Longitudinal Changes in Tumor Perfusion Pattern during the Radiation Therapy Course and its Clinical Impact in Cervical Cancer

Mayr, Nina A.; Wang, Jian Z.; Zhang, Dongqing; Grecula, J.C.; Lo, Simon S.; Jaroura, David; Montebello, Joseph F.; Zhang, Hualin; Li, Kaile; Lu, Lanchun; Huang, Zhibin; Fowler, Jeffrey; Wu, Dee; Knopp, Michael V.; Yuh, William T. C.

doi:10.1016/j.ijrobp.2009.04.084

Cited by 79 publications

(46 citation statements)

References 28 publications

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“…This finding appears consistent with the result from a serial dynamic MRI study that reported favorable outcome in patients with initially high perfusion or subsequent improvements (increase) of initially low perfusion 15. Quantitative comparison of the results between the 2 studies is however not possible because in the MRI study perfusion was quantified SI10 (the value of the plateau signal intensity above baseline such that 10% of the voxels of the heterogeneous tumor have lower signal intensities).…”

Section: Discussionsupporting

confidence: 83%

“…Mayr et al have found that pre‐ and during‐treatment DCE‐MRI measurements of primary cervical tumor perfusion correlate with local control and survival outcomes 15. Data on changes in DCE‐CT‐based perfusion parameters of primary cervical tumors during radiation or chemoradiation are more limited, with 1 study of 14 cervical cancer patients finding that tumor BF increased with radiation 16…”

Section: Introductionmentioning

confidence: 99%

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Pilot study of combined FDG‐PET and dynamic contrast‐enhanced CT of locally advanced cervical carcinoma before and during concurrent chemoradiotherapy suggests association between changes in tumor blood volume and treatment response

et al. 2018

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Modern PET/CT radiotherapy simulators offer FDG‐PET and dynamic contrast‐enhanced (DCE) CT imaging for combined volumetric assessment of tumor metabolism and perfusion. However, the clinical utility of such assessment has not been clearly defined. Thus, in a prospective longitudinal study of primary cervical tumors treated with concurrent chemoradiotherapy (CCRT) we evaluated: (1) whether PET and perfusion parameters correlate or provide complementary information; (2) what imaging changes occur during CCRT; and (3) whether any parameters are predictive of treatment response as assessed by PET/CT 3 months posttherapy. FDG‐PET/CT and DCE‐CT scans were performed on 21 patients prior to and during CCRT. Coregistered volumetric parametric maps of standardized uptake value (SUV) measures and perfusion parameters blood flow (BF), blood volume (BV), and permeability were generated. Summary statistics for these parameters and their changes were calculated within the metabolic tumor volume (MTV). Correlations between SUV and BF/BV/permeability on local and global bases were assessed with Pearson's coefficient r. MTV, maximum SUV, and mean SUV decreased significantly between the pre‐ and during‐treatment time points, while mean BV and permeability increased significantly. Global correlations between mean BF/BV/permeability and mean SUV values (−.15 < r < .29) were at most moderate. An increase in mean tumor BV during treatment was significantly correlated with complete metabolic response on 3‐month posttreatment PET/CT. Weak correlations of SUV and perfusion parameters suggest a complementary role of FDG‐PET and DCE‐CT for tumor characterization. The association between relative change in mean BV and outcome suggests a potential role for DCE‐CT in early evaluation of cervical tumor response to chemoradiotherapy.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Pilot study of combined FDG‐PET and dynamic contrast‐enhanced CT of locally advanced cervical carcinoma before and during concurrent chemoradiotherapy suggests association between changes in tumor blood volume and treatment response

et al. 2018

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“…In patients with advanced disease, there are several findings on MRI studies following initiation of treatment, which may help early prediction of the therapeutic outcome. MRI features good response to treatment include: Significant decrease in tumor size 2 mo after initiation of the therapy [43] , increased tumor ADC values on DWI 2 wk after indicative of the start of radiotherapy [44] and changes in quantitative pharmacokinetic parameters on DCE-MRI during the course of early (after 20-25 Gy) and mid-term (after 45-50 Gy) radiotherapy treatment [45] . Some authors have proposed DWI with ADC measurements, as a cancer biomarker for tumor response to therapy [46] ; however, since there is variability amongst imaging protocols and heterogeneity in ADC analysis, its use is still restricted.…”

Section: Guidelines For Cervical Cancer Follow-up (Ct Mri Pet-ct)mentioning

confidence: 99%

Current imaging strategies for the evaluation of uterine cervical cancer

Bourgioti

Chatoupis

Moulopoulos

2016

WJR

105

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Uterine cervical cancer still remains an important socioeconomic issue because it largely affects women of reproductive age. Prognosis is highly depended on extent of the disease at diagnosis and, therefore, accurate staging is crucial for optimal management. Cervical cancer is clinically staged, according to International Federation of Gynecology and Obstetrics guidelines, but, currently, there is increased use of cross sectional imaging modalities [computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)] for the study of important prognostic factors like tumor size, parametrial invasion, endocervical extension, pelvic side wall or adjacent/distal organs involvement and lymph node status. Imaging indications also include cervical cancer follow-up, evaluation of tumor response to treatment and selection of suitable candidates for less radical surgeries like radical trachelectomy for fertility preservation. The preferred imaging method for local cervical cancer evaluation is MRI; CT is equally effective for evaluation of extrauterine spread of the disease. PET-CT shows high diagnostic performance for the detection of tumor relapse and metastatic lymph nodes. The aim of this review is to familiarize radiologists with the MRI appearance of cervical carcinoma and to discuss the indications of cross sectional imaging during the course of the disease in patients with cervical carcinoma.

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“…It is believed that tumors that respond well to early treatment show an increase in tumoral enhancement and have a lower rate of recurrence [10]. Accordingly, tumors with persistent low perfusion throughout treatment means poor treatment response and hence poor prognosis [5,38,39]. Low perfusion can be measured by:…”

Section: Cancer Therapy and Oncology International Journalmentioning

confidence: 99%

“…Quantitative analysis, where some studies postulated low perfusion is the lower 10th percentile of the signalintensity curve (SI 10%) [5,39], while other considered SI 15% is more specific [5,40].…”

Section: Cancer Therapy and Oncology International Journalmentioning

confidence: 99%

Added Value of Perfusion in Gynaecological Imaging

Dogheim¹

2016

CTOIJ

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Longitudinal Changes in Tumor Perfusion Pattern during the Radiation Therapy Course and its Clinical Impact in Cervical Cancer

Cited by 79 publications

References 28 publications

Pilot study of combined FDG‐PET and dynamic contrast‐enhanced CT of locally advanced cervical carcinoma before and during concurrent chemoradiotherapy suggests association between changes in tumor blood volume and treatment response

Pilot study of combined FDG‐PET and dynamic contrast‐enhanced CT of locally advanced cervical carcinoma before and during concurrent chemoradiotherapy suggests association between changes in tumor blood volume and treatment response

Current imaging strategies for the evaluation of uterine cervical cancer

Added Value of Perfusion in Gynaecological Imaging

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