Magnetic resonance imaging for assessment of parametrial tumour spread and regression patterns in adaptive cervix cancer radiotherapy
Magnetic resonance imaging for assessment of parametrial tumour spread and regression patterns in adaptive cervix cancer radiotherapy
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DOI：
10.3109/0284186x.2013.818251
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发表时间：
2013-10-01
期刊：
影响因子：
3.1
通讯作者：
Dimopoulos, Johannes C. A.
中科院分区：
文献类型：
--
作者：
Schmid, Maximilian P.;Fidarova, Elena;Dimopoulos, Johannes C. A.
目的.探讨宫颈癌初次放化疗期间宫旁浸润的磁共振成像（MRI）形态学差异对肿瘤反应的影响。材料和方法。85例连续的FIGO IIB期（n = 59）和IIIB期（n = 26）宫颈癌患者接受了外射束放疗（+/-化疗）和图像引导自适应近距离放射治疗，在诊断时和近距离放射治疗时接受了T2加权MRI。根据子宫旁肿瘤浸润的主要形态和最大程度评估诊断时子宫旁肿瘤浸润的MRI模式，并将其分为5个肿瘤组（TG）：1）扩张型伴毛刺; 2）扩张型伴毛刺和浸润部分; 3）浸润到子宫旁间隙（PM）的内三分之一; 4）浸润到PM的中三分之一;和5）渗透到PM的外三分之一中。近距离放射治疗时的MRI用于识别PM内残留疾病的存在（残留与无残留疾病）和信号强度（高与中等）。在两个时间点分别评价每例患者的左侧和右侧PM。使用卡方检验和逻辑回归分析分析TG对PM内肿瘤缓解状态的影响。结果总共分析了170个PM。TG 1、2、3、4、5分别占12%、11%、35%、25%和12%。5%的PM是无肿瘤的。对于TG 1、2、3、4和5，分别在19%、68%、88%、90%和85%的PM中鉴定出PM中的残留肿瘤。与TG 1 + 2相比，TG 3-5在PM中具有显著更高的残留肿瘤率（88%对43%，p < 0.01）。结论PM浸润的MRI形态学特征似乎可以预测体外放射治疗和化疗期间的肿瘤反应。诊断时主要为浸润性肿瘤扩散导致近距离放射治疗时PM中残留肿瘤的发生率显著高于主要为扩张性肿瘤扩散。
Purpose. To investigate the impact of magnetic resonance imaging (MRI)-morphologic differences in parametrial infiltration on tumour response during primary radiochemotherapy in cervical cancer. Material and methods. Eighty-five consecutive cervical cancer patients with FIGO stages IIB (n = 59) and IIIB (n = 26), treated by external beam radiotherapy (+/- chemotherapy) and image-guided adaptive brachytherapy, underwent T2-weighted MRI at the time of diagnosis and at the time of brachytherapy. MRI patterns of parametrial tumour infiltration at the time of diagnosis were assessed with regard to predominant morphology and maximum extent of parametrial tumour infiltration and were stratified into five tumour groups (TG): 1) expansive with spiculae; 2) expansive with spiculae and infiltrating parts; 3) infiltrative into the inner third of the parametrial space (PM); 4) infiltrative into the middle third of the PM; and 5) infiltrative into the outer third of the PM. MRI at the time of brachytherapy was used for identifying presence (residual vs. no residual disease) and signal intensity (high vs. intermediate) of residual disease within the PM. Left and right PM of each patient were evaluated separately at both time points. The impact of the TG on tumour remission status within the PM was analysed using chi(2)-test and logistic regression analysis. Results. In total, 170 PM were analysed. The TG 1, 2, 3, 4, 5 were present in 12%, 11%, 35%, 25% and 12% of the cases, respectively. Five percent of the PM were tumour-free. Residual tumour in the PM was identified in 19%, 68%, 88%, 90% and 85% of the PM for the TG 1, 2, 3, 4, and 5, respectively. The TG 3-5 had significantly higher rates of residual tumour in the PM in comparison to TG 1 + 2 (88% vs. 43%, p < 0.01). Conclusion. MRI-morphologic features of PM infiltration appear to allow for prediction of tumour response during external beam radiotherapy and chemotherapy. A predominantly infiltrative tumour spread at the time of diagnosis resulted in a significantly higher rate of residual tumour in the PM at the time of brachytherapy in comparison to a predominantly expansive tumour spread.