title: Consecutive magnetic resonance imaging during brachytherapy for cervical carcinoma: predictive value of volume measurements with respect to persistent disease and prognosis.
abstract: BACKGROUND
  Cervical cancer is associated with a high yearly mortality. The presence of persistent disease after radiotherapy is a significant predictor of patient survival. The aim of our study was to assess if tumor volume regression measured with MR imaging at the time of brachytherapy can discriminate between patients who eventually will achieve a complete response to radiotherapy from those who will not. The second objective was to evaluate whether tumor volume regression predicts overall treatment failure.
  
  
  METHODS
  MRI was evaluated quantitatively in 35 patients; by means of tumor volumetry on T2-weighted MR images before treatment, at the first BCT application, and at the final BCT. The MR images were independently analyzed by two investigators. As a reference standard histopathologic confirmation of residual tumor and/or clinical exam during follow-up > 1 year were used. Area under the curve were compared, P-values <0.05 were considered significant.
  
  
  RESULTS
  There was a good correlation between volume measurements made by the two observers. A residual tumor volume >9.4 cm(3) at final BCT and tumor volume regression < 77 % of the pre-treatment volume were significantly associated with local residual tumor after completion of therapy (p < 0.02) (AUC, 0.98-1.00). A volume >2.8 cm(3) at final BCT was associated with overall treatment failure (p < 0.03).
  
  
  CONCLUSIONS
  Our study shows that volume analysis during BCT is a predictive tool for local tumor response and overall treatment outcome. The potential of local response assessment to identify patients at high risk of overall treatment failure is promising.
authors.affiliation: Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, Postbus 5800, 6202, AZ, Maastricht, The Netherlands. jordymongula@hotmail.com.
authors.forename: J E
authors.initials: JE
authors.lastname: Mongula
authors.affiliation: Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, Postbus 5800, 6202, AZ, Maastricht, The Netherlands. brigitte.slangen@mumc.nl.|GROW, School for Oncology and Developmental Biology, Maastricht, The Netherlands. brigitte.slangen@mumc.nl.
authors.forename: B F M
authors.initials: BF
authors.lastname: Slangen
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands. d.lambregts@mumc.nl.|Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. d.lambregts@mumc.nl.
authors.forename: D M J
authors.initials: DM
authors.lastname: Lambregts
authors.affiliation: MAASTRO clinic, Postbus 3035, 6202, NA, Maastricht, The Netherlands. f.cellinimd@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Cellini
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands. fch.bakers@mumc.nl.
authors.forename: F C H
authors.initials: FC
authors.lastname: Bakers
authors.affiliation: GROW, School for Oncology and Developmental Biology, Maastricht, The Netherlands. ludy.lutgens@maastro.nl.|MAASTRO clinic, Postbus 3035, 6202, NA, Maastricht, The Netherlands. ludy.lutgens@maastro.nl.
authors.forename: L C H W
authors.initials: LC
authors.lastname: Lutgens
authors.affiliation: Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, Postbus 5800, 6202, AZ, Maastricht, The Netherlands. toon.van.gorp@mumc.nl.|GROW, School for Oncology and Developmental Biology, Maastricht, The Netherlands. toon.van.gorp@mumc.nl.
authors.forename: T
authors.initials: T
authors.lastname: Van Gorp
authors.affiliation: Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, Postbus 5800, 6202, AZ, Maastricht, The Netherlands. arnold.kruse@mumc.nl.|GROW, School for Oncology and Developmental Biology, Maastricht, The Netherlands. arnold.kruse@mumc.nl.
authors.forename: A J
authors.initials: AJ
authors.lastname: Kruse
authors.affiliation: Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, Postbus 5800, 6202, AZ, Maastricht, The Netherlands. r.kruitwagen@mumc.nl.|GROW, School for Oncology and Developmental Biology, Maastricht, The Netherlands. r.kruitwagen@mumc.nl.
authors.forename: R F P M
authors.initials: RF
authors.lastname: Kruitwagen
authors.affiliation: GROW, School for Oncology and Developmental Biology, Maastricht, The Netherlands. beetstan@me.com.|Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands. beetstan@me.com.|Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. beetstan@me.com.
authors.forename: R G H
authors.initials: RG
authors.lastname: Beets-Tan
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*