Evaluation of the efficacy of chemoradiotherapy in cervical cancer using diffusion-weighted imaging and apparent diffusion coefficient

Ju, Fa-Jun

doi:10.2147/ott.s111829

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…On comparing them with pre-CCRT ADC values, there was a mean increase of 0.480 ± 0.134 × 10 −3 mm 2 /s which was statistically significant. Similar observations were also made by other authors[222324252627282930] and few recent studies [Table 6].…”

Section: Discussionsupporting

confidence: 91%

Role of apparent diffusion coefficient as a biomarker in the evaluation of cervical cancer

Dashottar

Pany

Lohia

2019

Indian Journal of Radiology and Imaging

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Background: Diffusion-weighted magnetic resonance imaging (DW-MRI) has evolved as a major diagnostic and prognostic tool in cervical cancer. The aim of our study was to compare the change in mean apparent diffusion coefficient (ADC) value before and after concurrent chemoradiation therapy (CCRT) in carcinoma cervix thereby establishing its role as a cancer biomarker. Materials and Methods: A hospital-based prospective study was conducted in 35 patients diagnosed with cervical cancer. All 35 patients underwent pelvic MRI before and after 6 months of CCRT. The study was done over a period of 12 months. Conventional axial and sagittal T2 imaging was followed by DW-MRI. In the axial DW/ADC images at “ b -value” of 800 s/mm 2 , a circular region of interest was drawn covering more than 60% of the tumor volume to calculate the ADC values. Statistical Package for the Social Sciences (version 21.0) was used for statistical evaluation. Chi-square test, independent samples t -test, and analysis of variance were used to analyze the data. The results are depicted as frequencies (number), proportion (percentages), and mean ± standard deviation. Results: Pre-CCRT mean ADC value was 0.814 × 10 −3 mm 2 /s. Post-CCRT mean ADC value was 1.294 × 10 −3 mm 2 /s. Mean ADC value of patients having lymph node involvement and parametrial extension was significantly lower when compared with those without lymph node involvement and parametrial extension ( P = 0.001). Nonresponders with residual lesion had lower ADC values than responders with no residual lesion. An interesting and unique observation was that pre-CCRT mean ADC value of responders was higher than nonresponders. Conclusion: An increase in mean ADC value of 0.480 × 10 −3 mm 2 /s after CCRT was found to be statistically significant ( P < 0.001) thereby proving its role as an imaging biomarker in cancer cervix.

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Section: Discussionsupporting

confidence: 91%

Role of apparent diffusion coefficient as a biomarker in the evaluation of cervical cancer

Dashottar

Pany

Lohia

2019

Indian Journal of Radiology and Imaging

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“…At present, the treatment of cervical cancer is mainly based on surgical treatment, supplemented by radiotherapy 27,28. The purpose of this study was to elucidate the molecular mechanism of SNG-induced anticancer effects in cervical cancer cells and to explore its effects on the growth of cervical cancer cells in vivo using the HeLa xenograft model.…”

Section: Discussionmentioning

confidence: 99%

<p>Sanguinarine exhibits potent efficacy against cervical cancer cells through inhibiting the STAT3 pathway in vitro and in vivo</p>

