A prospective study of DWI, DCE-MRI and FDG PET imaging for target delineation in brachytherapy for cervical cancer. Issue 3 (September 2016)

• Record Type: Journal Article
• Authors: Han, Kathy; Croke, Jennifer; Foltz, Warren; Metser, Ur; Xie, Jason; Shek, Tina; Driscoll, Brandon; Ménard, Cynthia; Vines, Doug; Coolens, Catherine; Simeonov, Anna; Beiki-Ardakani, Akbar; Leung, Eric; Levin, Wilfred; Fyles, Anthony; Milosevic, Michael F.
• Is Part Of: Radiotherapy and oncology. Volume 120:Issue 3(2016:Sep.)
• Page Start: 519
• Page End: 525
• Publication Date: 2016-09
• Subjects: Diffusion-weighted MRI -- Dynamic contrast-enhanced MRI -- FDG PET -- Cervical cancer -- Brachytherapy -- Target delineation; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2016.08.002
• Languages: English
• ISSNs: 0167-8140

Abstract

Abstract: Background and purpose: We examined the utility of dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted MRI (DWI), and FDG-PET imaging for brachytherapy target delineation in patients with locally advanced cervical cancer. Materials and methods: Twenty-two patients had DWI, DCE-MRI, and FDG-PET/CT scans after brachytherapy applicator insertion, in addition to standard T2-weighted (T2w) 3T MRI. Gross tumor volume (GTVB ) and high-risk clinical target volume (HRCTV) were contoured first on T2w images, and then modified if indicated upon review of DWI/DCE-MRI/FDG-PET images by two observers. The primary endpoint was utility, determined by the number of patients whose volumes were modified, and interobserver variability. Results: Eleven patients' T2w-GTVB were modified based on DWI/DCE-MRI/FDG-PET by observer 1, due to clearer demarcation (7) and residual disease not well visualized on T2w MRI (4). GTVB was modified in 17 patients by observer 2 (11 and 6, respectively). Incorporation of functional imaging improved the conformity index (CI) for GTVB from 0.54 (T2w alone) to 0.65 ( P = 0.003). HRCTV was modified in 3 and 8 patients by observers 1 and 2, respectively, with a trend toward higher CI using functional imaging (0.71 to 0.76, P = 0.06). Conclusions: DWI/DCE-MRI/FDG-PET imaging as a supplement to T2w MRI decreased interobserver variability in GTVB delineation.