Pre-treatment prediction of early response to chemoradiotherapy by quantitative analysis of baseline staging FDG-PET/CT and MRI in locally advanced cervical cancer

L.A. Min*, L.L.G.C. Ackermans, M.E. Nowee, J.J.W. van Griethuysen, S. Roberti, M. Maas, W.V. Vogel, R.G.H. Beets-Tan, D.M.J. Lambregts

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Web of Science)

Abstract

Background Early prediction of response to concurrent chemoradiotherapy (cCRT) could aid to further optimize treatment regimens for locally advanced cervical cancer (LACC) in the future. Purpose To explore whether quantitative parameters from baseline (pre-therapy) magnetic resonance imaging (MRI) and FDG-PET/computed tomography (CT) have potential as predictors of early response to cCRT. Material and Methods Forty-six patients with LACC undergoing cCRT after staging with FDG-PET/CT and MRI were retrospectively analyzed. Primary tumor volumes were delineated on FDG-PET/CT, T2-weighted (T2W)-MRI and diffusion-weighted MRI (DWI) to extract the following quantitative parameters: T2W volume; T2W signal(mean); DWI volume; ADC(mean); ADC(SD); MTV42%; and SUVmax. Outcome was the early treatment response, defined as the residual tumor volume on MRI 3-4 weeks after start of external beam radiotherapy with chemotherapy (before the start of brachytherapy): patients with a residual tumor volume <10 cm(3)were classified as early responders. Imaging parameters were analyzed together with FIGO stage to assess their performance to predict early response, using multivariable logistic regression analysis with bi-directional variable selection. Leave-one-out cross-validation with bootstrapping was used to simulate performance in a new, independent dataset. Results T2W volume (OR 0.94,P = 0.003) and SUVmax(OR 1.15,P = 0.18) were identified as independent predictors in multivariable analysis, rendering a model with an AUC of 0.82 in the original dataset, and AUC of 0.68 (95% CI 0.41-0.81) from cross-validation. Conclusion Although the predictive performance achieved in this small exploratory dataset was limited, these preliminary data suggest that parameters from baseline MRI and FDG-PET/CT (in particular pre-therapy tumor volume) may contribute to prediction of early response to cCRT in cervical cancer.
Original languageEnglish
Article number0284185120943046
Pages (from-to)940-948
Number of pages9
JournalActa Radiologica
Volume62
Issue number7
Early online date28 Jul 2020
DOIs
Publication statusPublished - Jul 2021

Keywords

  • cervix
  • chemoradiation
  • chemotherapy
  • concurrent chemoradiotherapy
  • diffusion-weighted mri
  • emission tomography/computed tomography
  • fluorodeoxyglucose
  • magnetic resonance diffusion
  • magnetic resonance imaging
  • magnetic-resonance
  • perfusion
  • positron emission tomography
  • primary neoplasms
  • prognostic value
  • radiation
  • tumor response
  • TUMOR RESPONSE
  • FLUORODEOXYGLUCOSE
  • PROGNOSTIC VALUE
  • MAGNETIC-RESONANCE
  • CONCURRENT CHEMORADIOTHERAPY
  • DIFFUSION-WEIGHTED MRI
  • EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY
  • Cervix
  • RADIATION
  • CHEMOTHERAPY
  • CHEMORADIATION

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