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Moore A, Paudyal R, Elder G, Lakhman Y, White C, Zhang Z, Broach VA, Liu Y, Damanto A, Cohen GN, Nunez DA, Dreyfuss A, Alektiar KM, Dave A, Kollmeier MA. Pre-Brachytherapy Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) Response as Predictor of Local Control in the Definitive Treatment of Cervical Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e534. [PMID: 37785655 DOI: 10.1016/j.ijrobp.2023.06.1820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Chemoradiation consisting of external beam radiotherapy (EBRT) followed by brachytherapy (BT) is the standard of care for Stage IB2-IVA cervical cancer (CC). Multi-parametric MRI (mpMRI) is a valuable tool for initial staging, treatment planning and response assessment. In this study, we aim to explore the potential of mpMRI, in particular DW-MRI, to predict overall tumor control following chemoradiation in CC. MATERIALS/METHODS We identified 78 consecutive patients treated with chemoradiation for FIGO IB2-IVA CC between 2012-2020, who had an MRI at baseline (MRb) and post-EBRT prior to brachytherapy boost (MRpb) that included DW-MRI (b-value = 0 and 800 s/mm2). Median age was 53 years, most patients had squamous cell carcinoma (76.9%) and advanced-stage disease (56.4% stage IIIA-IVA). Median time from completion of EBRT to MRpb was 3 days. Regions of interest (ROI) in primary tumor were delineated on DW image (b = 0 s/mm2) using ITK-SNAP software. DW-MRI data were fitted to a monoexponential model to calculate apparent diffusion coefficient (ADC) values using in-house software platform (MRI-QAMPER). MRpb mean ADC values (n = 78) and relative changes (%) in mean ADC values between MRb and MRpb (n = 64) were correlated with outcomes, including local failure (LF), regional or distant failure (RDF), and failure at any site (FAS), with death without failure as a competing risk. Median follow-up time was 45 months (95% CI 38, 53). RESULTS At first post treatment assessment, 72 patients (92.3%) had a complete response (CR) in the cervix and 68 patients (87.2%) had CR in all disease sites. Of patients who had CR in the cervix (n = 72), only 1 patient had local recurrence. Of patients who had CR in all disease sites, 10 later recurred (1 LF only, 1 LF&RDF, 8 RDF only). Overall, 7 patients (9%) had LF, and 19 patients (24.4%) had FAS. A higher mean ADC value in MRpb was associated with LF (HR 4.3, 95% CI 1.32, 14.6; P = 0.016), but not with RDF (P = 0.4) or FAS (P = 0.5). A higher relative change in the mean ADC value between MRb and MRpb was associated with a lower risk of LF (HR 0.94, 95% CI 0.90, 0.98; P = 0.002), but not with RDF (P = 0.8) or FAS (P = 0.4). CONCLUSION Treatment response as measured on prebrachytherapy DW-MRI is a significant predictor of local control in patients undergoing chemoradiation for stage IB2-IVA CC. ADC values, a quantitative imaging biomarker on MRpb may be instrumental in dose intensification/de-escalation efforts in CC.
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Affiliation(s)
- A Moore
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel
| | - R Paudyal
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - G Elder
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NEW YORK, NY
| | - Y Lakhman
- Department of Imaging, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C White
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer center, New York, NY
| | - Z Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - V A Broach
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Y Liu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Damanto
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - G N Cohen
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - A Dreyfuss
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - K M Alektiar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Dave
- Department of Medical Physics, Department of Imaging, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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