Significance of tumor volume and corpus uteri invasion in cervical cancer patients treated by radiotherapy

Abstract

The purpose of this study was to show that in advanced cervical cancer patients treated with curative intent, tumor volume and uterine involvement have independent prognostic value. Eligible patients were those seen at the Peter MacCallum Cancer Centre between December 1995 and June 2001, newly diagnosed with a histologic diagnosis of squamous cell carcinoma or adenocarcinoma of the cervix, FIGO-staged IB-IVA, and having undergone magnetic resonance imaging (MRI) and treated with curative intent. Potential prognostic factors considered were FIGO stage, clinical tumor diameter, histology, age, tumor volume, and corpus invasion status. MRI was used to determine the tumor volume and whether there was invasion of tumor into the corpus uteri. One hundred and seventy-nine patients were eligible for this study. The cut-off date for follow-up was October 2003, one patient was lost to follow-up, and the mean potential follow-up time was 4.5 years (range 0.2-7.7 years). There were 60 (34%), 78 (44%), 34 (19%), and 7 (4%) patients in FIGO stages IB, II, III, and IVA, respectively. The tumors of 107 (60%) patients exhibited corpus invasion. The median tumor volume was 33 mL (range 0.1-200 mL). The four factors, FIGO stage, clinical tumor diameter, corpus invasion, and tumor volume, were all strongly positively correlated (P < 0.001 in each case). The 5-year overall survival (OS) rate for all patients was 55% (standard error = 4%). Of the six factors examined, FIGO stage (P= 0.006), clinical tumor diameter (P= 0.013), corpus invasion (P < 0.001), and tumor volume (P < 0.001) were statistically significantly related to OS duration in unifactor analyses. However, only corpus invasion (P= 0.013) and tumor volume (P= 0.004) were significantly and independently associated with OS in multifactor analyses. In particular, after adjusting for corpus involvement and tumor volume, there was no evidence for any relationship between OS and either FIGO stage (P= 0.49) or clinical tumor diameter (P= 0.58). The results from the analysis of failure-free survival were very similar. We conclude that in patients with advanced cervical cancer, tumor volume and corpus invasion provide important prognostic information over and above that provided by FIGO stage, clinical tumor diameter, histology, and age.

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

“…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]. Narayan et al [12] demonstrated that, tumor volume measured by diameter-based method in advanced cervical cancer provide important prognostic information over and above that provided by FIGO stage, clinical tumor diameter, histology, and age. Other authors have suggested that pre-treatment ROI-based tumor volume was significant prognostic factor for patients with invasive cervical carcinoma [5,8,11,14,38].…”

“…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.…”

“…For clinical practice, the diameter-based tumor size measurement has been the standard method to assess tumor size and volume [9,11,12]. This method is used under the assumption that the confi guration of the tumor closely approximates an ellipsoid shape and employed simple diameter measurement of three orthogonal diameters that can be performed on film hard copies [20].…”

“…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].…”

Systemic therapy of recurrent or persistent cancer of the cervix. Recommendations of the Polish Gynecological Society

“…Wykonanie rezonansu magnetycznego oraz PET jest uznawane za wystarczające dla potwierdzenia przejścia procesu nowotworowego na powyższe struktury [5]. U około 50% chorych, u których w badaniu PET stwierdzono zajęcie węzłów chłonnych, nastąpi nawrót choroby po standardowej radiochemioterapii [6,7,8]. Najczęstszą przyczyną zgonów chorych na raka szyjki macicy jest rozsiew choroby, ale u około 35% chorych obserwuje się lokoregionalne nawroty choroby [10].…”