1
|
Pasciuto T, Moro F, Collarino A, Gambacorta MA, Zannoni GF, Oradei M, Ferrandina MG, Gui B, Testa AC, Rufini V. The Role of Multimodal Imaging in Pathological Response Prediction of Locally Advanced Cervical Cancer Patients Treated by Chemoradiation Therapy Followed by Radical Surgery. Cancers (Basel) 2023; 15:3071. [PMID: 37370682 DOI: 10.3390/cancers15123071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE This study aimed to develop predictive models for pathological residual disease after neoadjuvant chemoradiation (CRT) in locally advanced cervical cancer (LACC) by integrating parameters derived from transvaginal ultrasound, MRI and PET/CT imaging at different time points and time intervals. METHODS Patients with histologically proven LACC, stage IB2-IVA, were prospectively enrolled. For each patient, the three examinations were performed before, 2 and 5 weeks after treatment ("baseline", "early" and "final", respectively). Multivariable logistic regression models to predict complete vs. partial pathological response (pR) were developed and a cost analysis was performed. RESULTS Between October 2010 and June 2014, 88 patients were included. Complete or partial pR was found in 45.5% and 54.5% of patients, respectively. The two most clinically useful models in pR prediction were (1) using percentage variation of SUVmax retrieved at PET/CT "baseline" and "final" examination, and (2) including high DWI signal intensity (SI) plus, ADC, and SUVmax collected at "final" evaluation (area under the curve (95% Confidence Interval): 0.80 (0.71-0.90) and 0.81 (0.72-0.90), respectively). CONCLUSION The percentage variation in SUVmax in the time interval before and after completing neoadjuvant CRT, as well as DWI SI plus ADC and SUVmax obtained after completing neoadjuvant CRT, could be used to predict residual cervical cancer in LACC patients. From a cost point of view, the use of MRI and PET/CT is preferable.
Collapse
Affiliation(s)
- Tina Pasciuto
- Data Collection G-STeP Research Core Facility, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Francesca Moro
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Angela Collarino
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Maria Antonietta Gambacorta
- Radiation Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Radiology, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Gian Franco Zannoni
- Gynecopathology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Pathology, Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Marco Oradei
- ALTEMS (Graduate School of Health Economics and Management), Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Maria Gabriella Ferrandina
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Obstetrics and Gynecology, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Benedetta Gui
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Antonia Carla Testa
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Obstetrics and Gynecology, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Vittoria Rufini
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| |
Collapse
|
2
|
Hsiao YH, Yang SF, Chen YH, Chen TH, Tsai HD, Chou MC, Chou PH. Updated applications of Ultrasound in Uterine Cervical Cancer. J Cancer 2021; 12:2181-2189. [PMID: 33758596 PMCID: PMC7974902 DOI: 10.7150/jca.49479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 01/31/2021] [Indexed: 12/26/2022] Open
Abstract
Cervical cancer is a common gynecologic malignancy worldwide. It is the fourth for both incidence and mortality. For cervical cancer, imaging and pathology assessments are incorporated in the revised 2018 Federation of Gynecology and Obstetrics (FIGO) staging system. Uses of imaging techniques for the pre-treatment work-up of cervical cancer have been increasing. Among imaging techniques for the evaluation of cervical cancer, ultrasound is cheaper, faster and widely available than other imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI). Advanced technique in ultrasound, such as three-dimension (3D) ultrasound and color Doppler, have improved the clinical application of ultrasound in cervical cancer. Ultrasound may provide highly accurate information on detecting tumor presence and evaluating local tumor extent if performed by ultrasound-trained gynecologists; the experience of readers is also critical for correct pretreatment staging and assessment of response to treatment. Sonographic images could be useful to predict response of neoadjuvant chemotherapy, radiotherapy, chemotherapy and concurrent chemoradiotherapy in patients with cervical cancer. This review article attempted to present the most updated specific applications of ultrasound in cervical cancer.
Collapse
Affiliation(s)
- Yi-Hsuan Hsiao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.,Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan.,College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ya-Hui Chen
- Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan
| | - Tze-Ho Chen
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.,Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan
| | - Horng-Der Tsai
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.,Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Chih Chou
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Pang-Hsin Chou
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.,Women's Health Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan
| |
Collapse
|
3
|
Tomalczyk A, Tomasik B, Fijuth J, Moszynska-Zielinska M, Gottwald L. Assessment of cervical volume and spectral Doppler parameters in tumour dominant vessel of patients with locally advanced squamous cell cervical carcinoma. J OBSTET GYNAECOL 2021; 41:1116-1120. [PMID: 33427547 DOI: 10.1080/01443615.2020.1837752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We evaluated cervical volume and spectral Doppler parameters: peak systolic velocity (PSV), resistance index (RI) and pulsatility index (PI) in the tumour dominant vessel of 50 patients with cervical squamous cell carcinoma (SCC) staged IIB and IIIB and their changes during treatment. The patients underwent transvaginal Doppler ultrasonography prior to treatment, after external beam radiation therapy (EBRT) and 6 weeks after brachytherapy. Radiotherapy decreased cervical volume and PSV values of the tumour dominant vessel. The PSV values before EBRT in G1 + G2 tumours were higher than in G3 tumours. No correlations between cervical volume, PSV, RI and PI values with disease-free survival (DFS) and overall survival (OS) were found. We concluded, that sonographic assessment of changes in cervical volume of patients with locally advanced cervical SCC during treatment did not allow to predict treatment results. Spectral Doppler parameters PSV, RI and PI of tumour dominant vessel did not predict prognosis for these patients.Impact StatementWhat is already known on this subject? Transvaginal Doppler sonography is considered as a useful diagnostic method in patients with cervical carcinoma. However, despite numerous studies, the value of spectral Doppler parameters in tumour dominant vessel and cervical volume of patients with locally advanced cervical SCC is still not well defined.What the results of this study add? In our prospective study, we found that sonographic assessment of changes in cervical volume of patients with locally advanced cervical SCC during treatment did not allow to predict treatment results and spectral Doppler parameters of tumour dominant vessel did not predict prognosis for these patients.What the implications are of these findings for clinical practice and/or further research? Our study underlines the limited value of spectral Doppler technique in patients with cervical carcinoma. Further research should be focussed on identifying and validating novel prognostic and predictive factors.
Collapse
Affiliation(s)
- Adam Tomalczyk
- Department of Radiology, Copernicus Memorial Hospital, Lodz, Poland
| | - Bartłomiej Tomasik
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Jacek Fijuth
- Department of Radiotherapy, Chair of Oncology, Medical University of Lodz, Lodz, Poland.,Department of Teleradiotherapy, Regional Cancer Centre, Copernicus Memorial Hospital of Lodz, Lodz, Poland
| | | | - Leszek Gottwald
- Department of Radiotherapy, Chair of Oncology, Medical University of Lodz, Lodz, Poland.,Department of Teleradiotherapy, Regional Cancer Centre, Copernicus Memorial Hospital of Lodz, Lodz, Poland
| |
Collapse
|
4
|
Mangla M, Singla D. Transvaginal colour Doppler ultrasound in predicting response to chemoradiation in patients with carcinoma of the cervix. SOUTHERN AFRICAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 2015. [DOI: 10.1080/20742835.2015.1083722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
5
|
The role of ultrasound in the assessment of uterine cervical cancer. J Obstet Gynaecol India 2014; 64:311-6. [PMID: 25368452 DOI: 10.1007/s13224-014-0622-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022] Open
Abstract
Uterine cervical cancer is the second most frequent gynecological malignancy worldwide. The assessment of the extent of disease is essential for planning optimal treatment. Imaging techniques are increasingly used in the pre-treatment work-up of cervical cancer. Currently, MRI for local extent of disease evaluation and PET-scan for distant disease assessment are considered as first-line techniques. Notwithstanding, in the last few years, ultrasound has gained attention as an imaging technique for evaluating women with cervical cancer. In this paper, current knowledge about the use of ultrasound for assessing uterine cervical cancer will be reviewed and discussed.
