in 9/22 (41%), vaginal vault with extension to the pelvic wall in 5/22 (23%) and pelvic wall in 3/22 (13%). Infiltration of adjacent organs was detected in 9/22 (41%) patients. The mean volume of recurrences on pretreatment MR images was 38.83 cm3. On posttreatment MR images, relapses appeared hypointense in 19/22 (86%) patients and hyperintense in 3/22 (14%). The mean volume of recurrences on posttreatment MR images was 18.01 cm3. Complete response was seen in 11/22 (50%) patients, partial response in 8/22 (36%) and no change in 3/22 (14%).

Conclusions

MR imaging can provide an evaluation of all parameters necessary for planning treatment and assessing response to treatment.

Riassunto

Obiettivo

L’obiettivo primario del nostro lavoro è quello di illustrare le caratteristiche RM delle recidive di neoplasia uterina dopo chirurgia, e delle relative modificazioni dopo la terapia radio-chemioterapica concomitante. L’obiettivo secondario è quello di identificare le caratteristiche RM che possano predire la risposta al trattamento chemio-radioterapico.

Materiali e metodi

Sono state incluse in questo studio prospettico 22 pazienti con recidiva di neoplasia uterina, dopo terapia chirurgica (cervice: 13 pazienti; endometrio: 9 pazienti), confermate istologicamente. Criteri di inclusione sono stati: esecuzione di una risonanza magnetica (RM), alla diagnosi e durante il follow-up, e candidate al trattamento radio-chemioterapico concomitante. L’analisi delle immagini ha incluso: intensità del segnale della recidiva pelvica di neoplasia, nelle immagini T2-dipendenti; sede della recidiva; infiltrazione organi adiacenti. È stato calcolato il volume 3D della recidiva. Le immagini RM dopo trattamento sono state confrontate con quelle pre-trattamento, seguendo i medesimi criteri. È stato calcolato il volume 3D della neoplasia, post-terapia ed è stata definita la risposta al trattamento: completa, parziale, nessuna modifica, progressione.

Risultati

Il tumore recidivo è risultato iperintenso in 22/22 (100%) pazienti. La sede della recidiva pelvica è stata: cupola vaginale in 9/22 (41%) pazienti, vagina in 5/22 (23%), cupola vaginale con estensione alla parete pelvica in 5/22 (23%); parete pelvica in 3/22 (13%). L’infiltrazione degli organi adiacenti è stata rilevata in 9/22 (41%) pazienti. Il volume 3D medio della recidiva, nelle immagini RM pre-trattamento, è stato di 38,83 cm3. Nelle immagini RM dopo trattamento la lesione apparsa ipointensa in 19/22 (86%) pazienti ed iperintensa in 3/22 (14%). Il volume 3D medio della recidiva tumorale è stato di 18,01 cm3. Undici/22 (50%) pazienti hanno mostrato una risposta completa, 8/22 (36%) una risposta parziale, 3/22 (14%) nessun cambiamento.

Conclusioni

La RM è in grado di valutare i parametri utili per la pianificazione del trattamento radiochemioterapico e di rilevare la risposta al trattamento.

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References/Bibliografia

  1. Burke TW, Hoskins WJ, Heller PB et al (1987) Clinical pattern of tumor recurrence after radical hysterectomy in stage IB, cervical carcinoma. Obstet Gynecol 69:382–385

    PubMed  CAS  Google Scholar 

  2. Krebs HB, Helkamp F, Sevin BU et al (1982) Recurrent cancer of the cervix following radical hysterectomy and pelvic node dissection. Obstet Gynecol 59:422–426

    Google Scholar 

  3. Sears JD, Greven KM, Hoen HM, Randall ME (1994) Prognostic factors and treatment outcome for patients with locally recurrent endometrial cancer. Cancer 74:1303–1308

    Article  PubMed  CAS  Google Scholar 

  4. Thomas G, Dembo A, Fyles A et al (1990) Concurrent chemoradiation in advanced cervical cancer. Gynecol Oncol 38:446–451

    Article  PubMed  CAS  Google Scholar 

  5. Benedet JL, Bender H, Jones H III et al (2000) Staging classifications and clinical practice guidelines of gynaecologic cancers. Int J Gynecol Obstet 70:207–312

    Article  Google Scholar 

  6. Aalders JG, Abeler V, Kolstad P (1984) Recurrent adenocarcinoma of the endometrium: a clinical and histopathologic study of 379 patients. Gynecol Oncol 17:85–103

    Article  PubMed  CAS  Google Scholar 

  7. Larson DM, Copeland LJ, Stringer CA et al (1988) Recurrent cervical carcinoma of the cervix after radical hysterectomy for early stage cervical cancer. Gynecol Oncol 30:381–387

    Article  PubMed  CAS  Google Scholar 

  8. Ijaz T, Eifel PJ, Burke T, Oswald MJ (1998) Radiation therapy of pelvic recurrence after radical hysterectomy for cervical carcinoma. Gynecol Oncol 70:241–246

    Article  PubMed  CAS  Google Scholar 

  9. Hart KB, Han I, Shamsa F et al (1998) Radiation therapy for endometrial cancer in patients treated for postoperative recurrence. Int J Radiat Oncol Biol Phys 41:7–11

    PubMed  CAS  Google Scholar 

  10. Wylie J, Irwin C, Pintilie M et al (2000) Results of radical radiotherapy for recurrent endometrial cancer. Gynecol Oncol 77:66–72

