Pharmacokinetic parameters derived from dynamic contrast enhanced MRI of cervical cancers predict chemoradiotherapy outcome
Pharmacokinetic parameters derived from dynamic contrast enhanced MRI of cervical cancers predict chemoradiotherapy outcome
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DOI：
10.1016/j.radonc.2012.11.007
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发表时间：
2013-04-01
影响因子：
5.7
通讯作者：
Malinen, Eirik
中科院分区：
文献类型：
--
作者：
Andersen, Erlend K. F.;Hole, Knut Hakon;Malinen, Eirik
目的：评价宫颈癌患者放化疗前动态磁共振成像（DCE-MRI）的药代动力学参数对预后的价值。材料与方法：78例局部晚期宫颈癌患者放化疗前行DCE-MRI Gd-DTPA检查。药代动力学Brix和Tofts模型拟合所有肿瘤体素的对比增强曲线，提供几个药代动力学参数的直方图(Brix: A(Brix), k(ep), k（ei), Tofts: k -trans, nu(e)）。采用包括log-rank生存试验在内的百分位筛选方法来确定肿瘤内参数分布的临床最相关部分。临床终点为无进展生存期（PFS）和局部区域控制（LRC）。采用FIGO分期、肿瘤体积等多因素分析评价影像学参数对预后的影响。结果：A（Brix）、k（ei）、k -trans与临床LRC和PFS均有显著正相关（P < 0.05），而nu(e)仅与PFS有显著正相关。K （ep）与任何终点均无相关性。A（Brix）与K-trans和nu(e)呈正相关，且在log-rank检验中与终点的相关性最强。在以LRC为终点的多变量分析中，k（ei）和k -trans是独立的预后因素。结论：通过放化疗前获得的DCE-MR图像的药代动力学分析估计的参数可用于识别有治疗失败风险的患者。2012爱思唯尔爱尔兰有限公司版权所有。
Purpose: To assess the prognostic value of pharmacokinetic parameters derived from pre-chemoradiotherapy dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) of cervical cancer patients.Materials and methods: Seventy-eight patients with locally advanced cervical cancer underwent DCE-MRI with Gd-DTPA before chemoradiotherapy. The pharmacokinetic Brix and Tofts models were fitted to contrast enhancement curves in all tumor voxels, providing histograms of several pharmacokinetic parameters (Brix: A(Brix), k(ep), k(ei), Tofts: K-trans, nu(e)). A percentile screening approach including log-rank survival tests was undertaken to identify the clinically most relevant part of the intratumoral parameter distribution. Clinical endpoints were progression-free survival (PFS) and locoregional control (LRC). Multivariate analysis including FIGO stage and tumor volume was used to assess the prognostic significance of the imaging parameters.Results: A(Brix), k(ei), and K-trans were significantly (P < 0.05) positively associated with both clinical LRC and PFS, while nu(e) was significantly positively correlated with PFS only. k(ep) showed no association with any endpoint. A(Brix) was positively correlated with K-trans and nu(e), and showed the strongest association with endpoint in the log-rank testing. k(ei) and K-trans were independent prognostic factors in multivariate analysis with LRC as endpoint.Conclusions: Parameters estimated by pharmacokinetic analysis of DCE-MR images obtained prior to chemoradiotherapy may be used for identifying patients at risk of treatment failure. (C) 2012 Elsevier Ireland Ltd. All rights reserved.