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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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Ashley C, Brown D, Lakhman Y, Nincevic J, Stylianou A, Wu M, Selenica P, Patel J, Berger M, Leitao M, Sonoda Y, Jewell E, Reis-Filho J, Abu-Rustum N, Aghajanian C, Cadoo K, Weigelt B. Mutation detection in cell-free DNA using ultra-high depth sequencing in prospectively collected newly diagnosed endometrial cancer patients. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kim S, Wu M, Stylianou A, Ghafoor S, Lakhman Y, Park K, Leitao M, Sonoda Y, Gardner G, Broach V, Jewell E, Cohen S, Tew W, Zivanovic O, Roche KL, Mueller J, Zamarin D, Abu-Rustum N, Aghajanian C, Cadoo K, Weigelt B. Circulating cell-free DNA in patients with newly diagnosed and recurrent cervical cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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O'Cearbhaill R, Park J, Halton E, Diamonte C, Mead E, Lakhman Y, Kane P, Riviere I, Brentjens R. A phase I clinical trial of autologous chimeric antigen receptor (CAR) T cells genetically engineered to secrete IL-12 and to target the MUC16ecto antigen in patients (pts) with MUC16ecto+ recurrent high-grade serous ovarian cancer (HGSOC). Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Straubhar A, Filippova O, Cowan R, Lakhman Y, Sarasohn D, Nikolovski I, Torrisi J, Ma W, Mueller J, Leitao M, Broach V, Brown C, Abu-Rustum N, Jewell E, Gardner G, Sonoda Y, Zivanovic O, Chi D, Roche KL. Use of a dedicated radiologic assessment score to individualize the management of women with primary advanced epithelial ovarian cancer: A triage tool to optimize outcomes and minimize interventions. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Veeraraghavan H, Lakhman Y, Feier D, Vargas H, Hricak H, Deasy J, Sala E. SU-E-J-255: Automatic Segmentation Refined, Multiple Slice-Wise Voting Based Classification of Tumors From MRI. Med Phys 2015. [DOI: 10.1118/1.4924341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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D'Anastasi M, Lakhman Y, Miccò M, Scelzo C, Vargas H, Sosa R, Chi D, Abu-Rustum N, Sala E, Hricak H. Mehrwert für die Patientenversorgung bei der Zweitbefundung von Gynäkologischen MRTs durch Subspezialisierte Radiologen. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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