title: Predicting control of primary tumor and survival by DCE MRI during early therapy in cervical cancer.
abstract: OBJECTIVE
  To assess the early predictive power of MRI perfusion and volume parameters, during early treatment of cervical cancer, for primary tumor control and disease-free-survival.
  
  
  METHODS
  Three MRI examinations were obtained in 101 patients before and during therapy (at 2-2.5 and 4-5 weeks) for serial dynamic contrast enhanced (DCE) perfusion MRI and 3-dimensional tumor volume measurement. Plateau Signal Intensity (SI) of the DCE curves for each tumor pixel of all 3 MRI examinations was generated, and pixel-SI distribution histograms were established to characterize the heterogeneous tumor. The degree and quantity of the poorly-perfused tumor subregions, which were represented by low-DCE pixels, was analyzed by using various lower percentiles of SI (SI%) from the pixel histogram. SI% ranged from SI2.5% to SI20% with increments of 2.5%. SI%, mean SI, and 3-dimensional volume of the tumor were correlated with primary tumor control and disease-free-survival, using Student t test, Kaplan-Meier analysis, and log-rank test. The mean post-therapy follow-up time for outcome assessment was 6.8 years (range: 0.2-9.4 years).
  
  
  RESULTS
  Tumor volume, mean SI, and SI% showed significant prediction of the long-term clinical outcome, and this prediction was provided as early as 2 to 2.5 weeks into treatment. An SI5% of <2.05 and residual tumor volume of > or =30 cm(3) in the MRI obtained at 2 to 2.5 weeks of therapy provided the best prediction of unfavorable 8-year primary tumor control (73% vs. 100%, P = 0.006) and disease-free-survival rate (47% vs. 79%, P = 0.001), respectively.
  
  
  CONCLUSIONS
  Our results show that MRI parameters quantifying perfusion status and residual tumor volume provide very early prediction of primary tumor control and disease-free-survival. This functional imaging based outcome predictor can be obtained in the very early phase of cytotoxic therapy within 2 to 2.5 weeks of therapy start. The predictive capacity of these MRI parameters, indirectly reflecting the heterogeneous delivery pattern of cytotoxic agents, tumor oxygenation, and the bulk of residual presumably therapy-resistant tumor, requires future study.
authors: Department of Radiology, Ohio State University, Columbus, Ohio 43210, USA.
authors: William T C
authors: WT
authors: Yuh
authors: Nina A
authors: NA
authors: Mayr
authors: David
authors: D
authors: Jarjoura
authors: Dee
authors: D
authors: Wu
authors: John C
authors: JC
authors: Grecula
authors: Simon S
authors: SS
authors: Lo
authors: Susan M
authors: SM
authors: Edwards
authors: Vincent A
authors: VA
authors: Magnotta
authors: Steffen
authors: S
authors: Sammet
authors: Hualin
authors: H
authors: Zhang
authors: Joseph F
authors: JF
authors: Montebello
authors: Jeffrey
authors: J
authors: Fowler
authors: Michael V
authors: MV
authors: Knopp
authors: Jian Z
authors: JZ
authors: Wang
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy