scholarly journals Pretreatment MRI Radiomics Based Response Prediction Model in Locally Advanced Cervical Cancer

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 631
Author(s):  
Benedetta Gui ◽  
Rosa Autorino ◽  
Maura Miccò ◽  
Alessia Nardangeli ◽  
Adele Pesce ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Residual Tumour ◽  
Advanced Cervical Cancer ◽  
Treatment Pathways ◽  
Surgical Specimen ◽  
Locally Advanced Cervical Cancer

The aim of this study was to create a radiomics model for Locally Advanced Cervical Cancer (LACC) patients to predict pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NACRT) analysing T2-weighted 1.5 T magnetic resonance imaging (MRI) acquired before treatment start. Patients with LACC and an International Federation of Gynecology and Obstetrics stage from IB2 to IVA at diagnosis were retrospectively enrolled for this study. All patients underwent NACRT, followed by radical surgery; pCR―assessed on surgical specimen―was defined as absence of any residual tumour. Finally, 1889 features were extracted from MR images; features showing statistical significance in predicting pCR at the univariate analysis were selected following an iterative method, which was ad-hoc developed for this study. Based on this method, 15 different classifiers were trained considering the most significant features selected. Model selection was carried out using the area under the receiver operating characteristic curve (AUC) as target metrics. One hundred eighty-three patients from two institutions were analysed. The model, showing the highest performance with an AUC of 0.80, was the random forest method initialised with default parameters. Radiomics appeared to be a reliable tool in pCR prediction for LACC patients undergoing NACRT, supporting the identification of patient risk groups, which paves treatment pathways tailored according to the predicted outcome.

scholarly journals PO-161: Low Tesla MRgRT in neoadjuvant chemoradiotherapy for locally advanced cervical cancer

2019 ◽  
Vol 141 ◽  
pp. S71
Author(s):  
L. Boldrini ◽  
A. Piras ◽  
G. Chilorio ◽  
R. Autorino ◽  
D. Cusumano ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer

Phase I-II study of neoadjuvant chemoradiotherapy followed by radical surgery in locally advanced cervical cancer

2001 ◽  
Vol 12 (10) ◽  
pp. 853-858 ◽  
Author(s):  
Hiroshi Tsuda ◽  
Masahiro Tanaka ◽  
Takao Manabe ◽  
Shinichi Nakata ◽  
Osamu Ishiko ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Phase I ◽  
Radical Surgery ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer

The Variability of Applicator Position among High Dose Rate Intracavitary Brachytherapy Applications in Cervical Cancer Patients Treated with Ring & Tandem Applicators

2007 ◽  
Vol 93 (5) ◽  
pp. 432-438 ◽  
Author(s):  
Cuneyt Ebruli ◽  
Ayşe Nur Demiral ◽  
Riza Çetingöz ◽  
Ferhat Eyiler ◽  
Münir Kinay
Keyword(s):  
Cervical Cancer ◽  
Standard Deviation ◽  
Dose Rate ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
High Dose Rate ◽  
Intracavitary Brachytherapy ◽  
High Dose ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer

Objective To evaluate the interindividual and intraindividual applicator position variability in high dose rate ring and tandem intracavitary brachytherapy applications in locally advanced cervical cancer. Patients and Methods Eight patients with locally advanced cervical cancer formed the study population. They had been treated in Dokuz Eylül University Department of Radiation Oncology between the years 2000 and 2005 with high dose rate intracavitary brachytherapy using ring and tandem applicators. The 3-dimensional geometric variation of the applicator center in craniocaudal, mediolateral and anteroposterior directions was determined on the basis of bony reference points in 24 pairs of orthogonal films obtained in the conventional simulator. Then the following evaluations were performed: 1) the applicator position variability in all applications (interindividual variability), 2) the intraindividual applicator position variability relative to the first application, 3) the intraindividual applicator position variability relative to the average of three applications. Among the potential factors that might influence the reproducibility of ring and tandem applications, age, stage, the period between external radiotherapy and brachytherapy were evaluated by univariate analysis. Results Standard deviation of interindividual applicator variability was 3.83 mm in craniocaudal, 0.39 mm in mediolateral and 2.86 mm in anteroposterior directions. The standard deviation of intraindividual variability relative to the first application was 1.91 mm in craniocaudal, 0.4 mm in mediolateral, and 4.26 mm in anteroposterior directions. The standard deviation of intraindividual variability relative to the average of three applications was 0.95 mm in craniocaudal, 1.86 mm in mediolateral, and 1.24 mm in anteroposterior directions. According to univariate analysis, no factor influenced applicator position variability. Conclusions In order to extract definitive conclusions about factors that affect positional reproducibility of ring and tandem applicators, studies are needed that include larger numbers of patients.

Low Tesla magnetic resonance guided radiotherapy for locally advanced cervical cancer: first clinical experience

2020 ◽  
Vol 106 (6) ◽  
pp. 497-505 ◽  
Author(s):  
Luca Boldrini ◽  
Antonio Piras ◽  
Giuditta Chiloiro ◽  
Rosa Autorino ◽  
Francesco Cellini ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Magnetic Resonance ◽  
Clinical Experience ◽  
Linear Accelerator ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Pathologic Response ◽  
Advanced Cervical Cancer ◽  
Toxicity Profile ◽  
Locally Advanced Cervical Cancer

Objective: Magnetic resonance–guided radiotherapy (MRgRT) represents an innovative approach for personalized radiotherapy treatments and its applications are being explored in various anatomical sites to fully understand its potential advantages. This study describes the first clinical experience of MRgRT application in patients with locally advanced cervical cancer (LACC) undergoing neoadjuvant chemoradiotherapy. The feasibility of the technique is evaluated and its toxicity profile and clinical outcomes are reported. Methods: Patients with LACC (International Federation of Gynecology and Obstetrics stage IIA–IVA) undergoing neoadjuvant chemoradiotherapy (CRT) on a 0.35T Tri-60-Co hybrid unit (ViewRay) were retrospectively compared with randomly selected patients treated with a standard linear accelerator. Total prescribed dose was 50.6 Gy (2.3 Gy/fraction) to planning target volume 1 (PTV1) and 39.6 Gy (1.8 Gy/fraction) to PTV2, delivered using a simultaneous integrated boost. