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Tumor growth patterns on magnetic resonance imaging and treatment outcomes in patients with locally advanced cervical cancer treated with definitive radiotherapy

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Abstract

Background

To evaluate the prognostic value of tumor growth patterns on magnetic resonance (MR) images in patients with locally advanced cervical cancer (LACC) treated with definitive radiotherapy or concurrent chemoradiotherapy (RT/CCRT).

Methods

We retrospectively reviewed 102 patients with LACC who received definitive RT/CCRT and who underwent MR imaging before RT/CCRT. Growth patterns on pretreatment T2-weighted MR images were classified into expansive or infiltrative type according to tumor morphologic patterns in the myometrium and/or parametrial space.

Results

The median age was 60 years (range 26–90 years). The median follow-up time was 47.7 months (range 5.7–123 months). The numbers of patients with stages IB, II, III, and IVA were 17, 39, 43, and 3, respectively. The 3-year overall survival (OS) rates for stages IB, II, III, and IV were 87%, 76%, 74%, and 67%, respectively. Regarding growth patterns on MR images, 31 were of expansive type and 71 were of infiltrative type. The infiltrative type was significantly associated with lower OS and locoregional recurrence-free survival (LRRFS) than the expansive type (3-year OS, 70% vs. 93%, p = 0.003; 3-year LRRFS, 64% vs. 94%, p = 0.001). On multivariate analysis, infiltrative tumor growth patterns were a significant independent factor for low OS (hazard ratio [HR], 3.81; 95% confidence interval [CI] 1.26–16.7; p = 0.015) and low LRRFS (HR, 4.27; 95% CI 1.43–18.5; p = 0.007).

Conclusion

Tumor growth patterns on MR images could be an indicator of survival and locoregional control in patients with LACC treated with definitive RT/CCRT.

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Acknowledgements

The authors thank Ms. Natsumi Yamashita MD, Department of Clinical Research, National Hospital Organization Shikoku Cancer Center, for her statistical support.

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Author notes

  1. Shintaro Tsuruoka

    Present address: Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan

Authors and Affiliations

  1. Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan

    Shintaro Tsuruoka, Masaaki Kataoka, Kotaro Uwatsu & Hiromitsu Kanzaki

  2. Department of Diagnostic Radiology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime, 791-0280, Japan

    Akifumi Tokumasu

  3. Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan

    Yasushi Hamamoto, Noriko Takata, Hirofumi Ishikawa, Ayaka Ouchi & Teruhito Mochizuki

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  1. Shintaro Tsuruoka
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Correspondence to Shintaro Tsuruoka.

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Tsuruoka, S., Kataoka, M., Hamamoto, Y. et al. Tumor growth patterns on magnetic resonance imaging and treatment outcomes in patients with locally advanced cervical cancer treated with definitive radiotherapy. Int J Clin Oncol 24, 1119–1128 (2019). https://doi.org/10.1007/s10147-019-01457-3

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  • DOI: https://doi.org/10.1007/s10147-019-01457-3

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