Zhang¹,

Zhang²,

Venkat³

et al. 2019

CMAR

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Background Cervical cancer is the third most common malignancy among female cancer patients worldwide. Signal transducer and activator of transcription 3 (STAT3) is a transcription factor which regulates a variety of cancer cellular physiological activities including cervical cancer. Sanguinarine (SNG) is a natural plant-derived benzophenanthridine alkaloid that possesses antitumor activities in several cancer cells. However, its anticancer effect on human cervical cancer cells and the underlying mechanisms have not been fully defined. Methods In this study, the inhibitory effect of SNG on the proliferation and growth of HeLa cell was detected by MTT assay. Next, cell cycle and apoptosis of HeLa cells was analyzed using Annexin-V/PI double staining and flow cytometry. Then, we measured intracellular ROS generation induced by SNG in HeLa cells by DCFH-DA (10 μM) staining, and the expression level of p-STAT3 and STAT3 was detected by Western blot. Finally, in order to study the effect of SNG on tumor growth in vivo, athymic nude mice were used in the vivo experiments. Result This study showed that SNG dose-dependently decreased the tumor cell proliferation and induced a marked increase in cell apoptosis in HeLa cells. Western blot analysis results revealed that SNG-induced antitumor effect might be mediated by STAT3 inhibition. SNG increased the expression of the proapoptotic protein Bax and reduced the expression of the antiapoptotic protein Bcl-2. We further found that SNG dose-dependently increased ROS level in Hela cells. Moreover, pretreatment with N-acetyl-l-cysteine, a scavenger of ROS, almost reversed the SNG-induced anticancer effect. In addition, SNG inhibited human cervical cancer xenograft growth without exhibiting toxicity in vivo. Conclusion Our findings highlight STAT3 as a promising therapeutic target. We also demonstrate that SNG is a novel anticancer drug for the treatment of cervical cancer.

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“…The studies to date of DW-MRI during CRT as an early prognostic factor in squamous cell carcinoma have repeated the DW-MRI at different timepoints during CRT and used different measures of outcome (15,17,19,26,27). There are varying results on the validity of using absolute ADC levels at outset or during CRT to predict response however the change in ∆ADC between baseline and scans from the 2 nd week onwards, consistently correlates with outcome.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study of Diffusion-weighted Magnetic Resonance Imaging as an Early Prognostic Biomarker in Chemoradiotherapy in Squamous Cell Carcinomas of the Anus

et al. 2020

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The use of diffusion-weighted magnetic resonance imaging as a prognostic marker of treatment response would enable early individualisation of treatment. We aimed to quantify the changes in mean apparent-diffusion-coefficient (∆ADC Mean ) between a DW-MRI at diagnosis and on fraction 8-10 of chemoradiotherapy (CRT) as a biomarker for cellularity, and correlate these with ASCC recurrence. Methods and materialsThis prospective study recruited patients with localised anal cancer between October 2014 and November 2017. DW-MRI was performed at diagnosis and after fraction 8-10 of radical CRT. A region of interest (ROI) was delineated for all primary tumours and any lymph nodes >2 cm on highresolution T 2 -weighted images and propagated to the ADC map. Routine clinical follow up was collected from NHS electronic systems. ResultsTwenty-three of 29 recruited patients underwent paired DW-MRI scans. 26 ROIs were delineated among the 23 evaluable patients. The median (range) tumour volume was 13.6 cm 3 (2.8 cm 3 to 84.9 cm 3 ). Ten of 23 patients had lesions with ∆ADC Mean ≤20%. With a median follow-up of 41.2 months, 4 patients either failed to have a complete response to CRT, or subsequently relapsed. Three of 4 patients with disease relapse had lesions demonstrating ∆ADC Mean ≤20%, the other patient with persistent disease had ∆ADC Mean of 20.3%. ConclusionsWe demonstrated a potential correlation between patients with ∆ADC Mean ≤20% and disease relapse.Further investigation of the prognostic merit of DW-MRI change is needed in larger, prospective cohorts.

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Evaluation of the efficacy of chemoradiotherapy in cervical cancer using diffusion-weighted imaging and apparent diffusion coefficient

Cited by 8 publications

References 26 publications

Role of apparent diffusion coefficient as a biomarker in the evaluation of cervical cancer

Role of apparent diffusion coefficient as a biomarker in the evaluation of cervical cancer

<p>Sanguinarine exhibits potent efficacy against cervical cancer cells through inhibiting the STAT3 pathway in vitro and in vivo</p>

A Prospective Study of Diffusion-weighted Magnetic Resonance Imaging as an Early Prognostic Biomarker in Chemoradiotherapy in Squamous Cell Carcinomas of the Anus

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