Collapse
|
6
|
Testa AC, Di Legge A, De Blasis I, Moruzzi MC, Bonatti M, Collarino A, Rufini V, Manfredi R. Imaging techniques for the evaluation of cervical cancer. Best Pract Res Clin Obstet Gynaecol 2014; 28:741-68. [PMID: 24861248 DOI: 10.1016/j.bpobgyn.2014.04.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/16/2014] [Accepted: 04/22/2014] [Indexed: 02/07/2023]
Abstract
Improvements in the treatment of cervical carcinoma have made it possible to offer optimal and personalised treatment. Cervical cancer staging is based on clinical examination and histological findings. Many diagnostic methods are used in clinical practice. Magnetic resonance imaging is considered the optimal method for staging cervical carcinoma because of its high accuracy in assessing local extension of disease and distant metastases. Ultrasound has gained increased attention in recent years; it is faster, cheaper, and more widely available than other imaging techniques, and is highly accurate in detecting tumour presence and evaluating local extension of disease. Magnetic resonance imaging and ultrasound are often used together with computed tomography or positron emission tomography combined with computed tomography to assess the whole body, a more accurate detection of pathological lymph nodes and metabolic information of the disease.
Collapse
Affiliation(s)
- Antonia Carla Testa
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessia Di Legge
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
| | - Ilaria De Blasis
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Cristina Moruzzi
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Matteo Bonatti
- Department of Radiology, University of Verona, "G.B. Rossi" Hospital, Verona, Italy
| | - Angela Collarino
- Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Vittoria Rufini
- Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Manfredi
- Department of Radiology, University of Verona, "G.B. Rossi" Hospital, Verona, Italy
| |
Collapse
|
7
|
Non-invasive quantification of tumor vascular architecture during docetaxel-chemotherapy. Breast Cancer Res Treat 2012; 134:1013-25. [DOI: 10.1007/s10549-012-2015-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 02/29/2012] [Indexed: 10/28/2022]
|
8
|
Cosgrove D, Lassau N. Imaging of perfusion using ultrasound. Eur J Nucl Med Mol Imaging 2010; 37 Suppl 1:S65-85. [PMID: 20640418 DOI: 10.1007/s00259-010-1537-7] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ultrasound can be used to image perfusion in two ways: the traditional one using Doppler and the more recent using microbubble contrast agents. Doppler is simple to use and inexpensive but is limited to larger vessels with faster flow rates. It cannot interrogate the microvasculature because bulk tissue movement is faster than capillary flow. It has been used for liver and tumour flow. Contrast studies are much richer and can assess both the macro- and microcirculation. One approach analyses the time-intensity curves in a region of interest, e.g. a tumour, myocardium, brain, following bolus i.v. injection. Another approach measures the time taken for the microbubbles to cross a vascular bed of interest. These arrival times can be useful for the liver in both diffuse and focal diseases and for the kidney. Features derived from time-intensity curves following bolus i.v. injections of microbubbles form sensitive early indicators of the vascular response of tumours to antivascular drugs. This approach, known as dynamic contrast-enhanced ultrasound (DCE-US), has been accepted as a valid technique for monitoring tumour response by several authorities.
Collapse
Affiliation(s)
- David Cosgrove
- Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, UK.
| | | |
Collapse
|
9
|
Cosgrove D, Lassau N. [Assessment of tumour angiogenesis using contrast-enhanced ultrasound]. ACTA ACUST UNITED AC 2009; 90:156-64. [PMID: 19212283 DOI: 10.1016/s0221-0363(09)70094-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Microbubbles are useful for imaging tumour angiogenesis and relatively crude forms of this approach are now routinely used for subjective diagnosis, especially in the liver. More sophisticated methods use quantitative approaches to measure the amount and the time course of bolus or reperfusion curves and have shown great promise in revealing effective tumour response to anti-angiogenic drugs in humans before tumour shrinkage occurs. These are beginning to be accepted into clinical practice. In the long term, targeted microbubbles for molecular imaging and eventually for directed anti-tumour therapy are expected to be tested.
