title: Predicting tumor recurrence in patients with cervical carcinoma treated with definitive chemoradiotherapy: value of quantitative histogram analysis on diffusion-weighted MR images.
abstract: Background Further research is required for evaluating the use of ADC histogram analysis in more advanced stages of cervical cancer treated with definitive chemoradiotherapy (CRT). Purpose To investigate the utility of apparent diffusion coefficient (ADC) histogram derived from diffusion-weighted magnetic resonance images in cervical cancer patients treated with definitive CRT. Material and Methods The clinical and radiological data of 50 patients with histologically proven cervical squamous cell carcinoma treated with definitive CRT were retrospectively analyzed. The impact of clinicopathological factors and ADC histogram parameters on prognostic factors and treatment outcomes was assessed. Results The mean and median ADC values for the cohort were 1.043 ± 0.135 × 10-3mm2/s and 1.018 × 10-3mm2/s (range, 0.787-1.443 × 10-3mm2/s). The mean ADC was significantly lower for patients with advanced stage (≥IIB) or lymph node metastasis compared with patients with stage <IIB or no lymph node metastasis. The mean ADC, 75th percentile ADC (ADC75), 90th percentile ADC (ADC90), and 95th percentile ADC (ADC95) were significantly lower in patients with tumor recurrence compared with patients without recurrence. In multivariate analysis, tumor size, ADC75 and ADC95 were independent prognostic factors for both overall survival and disease-free survival. Conclusion ADC histogram parameters could be markers for disease recurrence and for predicting survival outcomes. ADC75, ADC90, and ADC95 of the primary tumor were significant predictors of disease recurrence in cervical cancer patients treated with definitive CRT.
authors.affiliation: 1 Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Gurcan
authors.initials: G
authors.lastname: Erbay
authors.affiliation: 2 Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Onal
authors.affiliation: 1 Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Elif
authors.initials: E
authors.lastname: Karadeli
authors.affiliation: 2 Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey.
authors.forename: Ozan C
authors.initials: OC
authors.lastname: Guler
authors.affiliation: 3 Department of Electrical and Electronics Engineering, Cukurova University Faculty of Engineering and Architecture, Adana, Turkey.
authors.forename: Sami
authors.initials: S
authors.lastname: Arica
authors.affiliation: 1 Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Zafer
authors.initials: Z
authors.lastname: Koc
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002584:Cervix Uteri / Q000000981:diagnostic imaging; D059248:Chemoradiotherapy / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D055815:Young Adult
keywords: Cervical cancer; apparent diffusion coefficient; chemoradiotherapy; magnetic resonance imaging (MRI); prognostic factor