Restricted accessResearch articleFirst published online 2021-2
Volume computed tomography perfusion as a predictive marker for treatment response to concurrent chemoradiotherapy in cervical cancer: a prospective study
Computed tomography perfusion (CTP) can provide information on blood perfusion as a reliable marker of tumor response to therapy.
Purpose
To assess the role of volume CTP (vCTP) parameters in predicting treatment response to concurrent chemoradiotherapy (CCRT) for cervical cancer.
Material and Methods
Thirty-three patients with cervical cancer underwent vCTP. Three CTP parameters of cervical cancer—including arterial flow (AF), blood volume (BV), and permeability surface (PS)—were measured in two different ways: the region of interest incorporating the “local hot” with the highest enhancement and “cold spot” with the lowest enhancement; and “whole-tumor” measurements. The patients were divided into non-residual and residual tumor groups according to the short-term response to treatment. The clinical and perfusion parameters were compared between the two groups.
Results
There was no significant difference in age, body mass index, FIGO stage, pathological grade, or pretreatment tumor size between the two groups (P > 0.05). The non-residual tumor group had higher pretreatment AF in high-perfusion and low-perfusion subregions than the residual tumor group (P <0.05), but the AF in whole-tumor regions was not different between the two groups (P > 0.05). There were no differences in BV and PS between the two groups (P > 0.05). The diagnostic potency of AF in the low-perfusion subregion was higher than that in the high-perfusion subregion.
Conclusion
vCTP parameters are valuable for the prediction of short-term effects. The AF in the low-perfusion subregion was a more effective index for predicting treatment response to CCRT of cervical cancer.
DagZYilmazBDoganAK, et al.
Comparison of the prognostic value of F-18 FDG PET/CT metabolic parameters of primary tumors and MRI findings in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy.Brachytherapy2019;
18:154–162.
2.
HuKWangWLiuX, et al.
Comparison of treatment outcomes between squamous cell carcinoma and adenocarcinoma of cervix after definitive radiotherapy or concurrent chemoradiotherapy. Radiat Oncol2018;
13:249.
3.
YangWQiangJWTianHP, et al.
Multi-parametricMRI in cervical cancer: early prediction of response to concurrent chemoradiotherapy in combination with clinical prognostic factors. Eur Radiol2018;
28:437–445.
4.
EisenhauerEATherassePBogaertsJ, et al.
New response evaluation criteria in solid tumors: revised RECIST guideline (version 1.1). Eur J Cancer2009;
45:228–247.
5.
ParkJJKimCKParkSY, et al.
Assessment of early response to concurrent chemoradiotherapy in cervical cancer: value of diffusion-weighted and dynamic contrast-enhanced MR imaging. Magn Reson Imaging2014;
32:993–1000.
6.
HarryVN.Novel imaging techniques as response bio-markers in cervical cancer. Gynecol Oncol2010;
116:253–261.
7.
KimJHKimCKParkBK, et al.
Dynamic contrast-enhanced 3-T MR imaging in cervical cancer before and after concurrent chemoradiotherapy. Eur Radiol2012;
22:2533–2539.
8.
Jalaguier-CoudrayAVillard-MahjoubRDeloucheA, et al.
Value of dynamic contrast-enhanced and diffusion-weighted MR imaging in the detection of pathologic complete response in cervical cancer after neoadjuvant therapy: a retrospective observational study. Radiology2017;
284:432–442.
9.
KimCKParkSYParkBK, et al.
Blood oxygenation level-dependent MR imaging as a predictor of therapeutic response to concurrent chemoradiotherapy in cervical cancer: a preliminary experience. Eur Radiol2014;
24:1514–1520.
10.
HuXLiuHYeM, et al.
Prognostic value of microvessel density in cervical cancer. Cancer Cell Int2018;
18:152.
11.
CooperRAWestCMWilksDP, et al.
Tumor vascularity is a significant prognostic factor for cervix carcinoma treated with radiotherapy: independence from tumor radiosensitivity. Br J Cancer1999;
81:354–358.
12.
AncutaCAncutaEZugun-EloaeF, et al.
Neoangiogenesis in cervical cancer: focus on CD34 assessment. Rom J Morphol Embryol2010;
51:289–294.
13.
LiXSFanHXZhuHX, et al.
The value of perfusion CT in predicting the short-term response to synchronous radiochemotherapy for cervical squamous cancer. Eur Radiol2012;
22:617–624.