Collapse
Affiliation(s)
- D Cosgrove
- Imaging Sciences Department, Imperial College, Hammersmith Hospital, London W120HS, UK.
| | | |
Collapse
|
10
|
Jurado M, Galván R, Martinez-Monge R, Mazaira J, Alcazar JL. Neoangiogenesis in early cervical cancer: correlation between color Doppler findings and risk factors. A prospective observational study. World J Surg Oncol 2008; 6:126. [PMID: 19032773 PMCID: PMC2611993 DOI: 10.1186/1477-7819-6-126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 11/25/2008] [Indexed: 11/18/2022] Open
Abstract
Background The aim of the present article was to evaluate whether angiogenic parameters as assessed by transvaginal color Doppler ultrasound (TVCD) may predict those prognostic factors related to recurrence. Methods A total of 27 patients (mean age: 51.3 years, range: 29 to 85) with histologically proven early stage invasive cervical cancer were evaluated by TVCD prior to surgery. Subjective assessment of the amount of vessels within the tumor (scanty-moderate or abundant) and pulsatility index (PI) were recorded. All patients underwent radical hysterectomy and pelvic lymph node dissection. Postoperative treatment (RT or chemoradiotherapy) was given according to risk factors (positive lymph nodes, parametrial and vaginal margin involvement, depth stromal invasion, lymph-vascular space involvement) Results Tumors with "abundant" vascularization were significantly associated with pelvic lymph node metastases, depth stromal invasion > 10 mm, lymph-vascular space involvement, tumor diameter > 17.5 mm, and parametrial involvement. Postoperative treatment was significantly more frequent in patients with "abundant" vascularization (OR: 20.8, 95% CIs: 2 to 211). The presence of scanty-moderate vascularization with a PI < 0.82 or abundant vascularization with either PI > 0.82 or PI < 0.82 was associated with high-risk group in 94.4% of the cases (OR: 21.2, 95% CI: 1.9 to 236.0) Conclusion The results are consistent with a relationship between tumor angiogenesis and prognostic factors for recurrence in early cervical cancer. "Abundant" vascularization and PI < 0.82 may be related to postoperative treatment due to risk factors.
Collapse
Affiliation(s)
- Matias Jurado
- Department of Gynecology, Clínica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
| | | | | | | | | |
Collapse
|
11
|
Ángela Pascual M, Hereter L, Graupera B, Fernández Cid M, Dexeus S. Ecografía 3D/4D en ginecología: técnica y metodología. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s0304-5013(06)72605-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
12
|
Hsu KF, Su JM, Huang SC, Cheng YM, Kang CY, Shen MR, Chang FM, Chou CY. Three-dimensional power Doppler imaging of early-stage cervical cancer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:664-671. [PMID: 15517537 DOI: 10.1002/uog.1756] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To characterize intratumoral vascularization in early-stage cervical cancer by three-dimensional (3D) power Doppler ultrasound. METHODS One hundred and forty-one patients with carcinoma of the uterine cervix and 30 normal controls were studied by transvaginal 3D power Doppler ultrasound. The tumor volume of the cervical cancer was determined. The blood flow within the tumor or normal cervix was measured and expressed as the vascularization index (VI), flow index (FI) and vascularization flow index (VFI). RESULTS Of the 141 patients with cervical cancer, 44 patients had undergone prior cervical conization. Eighty-seven patients had measurable cervical tumors, of whom five had had prior conization. Abundant intratumoral power Doppler signals could be detected, and the VI, FI and VFI were significantly elevated in cervical cancer patients compared with women with a normal cervix and patients in whom no cervical tumor could be detected (P < 0.05, one-way ANOVA). We observed four types of intratumoral vascularity patterns, which did not significantly differ in VI, FI and VFI: localized, peripheral, scattered and single-vessel types. Cervical tumor volume was positively correlated with FI (linear regression, r = 0.373, P = 0.001), but not with VI or VFI. CONCLUSIONS 3D power Doppler ultrasound provides a useful tool to investigate intratumoral vascularization and volume of cervical cancer.
