Cervical cancer: serial MR imaging before and after primary radiation therapy--a 2-year follow-up study.

Abstract

Serial magnetic resonance imaging studies were performed in 28 patients undergoing primary radiation therapy for invasive cervical cancer. T2-weighted spin-echo pulse sequences with long repetition times (2,500 msec) and echo times (30-100 msec) were used at a field strength of 1.5 T. Eighteen tumors responded promptly to radiation therapy with a volume reduction and significant decrease of signal intensity in the early posttreatment phase (1-3 months) and with total tumor regression at 1-6 months (immediate responders). At 6 months seven tumors were visible as residual tumors with declining signal intensity; all seven of these tumors had resolved at 9 months (delayed responders). Thus, a delayed response with residual tumor at 6 months was still compatible with subsequent clinical cure. The tumors showed progression and no marked change in signal intensity (nonresponders). Primary tumors with a volume of more than 50 cm3 were more likely to have no or delayed response. An early (2-3 months) and significant decrease in the signal intensity and volume of a tumor indicates a favorable response. Large primary tumors may show a delayed response.

Method of Tumor Volume Evaluation using Magnetic Resonance Imaging for Outcome Prediction in Cervical Cancer Treated with Concurrent Chemotherapy and Radiotherapy

“…Similarly, Mayr et al [9] reported that for the pre-treatment measurement both the diameter-based method and ROI volumetry in cervical carcinoma treated with radiation therapy alone provided similar predictive accuracy, particularly for patients with small (<40 cm 3 ) and large (≥100 cm 3 ) pre-radiotherapy tumor size. However, the predictive value of tumor volume in our results measured by either method has limitation.…”

“…Accurate staging in cervical carcinoma is essential in therapeutic decision-making, determining prognosis, and comparing the results of different treatment modalities in these inoperable patients. Recently, primary tumor size has been well established in a large number of studies as an important independent predictor to survival in inoperable cervical cancer [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Therefore, the appropriate method and its accuracy for tumor size measurement to provide p-value comparing <20 mL and 20-39 mL groups.…”

“…Clinical palpation is also a subjective method and has significant interobserver variability [26][27][28]. More recent studies have shown that the three-dimensional quantitative imaging-based method of tumor size measurement using MRI is highly accurate in determining actual tumor size and extent to surrounding tissue [2,3,15,16,[29][30][31][32][33][34][35][36][37]. MRI has been recognized as an important imaging modality for the management of cervical cancer because of its multiplanar capability and distinct tissue contrast, particularly between tumor and surrounding normal tissue [9].…”

“…The size and volume of the primary tumor are well-established prognostic factors and predictors of the radiation therapy outcome for cervical cancer patients [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. With the advent of magnetic resonance imaging (MRI), it has become possible to estimate the size of the primary tumor more accurately than was prior possible by clinical palpation or computer tomography (CT) in inoperable patient [15][16][17].…”

Female Pelvis: Genital Organs

“…7 ). A delayed response (6-9 months) has been described for large cervical cancers (Engin 2006 ;Flueckinger et al 1992 ). Parametrial fi brosis displaying low SI on T2WI is most evident in areas of previous tumor invasion (Engin 2006 ).…”