MRI-guided dynamic risk assessment in cervical cancer based on tumor hypoxia at diagnosis and volume response at brachytherapy

Kjersti Skipar ¹, Tord Hompland ², Kjersti V Lund ³

⁰Department of Radiation Biology, Oslo University Hospital, Oslo, Norway; Department of Oncology, Telemark Hospital Trust, Skien, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology +

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March 31, 2024

View abstract on PubMed

Summary

Combining pretreatment hypoxia and tumor volume changes during therapy significantly improves risk classification for locally advanced cervical cancer (LACC) patients, enhancing disease-free survival prediction.

Area Of Science

Oncology
Radiology
Medical Imaging

Background

Accurate risk stratification is crucial for optimizing treatment outcomes in locally advanced cervical cancer (LACC).
Current methods may not sufficiently capture individual patient risk of recurrence.
Imaging biomarkers offer potential for improved patient classification.

Purpose Of The Study

To evaluate if combining pretreatment hypoxia and tumor response during therapy can enhance risk classification in LACC patients.
To assess the predictive value of imaging-based parameters for disease-free survival (DFS).

Main Methods

Ninety-three LACC patients underwent pre-treatment and mid-treatment MRI (T2W, DCE, DW).
Pretreatment hypoxic fraction (HFpre) was quantified using the CSH-imaging method.
Tumor volume regression and changes in apparent diffusion coefficient (ADC) were assessed during brachytherapy.

Main Results

Pretreatment hypoxia (HFpre) was the strongest predictor of DFS.
Combining HFpre with volume regression significantly improved DFS prediction compared to HFpre alone.
This combined approach accurately classified patients into intermediate- or high-risk groups for recurrence.

Conclusions

The combination of pretreatment hypoxia and intra-therapy volume regression enhances risk classification for LACC patients.
Integrating ADC changes with volume regression shows potential as a novel tumor response metric.