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Abstract：
BACKGROUND: Diffusion-weighted magnetic resonance imaging (DWI) provides a measurement of tumor cellularity. We evaluated the potential of apparent diffusion coefficient (ADC) values obtained from post-external beam radiation therapy (EBRT) DWI and prior to brachytherapy (BT) to predict for complete metabolic response (CMR) in bulky cervical cancer.
METHODS: Clinical and DWI (b value = 500 s/mm2) data were obtained from patients undergoing interstitial BT with high-risk clinical target volumes (HR-CTVs) > 30 cc. Volumes were contoured on co-registered T2 weighted images and 90th percentile ADC values were calculated. Patients were stratified by CMR (defined by PET-CT at three months post-BT). Relation of CMR with 90th percentile ADC values and other clinical factors (International Federation of Gynecology and Obstetrics (FIGO) stage, histology, tumor and HR-CTV size, pre-treatment hemoglobin, and age) was assessed both in univariate and multivariate logistic regression analyses. Youden\'s J statistic was used to identify a threshold value.
RESULTS: Among 45 patients, twenty-eight (62%) achieved a CMR. On univariate analysis for CMR, only 90th percentile ADC value was significant (p = 0.029) while other imaging and clinical factors were not. Borderline significant factors were HR-CTV size (p = 0.054) and number of chemotherapy cycles (p = 0.078). On multivariate analysis 90th percentile ADC (p < 0.0001) and HR-CTV size (p < 0.003) were highly significant. Patients with 90th percentile ADC values above 2.10 × 10- 3 mm2/s were 5.33 (95% CI, 1.35-24.4) times more likely to achieve CMR.
CONCLUSIONS: Clinical DWI may serve to risk-stratify patients undergoing interstitial BT for bulky cervical cancer.
METHODS: Clinical and DWI (b value = 500 s/mm2) data were obtained from patients undergoing interstitial BT with high-risk clinical target volumes (HR-CTVs) > 30 cc. Volumes were contoured on co-registered T2 weighted images and 90th percentile ADC values were calculated. Patients were stratified by CMR (defined by PET-CT at three months post-BT). Relation of CMR with 90th percentile ADC values and other clinical factors (International Federation of Gynecology and Obstetrics (FIGO) stage, histology, tumor and HR-CTV size, pre-treatment hemoglobin, and age) was assessed both in univariate and multivariate logistic regression analyses. Youden\'s J statistic was used to identify a threshold value.
RESULTS: Among 45 patients, twenty-eight (62%) achieved a CMR. On univariate analysis for CMR, only 90th percentile ADC value was significant (p = 0.029) while other imaging and clinical factors were not. Borderline significant factors were HR-CTV size (p = 0.054) and number of chemotherapy cycles (p = 0.078). On multivariate analysis 90th percentile ADC (p < 0.0001) and HR-CTV size (p < 0.003) were highly significant. Patients with 90th percentile ADC values above 2.10 × 10- 3 mm2/s were 5.33 (95% CI, 1.35-24.4) times more likely to achieve CMR.
CONCLUSIONS: Clinical DWI may serve to risk-stratify patients undergoing interstitial BT for bulky cervical cancer.
摘要：
背景：扩散加权磁共振成像（DWI）提供了肿瘤细胞性的测量。我们评估了从外部束放射治疗（EBRT）DWI和近距离放射治疗（BT）之前获得的表观扩散系数（ADC）值的潜力，以预测大体积宫颈癌的完全代谢反应（CMR）。
方法：临床和DWI（b值=500s/mm2）数据来自接受间质BT的高风险临床目标体积（HR-CTV）>30cc的患者。在共同配准的T2加权图像上对体积进行轮廓化，并计算第90百分位ADC值。患者通过CMR（在BT后三个月通过PET-CT定义）进行分层。CMR与第90百分位数ADC值和其他临床因素的关系（国际妇产科联合会（FIGO）阶段，组织学,肿瘤和HR-CTV大小，治疗前血红蛋白,和年龄）在单变量和多变量逻辑回归分析中均进行了评估。Youden的J统计量用于确定阈值。
结果：在45名患者中，28人（62%）实现了CMR。关于CMR的单变量分析，只有第90百分位数的ADC值是显著的(p=0.029),而其他影像学和临床因素则不显著.临界显著因素是HR-CTV大小(p=0.054)和化疗周期数(p=0.078)。在多变量分析中，第90个百分位数的ADC（p<0.0001）和HR-CTV大小（p<0.003）高度显着。第90百分位ADC值高于2.10×10-3mm2/s的患者达到CMR的可能性是5.33倍（95％CI，1.35-24.4）。
结论：临床DWI可能有助于对接受间质性BT治疗的大宫颈癌患者进行风险分层。
方法：临床和DWI（b值=500s/mm2）数据来自接受间质BT的高风险临床目标体积（HR-CTV）>30cc的患者。在共同配准的T2加权图像上对体积进行轮廓化，并计算第90百分位ADC值。患者通过CMR（在BT后三个月通过PET-CT定义）进行分层。CMR与第90百分位数ADC值和其他临床因素的关系（国际妇产科联合会（FIGO）阶段，组织学,肿瘤和HR-CTV大小，治疗前血红蛋白,和年龄）在单变量和多变量逻辑回归分析中均进行了评估。Youden的J统计量用于确定阈值。
结果：在45名患者中，28人（62%）实现了CMR。关于CMR的单变量分析，只有第90百分位数的ADC值是显著的(p=0.029),而其他影像学和临床因素则不显著.临界显著因素是HR-CTV大小(p=0.054)和化疗周期数(p=0.078)。在多变量分析中，第90个百分位数的ADC（p<0.0001）和HR-CTV大小（p<0.003）高度显着。第90百分位ADC值高于2.10×10-3mm2/s的患者达到CMR的可能性是5.33倍（95％CI，1.35-24.4）。
结论：临床DWI可能有助于对接受间质性BT治疗的大宫颈癌患者进行风险分层。