14.
ShibuyaKTsushimaYHorisokoE, et al.
Blood flow change quantification in cervical cancer before and during radiation therapy using perfusion CT. J Radiat Res2011;
52:804–811.
15.
WuDTanMZhouM, et al.
Liver computed tomographic perfusion in the assessment of microvascular invasion in patients with small hepatocellular carcinoma. Invest Radiol2015;
50:188–194.
16.
Lundsgaard HansenMFallentinELauridsenC, et al.
Computed tomography (CT) perfusion as an early predictive marker for treatment response to neoadjuvant chemotherapy in gastroesophageal junction cancer and gastric cancer–a prospective study. PLoS One2014;
20;9:e97605.
17.
CaiXRZhouQCYuJ, et al.
Assessment of renal function in patients with unilateral ureteral obstruction using whole-organ perfusion imaging with 320- detector row computed tomography. PLoS One2015;
15;10:e0122454.
18.
YueDTongDRFei FeiW, et al.
Imaging features of the whole uterus volume CT perfusion and influence factors of blood supply: a primary study in patients with cervical squamous carcinoma. Acad Radiol. 2019;
26:e216–e223.
19.
NgCSZhangZLeeSI, et al.
CT perfusion as an early biomarker of treatment efficacy in advanced ovarian cancer: an ACRIN and GOG study. Clin Cancer Res2017;
23:3684–3691.
20.
KinoAShafferJMaturenKE, et al.
Perfusion CT measurements predict tumor response in rectal carcinoma. Abdom Radiol (NY) 2017;
42:1132–1140.
21.
MilesKA.Measurement of tissue perfusion by dynamic computed tomography. Br J Radiol1991;
64:409–412.
22.
NamHParkWHuhSJ, et al.
The prognostic significance of tumor volume regression during radiotherapy and concurrent chemoradiotherapy for cervical cancer using MRI. Gynecol Oncol2007;
107:320–325.
23.
PecorelliSZiglianiLOdicinoF.Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet2009;
105:107–108.
24.
FuCFengXBianD, et al.
Basic T1 Perfusion magnetic resonance imaging evaluation of the therapeutic effect of neoadjuvant chemotherapy in locally advanced cervical cancer. Int J Gynecol Cancer2013;
23:1270–1278.
25.
LambregtsDMBeetsGLMaasM, et al.
Tumor ADC measurements in rectal cancer: effect of ROI methods on ADC values and interobserver variability. Eur Radiol2011;
21:2567–2574.
26.
LyngHVorrenAOSundforK, et al.
Intra- and intertumor heterogeneity in blood perfusion of human cervical cancer before treatment and after radiotherapy. Int J Cancer2001;
96:182–190.
27.
HuangZBMayrNALoSS, et al.
Characterizing at-risk voxels by using perfusion magnetic resonance imaging for cervical cancer during radiotherapy. J Cancer Sci Ther2013;
4:254–259.
28.
MayrNAYuhWTCJajouraD, et al.
Ultra-early predictive assay for treatment failure using functional magnetic resonance imaging and clinical prognostic parameters in cervical cancer. Cancer2010;
116:903–912.
29.
YamashitaYBabaTBabaY, et al.
Dynamic contrast-enhanced MR imaging of uterine cervical cancer: pharmacokinetic analysis with histopathologic correlation and its importance in predicting the outcome of radiation therapy. Radiology2000;
216:803–809.
30.
KilicSCracchioloBGabelM, et al.
The relevance of molecular biomarkers in cervical cancer patients treated with radiotherapy. Ann Transl Med2015;
3:261.
31.
FuZChenDChengH, et al.
Hypoxia-inducible factor-1alpha protects cervical carcinoma cells from apoptosis induced by radiation via modulation of vascular endothelial growth factor and p53 under hypoxia. Med Sci Monit2015;
21:318–325.
32.
RanaLSharmaSSoodS, et al.
Volumetric CT perfusion assessment of treatment response in head and neck squamous cell carcinoma: Comparison of CT perfusion parameters before and after chemoradiation therapy. Eur J Radiol Open2015;
2:46–54.
33.
ZhengWXiongYHHanJ, et al.
Contrast-enhanced ultrasonography of cervical carcinoma: perfusion pattern and relationship with tumor angiogenesis. Br J Radiol2016;
89:20150887.
