Sequential magnetic resonance imaging of cervical cancer

Wang, Jian Z.; Mayr, Nina A.; Zhang, Dongqing; Li, Kaile; Grecula, J.C.; Montebello, Joseph F.; Lo, Simon S.; Yuh, William T. C.

doi:10.1002/cncr.25260

Cited by 73 publications

(31 citation statements)

References 25 publications

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“…Tumor volume changes after therapy have shown to be associated with survival in different solid tumors, including locally-advanced rectal adenocarcinoma treated with chemoradiotherapy and surgery [42], cervical cancer receiving radiotherapy [43], and malignant pleural mesothelioma treated with chemotherapy, extrapleural pneumonectomy, and radiation [44]. In lung cancer, Zhao et al reported that semiautomated tumor segmentation identified a larger number of patients with absolute tumor volume changes, compared with unidimensional or bidimensional techniques [23].…”

Section: Discussionmentioning

confidence: 99%

Tumor Volume Decrease at 8 Weeks Is Associated with Longer Survival in EGFR-Mutant Advanced Non–Small-Cell Lung Cancer Patients Treated with EGFR TKI

Nishino

Dahlberg

Cardarella

et al. 2013

Journal of Thoracic Oncology

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Background The study investigated if tumor volume changes at 8 weeks of therapy are associated with outcomes in advanced NSCLC patients with sensitizing EGFR mutations treated with EGFR tyrosine kinase inhibitors (TKIs). Patients and methods In 56 advanced NSCLC patients with sensitizing EGFR mutations treated with first-line erlotinib or gefitinib, tumor volumes of dominant lung lesions were measured on baseline and follow-up CT and were analyzed for association with survival. Results Among 56 eligible patients, the median tumor volume was 17.8 cm3 (range: 1.3-172.7 cm3) on the baseline scans. 49 patients had follow-up CT at approximately 8 weeks; the median tumor volume at 8 weeks was 7.1 cm3 (range: 0.4-62.3 cm3), with the median proportional volume change of -59% (range: -90% to +91%) from baseline. The proportional volume change at 8 weeks was associated with survival (p=0.02). Using the cut-off value of 38% volume decrease (75th percentile) at 8 weeks, patients with volume decrease >38% (n=37) had a median overall survival of 43.5 months compared to 16.3 months among those with volume decrease ≤38% (n=12) (p=0.01). The median progression-free survival for patients with >38% volume decrease was 12.6 months, compared to 5.5 months for those with ≤38% volume decrease (p=0.2). Conclusions The proportional volume change at 8 weeks is associated with overall survival in EGFR-mutant advanced NSCLC patients treated with first-line EGFR-TKIs. The observation of the study, if confirmed in larger study cohorts, indicates that tumor volume analysis at 8 weeks may provide an early marker for survival, and contribute to therapeutic decision making by identifying patients who may benefit from additional anti-cancer therapy after 8 weeks of EGFR-TKI therapy.

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Section: Discussionmentioning

confidence: 99%

Tumor Volume Decrease at 8 Weeks Is Associated with Longer Survival in EGFR-Mutant Advanced Non–Small-Cell Lung Cancer Patients Treated with EGFR TKI

Nishino

Dahlberg

Cardarella

et al. 2013

Journal of Thoracic Oncology

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“…Treatment response can be assessed as early as during the course of radiation therapy by measurement of initial tumor volume and tumor regression rate (22, 28-30). The tumor volumes were measured by using T2-weighted MR images and the initial tumor volumes estimated from the first MRI scans were significantly correlated with treatment outcome.…”

Section: Discussionmentioning

confidence: 99%

Onset Time of Tumor Repopulation for Cervical Cancer: First Evidence From Clinical Data

Huang

Mayr

Gao

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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Purpose Accelerated tumor repopulation has significant implications in low-dose-rate (LDR) brachytherapy. Repopulation onset time remains undetermined for cervical cancer. The purpose of this study was to determine the onset time of accelerated repopulation in cervical cancer using clinical data. Methods and Materials The linear-quadratic (LQ) model extended for tumor repopulation was used to analyze the clinical data and MRI-based 3D tumor volumetric regression data of 80 cervical cancer patients who received external beam radiotherapy (EBRT) and low dose rate (LDR) brachytherapy. The LDR dose was converted to EBRT dose in 1.8 Gy fractions using the LQ formula, and the total dose ranged from 61.4 to 99.7 Gy. The patients were divided into 11 groups according to total dose and treatment time. The tumor control probability (TCP) was calculated for each group. The least χ2 method was used to fit the TCP data with two free parameters: onset time (Tk) of accelerated repopulation and the number of clonogens (K) while other LQ model parameters were adopted from the literature, due to the limited patient data. Results Among the 11 patient groups, TCP varied from 33% to 100% as a function of radiation dose and overall treatment time. Higher dose and shorter treatment duration were associated higher TCP. Using the LQ model, the best fit was achieved with the onset time Tk=19 days, K=139, with uncertainty ranges of (11, 22) days for Tk, and (48, 1822) for K, respectively. Conclusion This is the first report of accelerated repopulation onset time in cervical cancer, derived directly from the clinical data using the LQ model. Our study verifies that accelerated repopulation does exist in cervical cancer and has a relatively short onset time. Dose escalation may be required to compensate for the effects of tumor repopulation if the radiation therapy course is protracted.

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“…1). The regression demonstrated by MRI after 45 Gy EBRT compared to the baseline MRI has been shown to be a potentially significant predictor of local recurrence (15). 3D imaging, particularly with MRI, provides a significant benefit to ensure dosimetric coverage of the tumor and avoidance of the nearby OAR (vagina, bladder, rectum, sigmoid, and bowel) (Fig.…”

Section: Clinical Approachmentioning

confidence: 99%

Magnetic Resonance Image Guided Brachytherapy

Tanderup

Viswanathan

Kirisits

et al. 2014

Seminars in Radiation Oncology

111

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The application of MRI-guided brachytherapy has demonstrated significant growth during the last two decades. Clinical improvements in cervix cancer outcomes have been linked to the application of repeated MRI for identification of residual tumor volumes during radiotherapy. This has changed clinical practice in the direction of individualized dose administration, and mounting evidence of improved clinical outcome with regard to local control, overall survival as well as morbidity. MRI-guided prostate HDR and LDR brachytherapy has improved the accuracy of target and organs-at-risk (OAR) delineation, and the potential exists for improved dose prescription and reporting for the prostate gland and organs at risk. Furthermore, MRI-guided prostate brachytherapy has significant potential to identify prostate subvolumes and dominant lesions to allow for dose administration reflecting the differential risk of recurrence. MRI-guided brachytherapy involves advanced imaging, target concepts, and dose planning. The key issue for safe dissemination and implementation of high quality MRI-guided brachytherapy is establishment of qualified multidisciplinary teams and strategies for training and education.

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Sequential magnetic resonance imaging of cervical cancer

Cited by 73 publications

References 25 publications

Tumor Volume Decrease at 8 Weeks Is Associated with Longer Survival in EGFR-Mutant Advanced Non–Small-Cell Lung Cancer Patients Treated with EGFR TKI

Tumor Volume Decrease at 8 Weeks Is Associated with Longer Survival in EGFR-Mutant Advanced Non–Small-Cell Lung Cancer Patients Treated with EGFR TKI

Onset Time of Tumor Repopulation for Cervical Cancer: First Evidence From Clinical Data

Magnetic Resonance Image Guided Brachytherapy

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