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MRI Assessment of Cervical Cancer for Adaptive Radiotherapy

MR-tomographische Beurteilung des Zervixkarzinoms für die adaptive Radiotherapie

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Purpose:

To assess the importance of the information obtained from MRI for adaptive cervix cancer radiotherapy.

Patients and Methods:

49 patients with cervix cancer, treated by external-beam radiotherapy (EBRT) and MRI-assisted high-dose-rate brachytherapy ± concomitant cisplatin, underwent MRI at diagnosis and at the time of brachytherapy fractions. 190 MRI examinations were performed. Pretreatment scans were correlated with clinical examination (CE) findings. Measurements in 3-D of the tumor extension and also of the distance from the tumor to the pelvic side wall were performed using both MRI and CE. The tumor volume regression induced initially by EBRT and the subsequent regression after each brachytherapy fraction were assessed.

Results:

MRI and CE showed 92% agreement in overall parametrial staging and 73% agreement in terms of vaginal involvement. There was, however, disagreement in parametrial side (right/left) classification in 25% of the parametria examined. These were patients with unilateral displacement of the cervix and contralateral invasion of the parametrium. The mean tumor volume on the pretreatment MRI scan (GTVD) was 61 cm3. At the time of the four brachytherapy fractions the mean was 16 cm3, 10 cm3, 9 cm3, and 8 cm3, defined as the GTVBT plus the gray zones in the parametria.

Conclusion:

CE and MRI findings agree well in terms of overall staging. The clinical assessment of side-specific parametrial invasion improved when having access to the additional knowledge obtained from MRI. The greatest decrease in tumor volume occurs during EBRT, whereas tumor regression between the first and subsequent brachytherapy fractions is minor.

Ziel:

Ermittlung der Bedeutung der MRT für die adaptive Radiotherapie des Zervixkarzinoms.

Patienten und Methodik:

49 Patientinnen mit Zervixkarzinom, behandelt mittels Teletherapie und MRT-gestützter High-Dose-Rate-Brachytherapie ± konkomitante Cisplatingabe, erhielten eine MRT zum Zeitpunkt der Diagnose und zum Zeitpunkt der Brachytherapiefraktionen. Insgesamt wurden 190 MRT-Untersuchungen durchgeführt. Der Befund der diagnostischen MRT wurde dem der klinischen Untersuchung gegenübergestellt. Es erfolgten Messungen der Tumorausdehnung in 3-D und der Entfernung zwischen Tumor und Beckenwand. Zusätzlich wurden die primär durch die Teletherapie und anschließend die durch jede Fraktion der Brachytherapie verursachte Regression des Tumorvolumens ermittelt.

Ergebnisse:

Die Übereinstimmung zwischen MRT und klinischer Untersuchung für die Ermittlung des parametranen Tumorstadiums betrug 92% (Tabelle 1) und bezüglich der vaginalen Beteiligung 73% (Tabelle 3). Die seitengetrennte Beurteilung der Parametrien (links/rechts) zeigte jedoch inkongruente Ergebnisse in 25% der untersuchten Parametrien (Tabelle 1). Dabei handelte es sich um Patientinnen mit unilateraler Lageveränderung der Zervix und kontralateraler parametraner Infiltration (Abbildung 1). Das mittlere Tumorvolumen bei den diagnostischen MRT-Untersuchungen (GTVD) betrug 61 cm3 (Abbildung 2). Die Bestimmung der Tumorvolumina der vier einzelnen Fraktionen der Brachytherapie (GTVBT plus graue Zonen in den Parametrien) ergab einen Mittelwert von jeweils 16 cm3, 10 cm3, 9 cm3 und 8 cm3 (Abbildung 2).

Schlussfolgerung:

Die klinische Untersuchung und die MRT zeigen eine gute Übereinstimmung bezüglich der Beurteilung des Gesamttumorstadiums. Die Objektivität der Ergebnisse der seitengetrennten klinischen Untersuchung der Parametrien wird durch die Hinzuziehung der MRT deutlich verbessert. Der Hauptteil der Tumorregression erfolgt während der Teletherapie, wobei die Tumorregression zwischen den einzelnen Fraktionen der Brachytherapie als gering einzuschätzen ist.

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Authors and Affiliations

  1. Department of Radiotherapy, Medical University of Vienna, Vienna, Austria

    Johannes C. A. Dimopoulos MD, Gertrude Schirl, Anja Baldinger & Richard Pötter

  2. Department of Radiology, Medical University of Vienna, Vienna, Austria

    Thomas H. Helbich

  3. Department of Radiotherapy, Medical University of Vienna, General Hospital of Vienna, Währinger Gürtel 18–20, 1090, Vienna, Austria

    Johannes C. A. Dimopoulos MD

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  1. Johannes C. A. Dimopoulos MD
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  2. Gertrude Schirl
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Correspondence to Johannes C. A. Dimopoulos MD.

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Dimopoulos, J.C.A., Schirl, G., Baldinger, A. et al. MRI Assessment of Cervical Cancer for Adaptive Radiotherapy. Strahlenther Onkol 185, 282–287 (2009). https://doi.org/10.1007/s00066-009-1918-7

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  • DOI: https://doi.org/10.1007/s00066-009-1918-7

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