Longitudinal changes in tumor perfusion pattern during the radiation therapy course and its clinical impact in cervical cancer.
OBJECTIVE
To study the temporal changes of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) perfusion patterns during the radiation therapy (RT) course and their influence on local control and survival in cervical cancer.


METHODS
DCE-MRI was performed in 98 patients with Stage IB(2)-IVA cervical cancer before RT (pre-RT) and during early RT (20-25 Gy) and mid-RT (45-50 Gy). Signal intensity (SI) from the DCE-MRI time-SI curve was derived for each tumor voxel. The poorly perfused low-DCE tumor subregions were quantified as lower 10th percentiles of SI (SI10). Local control, disease-specific survival, and overall survival were correlated with DCE parameters at pre-RT, early RT, and mid-RT. Median follow-up was 4.9 (range, 0.2-9.0) years.


RESULTS
Patients (16/98) with initial pre-RT high DCE (SI10 >or=2.1) had 100% 5-year local control, 81% disease-specific survival, and 81% overall survival, compared with only 79%, 61%, and 55%, respectively, in patients with pre-RT low DCE. Conversion from pre-RT low DCE to high DCE in early RT (28/82 patients) was associated with higher local control, disease-specific survival, and overall survival (93%, 74%, and 67%, respectively). In comparison with all other groups, outcome was worst in patients with persistently low DCE from pre-RT throughout the mid-RT phase (66%, 44%, and 43%; p = 0.003, 0.003, and 0.020; respectively).


CONCLUSIONS
Longitudinal tumor perfusion changes during RT correlate with treatment outcome. Persistently low perfusion in pre-RT, early RT, and mid-RT indicates a high risk of treatment failure, whereas outcome is favorable in patients with initially high perfusion or subsequent improvements of initially low perfusion. These findings likely reflect reoxygenation and may have potential for noninvasive monitoring of intra-treatment radio-responsiveness and for guiding adaptive therapy.
Department of Radiation Oncology, Ohio State University, Arthur G. James Cancer Hospital and Solove Research Institute, 300 W 10th Ave, Rm. 078, Columbus, OH 43210, USA. Nina.Mayr@osumc.edu
Nina A
NA
Mayr
Jian Z
JZ
Wang
Dongqing
D
Zhang
John C
JC
Grecula
Simon S
SS
Lo
David
D
Jaroura
Joseph
J
Montebello
Hualin
H
Zhang
Kaile
K
Li
Lanchun
L
Lu
Zhibin
Z
Huang
Jeffery M
JM
Fowler
Dee H
DH
Wu
Michael V
MV
Knopp
William T C
WT
Yuh
D000230:Adenocarcinoma / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D010101:Oxygen Consumption; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D013997:Time Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000098:blood supply* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*