Collapse
Affiliation(s)
- K-F Hsu
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Alcázar JL, Castillo G, Martínez-Monge R, Jurado M. Transvaginal color Doppler sonography for predicting response to concurrent chemoradiotherapy for locally advanced cervical carcinoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2004; 32:267-272. [PMID: 15211671 DOI: 10.1002/jcu.20033] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE This study was conducted to evaluate the potential role of transvaginal color Doppler sonography (TVCD) in predicting response to concurrent chemoradiotherapy for locally advanced cervical cancer. METHODS AND MATERIALS Tumor vascularity was assessed using TVCD before the start of concurrent chemoradiotherapy in 21 patients (median age, 47 years; range, 31-75 years) with histologically proven locally advanced cervical cancer. The lowest resistance index (RI), lowest pulsatility index (PI), and highest peak systolic velocity (PSV) from central vessels within the tumor were recorded and used for analysis. All patients were clinically evaluated by physical examination and CT scanning after completing the chemoradiotherapy protocol. Complete clinical response (CR) was determined when no residual tumor was found. Partial clinical response (PR) was determined when the tumor volume had decreased more than 50%. RESULTS CR was achieved in 11 patients (52%), whereas 10 (48%) had PR. The initial median tumor volume was not statistically different between those with CR (26 cm3) and those with PR (28 cm3) (p = 0.71). RI was higher in those tumors with CR (median, 0.47) than in those with PR (median, 0.29) (p < 0.01). Likewise, PI was higher in tumors with CR (median, 0.81) than in those with PR (median, 0.41) (p < 0.01). No differences were found in PSV. The likelihood ratio for CR for tumors with a lowest RI of 0.35 or more was 2.7 (95% confidence interval, 1.8-3.6) and the likelihood ratio for CR for tumors with a lowest PI of 0.45 or more was 3.3 (95% confidence interval, 2.1-4.5). CONCLUSIONS The results suggest that TVCD may be useful in predicting clinical response to concurrent chemoradiation in patients with locally advanced cervical cancer.
Collapse
Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, School of Medicine, University of Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain
| | | | | | | |
Collapse
|
14
|
Testa AC, Mansueto D, Lorusso D, Fruscella E, Basso D, Scambia G, Ferrandina G. Angiographic power 3-dimensional quantitative analysis in gynecologic solid tumors: feasibility and reproducibility. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:821-828. [PMID: 15244306 DOI: 10.7863/jum.2004.23.6.821] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To determine the reproducibility of a simplified method of power Doppler 3-dimensional (3D) sonographic examination. METHODS Twenty-nine patients with solid pelvic masses underwent transvaginal 3D power Doppler evaluation. The volume of interest was obtained by drawing the margins of the largest section of the mass in the 3 orthogonal planes. The 3D vascular parameters ("relative color," "average color," and "flow measure") obtained by our method were compared with those calculated by a manufacturer-suggested model based on several parallel section planes drawn on the longitudinal frames. The intraobserver variability was quantified on 5 different 3D images acquired by the same operator at 5-minute intervals for each patient. The intraobserver variability was also assayed in 10 patients at 24-hour intervals. Ten patients were scanned by a second sonographer for interobserver variability. RESULTS There was high agreement between the 3D parameters obtained with the 2 methods. The 3D indices were similar in repeated observations at 5-minute intervals (median coefficients of variation for relative color, average color, and flow measure, 10.9, 4.5, and 13.0, respectively) and at 24-hour intervals (intraclass correlation coefficients for relative color, average color, and flow measure, 0.920, 0.978, and 0.978) and by the second sonographer (interclass correlation coefficients for relative color, average color, and flow measure, 0.978, 0.966, and 0.997). CONCLUSIONS The acceptable rates of intraobserver and interobserver variability make this approach potentially suitable for research protocols.
Collapse
|
15
|
Chen CA, Cheng WF, Lee CN, Su YN, Hsieh CY, Hsieh FJ. Power Doppler vascularity index for predicting the response of neoadjuvant chemotherapy in cervical carcinoma. Acta Obstet Gynecol Scand 2004; 83:591-7. [PMID: 15144343 DOI: 10.1111/j.0001-6349.2004.00522.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate whether the power Doppler vascularity index (PDVI) can predict the response to neoadjuvant chemotherapy (NACT) in cervical carcinoma. METHODS Twenty-five women with bulky early stage cervical carcinoma treated by NACT followed by surgery were enrolled. Their response to NACT was evaluated. Clinical characteristics and pathologic data were recorded. Transvaginal power Doppler was performed before, during and after NACT. PDVI was detected using power Doppler and a quantitative image processing system. Factors that can potentially correlate with the response to NACT were analyzed. RESULTS Twelve (48%) patients showed a response (responders) to NACT and 13 (52%) were unchanged or had progressive disease (nonresponders) after NACT. Higher PDVI values were noted in tumors with lymphovascular emboli and pelvic lymph node metastasis both before and after NACT. The mean values of the PDVI of the nonresponders before (19.27 +/- 6.01 vs. 12.28 +/- 7.06, p = 0.014), during (20.2 +/- 1.5 vs. 12.9 +/- 2.1, p = 0.009) and after NACT (18.1 +/- 6.0 vs. 9.3 +/- 5.4, p = 0.001) were significantly higher than those of the responders. When the cutoff point for predicting nonresponders to NACT was set at a PDVI value of 15%, the sensitivity was 92.3% and the specificity 66.7%. CONCLUSIONS The power Doppler vascularity index can predict the response to neoadjuvant chemotherapy in cervical cancer, and might be useful for the evaluation of response to chemotherapy in cancer patients in the future.
Collapse
Affiliation(s)
- Chi-An Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
16
|
Affiliation(s)
- D Cosgrove
- Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, UK
| |
Collapse
|
17
|
Alcázar JL, Castillo G, Jurado M, López-García G. Intratumoral blood flow in cervical cancer as assessed by transvaginal color doppler ultrasonography: Correlation with tumor characteristics. Int J Gynecol Cancer 2003; 13:510-4. [PMID: 12911729 DOI: 10.1046/j.1525-1438.2003.13302.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The objective of this study was to evaluate whether intratumoral blood flow as assessed by transvaginal color Doppler ultrasonography (TVCD) correlates with some tumor features in cervical cancer. Clinical, sonographic, and histologic data on 49 women (mean age: 50.3 years, range: 25-85 years) diagnosed as having a carcinoma from the uterine cervix were reviewed. Intratumoral blood flow was assessed by TVCD in all cases. Subjective impression of the amount of flow (scanty, moderate, or abundant) as well as the lowest resistance index (RI) and highest peak systolic velocity (PSV, cm/s) were used for analysis. These data were correlated with some tumoral features such as histologic type, histologic grade, tumor volume, and tumor stage. Intratumoral blood flow was found in all cases. Abundant blood flow was found more frequently in squamous carcinoma, moderately or poorly differentiated tumors, tumors with larger volume, and advanced stage tumors (P < 0.0001). Significantly lower RI was found in moderately or poorly differentiated tumors and advanced stage tumors (P < 0.01) and significantly higher PSV was found in moderately or poorly differentiated tumors, tumors with larger volume, and advanced stage tumors (P < 0.01). No correlation was found between RI and PSV and histologic type. Our data indicate that intratumoral blood flow as assessed by TVCD correlates well with some tumor features in cervical cancer.
Collapse
Affiliation(s)
- J L Alcázar
- Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
| | | | | | | |
Collapse
|
18
|
Cellini N, Morganti AG, Macchia G, Valentini V, Luzi S, Smaniotto D. Chemoradiation in cervical carcinoma: a must? Expert Rev Anticancer Ther 2002; 2:83-9. [PMID: 12113072 DOI: 10.1586/14737140.2.1.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cervical carcinoma is one of the most frequent gynecological malignancies. Literature shows that while the rate is exceedingly low in systematically screened populations, the incidence remains high because of large populations of at-risk women--particularly in underserved nations and in medically indigent subpopulations of Western nations--who are not screened. Recently, a series of randomized trials has demonstrated the possibility to dramatically improve the prognosis of these patients by using concurrent chemoradiation. In particular, concurrent chemoradiation represents a major treatment option in patients with bulky IB-IIA disease, IIB-IVA disease and resected IB-IIA disease with poor prognostic factors. However, further studies are necessary to optimize treatment schedules and particularly to define the best drug combination to be used during radiation therapy, improve patients selection by the analysis of anatomical (TNM stage) and non-anatomical (tumor oxygenation, genetic markers, tumor angiogenesis) prognostic factors, explore novel treatment strategies, such as use of neoadjuvant chemoradiation in locally advanced tumors, integration of antiangiogenetic therapies in chemoradiation schedules, use of supportive treatments aimed to overcome tumor hypoxia, to evaluate the possibility of 'cure' of locally recurrent tumors by chemoradiation and finally to define the best 'second-line' treatment for patients failing after chemoradiation with or without surgery.
Collapse
Affiliation(s)
- Numa Cellini
- Radiation Therapy Department Policlinico A. Gemelli, Università Cattolica del S. Cuore 00168, Roma, Italy.
| | | | | | | | | | | |
Collapse
|