    Article  PubMed  CAS  Google Scholar 

  11. Nigro ND, Vaitkevicus VK, Considine B (1993) Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum 36:709–711

    Article  PubMed  CAS  Google Scholar 

  12. Runowicz CD, Walder S, Rodriguez-Rodriguez L et al (1989) Concomitant cisplatin and radiotherapy in locally advanced cervical carcinoma. Gynecol Oncol 34:395–401

    Article  PubMed  CAS  Google Scholar 

  13. Jurado M, Martinez-Monge R, Aristu J et al (1995) Simultaneous chemoradiotherapy followed by radical hysterectomy in “bulky” IB-IIA stages and locally advanced of cervical carcinoma. Progresos de Obstetricia y Ginecologia 38:314–319

    Google Scholar 

  14. Manfredi R, Maresca G, Smaniotto D et al (1998) MR imaging assessment of cervical cancer response to neoadjuvant therapy. Radiology 209:819–824

    PubMed  CAS  Google Scholar 

  15. Mancuso S, Smaniotto D, Benedetti-Panici P et al (2000) Phase I-II trial of preoperative chemoradiation in locally advanced cervical carcinoma. Gynecol Oncol 78:324–328

    Article  PubMed  CAS  Google Scholar 

  16. Parham G, Syed S, Savage E (1993) Concurrent chemoradiation followed by a modified abdominal hysterectomy and pelvic and retroperitoneal paraaortic lymphadenectomy: effective multimodality treatment for advanced bulky cervical cancer. Gynecol Oncol 49:107

    Article  Google Scholar 

  17. Ebner F, Kressel HY, Mintz MC et al (1988) Tumor recurrence versus fibrosis in the female pelvis: differentiation with MR imaging at 1,5T. Radiology 166:333–340

    PubMed  CAS  Google Scholar 

  18. Sohaiba SA, Houghtona SL, Meronib R et al (2007) Recurrent endometrial cancer: patterns of recurrent disease and assessment of prognosis. Clinical Radiology 62:28–34

    Article  Google Scholar 

  19. Piver MS, Rutledge F, Smith JP (1974) Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 44:265–272

    PubMed  CAS  Google Scholar 

  20. ICRU Report 50 (1993) Prescribing, recording and reporting photon beam therapy. International Commission on Radiation Units and Measurements

  21. Miller AB, Hoogstraten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47:207–214

    Article  PubMed  CAS  Google Scholar 

  22. Hawnaur JM, Johnson RJ, Buckley CH et al (1994) Staging, volume estimation and assessment of nodal status in carcinoma of the cervix: comparison of magnetic resonance imaging with surgical findings. Clin Radiol 49:443–452

    Article  PubMed  CAS  Google Scholar 

  23. World Health Organization (1979) WHO handbook for reporting results of cancer treatment. World Health Organization Offset Publication No. 48, Geneva

    Google Scholar 

  24. Kaplan FL, Meier P (1958) Non parametric estimation from incomplete observations. Am J Stat Assoc 53:457–481

    Article  Google Scholar 

  25. Peto R, Peto J (1972) Asimptomatically efficient rank invariant procedures. J R Stat Soc 135:185–207

    Article  Google Scholar 

  26. Cox DR (1972) Regression model and life tables. J Royal Stat Soc Series B 34:187–220

    Google Scholar 

  27. Averette HE, Nguyen HN, Donato DT et al (1993) Radical hysterectomy for invasive cervical cancer. A 25-year prospective experience with Miami technique. Cancer 71:1422–1437

    PubMed  CAS  Google Scholar 

  28. Thigpen T, Vance RB, Khansur T (1995) The platinum compounds and the paclitexel in the management of carcinomas of the endometrium and uterine cervix. Seminars Oncol 22:67–75

    CAS  Google Scholar 

  29. Mandell LR, Nori D, Hilaris B (1985) Recurrent stage I endometrial cancer: results of treatment and prognostic factors. Int J Radiat Oncol Biol Phys 11:1103–1109

    PubMed  CAS  Google Scholar 

  30. Smaniotto D, D’Agostino G, Luzi S et al (2005) Concurrent 5-fluorouracil, mitomycin C and radiation with or without brachytherapy in recurrent cervical cancer: a scoring system to predict clinical response and outcome. Tumori 91:295–301

    PubMed  CAS  Google Scholar 

  31. Sartori E, Pasinetti B, Carrara L et al (2007) Pattern of failure and value of follow-up procedures in endometrial and cervical cancer patients. Gynecol Oncol 107:241–247

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy

    R. Manfredi, S. Baltieri, A. Tognolini & R. Graziani

  2. Department of Radiation Therapy, “A. Gemelli” University Hospital, Rome, Italy

    D. Smaniotto & N. Cellini

  3. Department of Bioimages and Radiological Sciences, “A. Gemelli” University Hospital, Rome, Italy

    L. Bonomo

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  1. R. Manfredi
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  2. S. Baltieri
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  3. A. Tognolini
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  4. R. Graziani
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  5. D. Smaniotto
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  6. N. Cellini
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  7. L. Bonomo
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Correspondence to R. Manfredi.

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Manfredi, R., Baltieri, S., Tognolini, A. et al. Recurrent uterine cancer after surgery: magnetic resonance imaging patterns and their changes after concomitant chemoradiation. Radiol med 113, 1143–1156 (2008). https://doi.org/10.1007/s11547-008-0312-3

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  • DOI: https://doi.org/10.1007/s11547-008-0312-3

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