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.
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。