Volumetric assessment of apparent diffusion coefficient predicts outcome following chemoradiation for cervical cancer. (June 2019)

• Record Type: Journal Article
• Authors: Ho, Jennifer C.; Fang, Penny; Cardenas, Carlos E.; Mohamed, Abdallah S.R.; Fuller, Clifton D.; Allen, Pamela K.; Bhosale, Priya R.; Frumovitz, Michael M.; Jhingran, Anuja; Klopp, Ann H.
• Is Part Of: Radiotherapy and oncology. Volume 135(2019)
• Page Start: 58
• Page End: 64
• Publication Date: 2019-06
• Subjects: Cervical cancer -- Diffusion weighted imaging -- Apparent diffusion coefficient -- Chemoradiation; 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.2019.02.012
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: 90th% ADC of tumor on MRI significantly predicts PFS and DMFS in cervical cancer patients treated with CRT. Overall survival, PFS, and DMFS were worse in patients with 90th percentile ADC < 1.917. Patients with a low 90th percentile ADC value (<1.917), as well as a high MRI volume (>18.9 cm 3 ) have the worst prognosis. Abstract: Objective: To determine the utility of volumetric diffusion weighted imaging (DWI) compared to other clinical factors for predicting recurrence and survival in cervical cancer patients treated with definitive chemoradiation. Methods and materials: We retrospectively studied cervical cancer patients treated with definitive chemoradiation between 2009–2013 at a single institution with a baseline MRI with DWI and 18F-FDG positron emission tomography/computed tomography (FDG-PET) scan. To identify clinical and imaging metrics correlated with survival and recurrence endpoints, variable importance values were calculated from random forest models. To provide clinically relevant threshold values, recursive partitioning analysis dichotomized patients into potential risk groups based on selected metrics. Cox's proportional hazard models assessed the effect of clinical and imaging factors on survival endpoints. Results: Ninety-three patients were included in the analysis (median age 50 years). At a median follow-up of 35.6 months, 32 patients (34%) had disease recurrence. In the best multivariate model including clinical and imaging parameters, 90th percentile ADC < 1.917 was the only significantly associated factor with worse progression free survival (PFS). Overall survival, PFS, and distant metastasis free survival (DMFS) were significantly different between patient groups divided on 90th percentile ADC with threshold of 1.917 × 10 −3 mm 2 /s and MRI volume with threshold of 18.9 cc ( P = 0.037, P = 0.0002, P = 0.001). High MRI volume and low ADC were associated with worse clinical outcomes. Conclusions: Volumetric 90th percentile ADC value of the primary tumor on pretreatment MRI was a significant predictor of PFS and DMFS in cervical cancer patients, independent of established clinical factors and SUV on FDG-PET.