Vaginal recurrence of endometrial cancer: MRI characteristics and correlation with patient outcome after salvage radiation therapy.
Vaginal recurrence of endometrial cancer: MRI characteristics and correlation with patient outcome after salvage radiation therapy.
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DOI：
10.1007/s00261-020-02453-2
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发表时间：
2020-04
期刊：
影响因子：
--
通讯作者：
Lee LJ
中科院分区：
文献类型：
--
作者：
Steiner A;Alban G;Cheng T;Kapur T;Bay C;McLaughlin PY;King M;Tempany C;Lee LJ
目的评价子宫内膜癌(EC)阴道复发的MRI表现，包括肿瘤体积在挽救放疗过程中缩小的特点，并确定与生存相关的影像特征。对2004至2017年间接受体外放射治疗(EBRT)后再接受近距离放射治疗(BT)，并在基线和/或BT前两个时间点进行盆腔MRI检查的EC阴道复发患者进行了回顾性研究。MRI特征包括T2和T1加权图像上的复发位置和组织特征仅在基线时进行评估。肿瘤体积在治疗前和治疗前都进行了测量。生存率和相关性分别用COX回归和Fisher‘s精确检验进行评估。纳入62例患者，36例基线和50例BT前盆腔磁共振成像(24/62例同时进行了这两种磁共振成像)。阴道复发最常见的部位是阴道尖(27/36，75%)。对比剂后周边强化或低T2信号的肿瘤无复发生存期(RFs)较长(经组织学校正后，HR分别为0.2，95%CI 0.1~0.9，P<；0.05；HR 0.2，95%CI 0.1~0.8，P<；0.05)。BT治疗前肿瘤缩小的中位数为69%(范围1-99%)。BT前的绝对肿瘤体积或体积缩小均与RFS无关。子宫切除时淋巴血管侵犯(LVSI)和辅助性RT与阴道远端复发相关(均P<；0.05)。基线时边缘强化的阴道复发预示着RFS的改善，而BT治疗前肿瘤体积缩小则不能。在EC诊断时，阴道远端复发在LVSI和辅助性RT的患者中更为常见。
To evaluate MRI characteristics in vaginal recurrence of endometrial cancer (EC) including tumor volume shrinkage during salvage radiotherapy, and to identify imaging features associated with survival. Patients with vaginal recurrence of EC treated with external beam radiotherapy (EBRT) followed by brachytherapy (BT), and with available pelvic MRI at two time points: baseline and/or before BT were retrospectively identified from 2004 to 2017. MRI features including recurrence location and tissue characteristics on T2- and T1-weighted images were evaluated at baseline only. Tumor volumes were measured both at baseline and pre-BT. Survival rates and associations were evaluated by Cox regression and Fisher’s exact test, respectively. Sixty-two patients with 36 baseline and 50 pre-BT pelvic MRIs were included (24/62 with both MRIs). Vaginal recurrence of EC was most commonly located in the vaginal apex (27/36, 75%). Tumors with a post-contrast enhancing peripheral rim or low T2 signal rim at baseline showed longer recurrence-free survival (RFS) (HR 0.2, 95% CI 0.1–0.9, P < 0.05 adjusted for histology; HR 0.2, 95% CI 0.1–0.8, P < 0.05, respectively). The median tumor shrinkage at pre-BT was 69% (range 1–99%). Neither absolute tumor volumes nor volume regression at pre-BT were associated with RFS. Lymphovascular space invasion (LVSI) at hysterectomy and adjuvant RT were associated with recurrence involving the distal vagina (both P < 0.05). Vaginal recurrences with rim enhancement at baseline MRI predicted improved RFS, while tumor volume shrinkage at pre-BT did not. Distal vaginal recurrence was more common in patients with LVSI and adjuvant RT at EC diagnosis.
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作者：
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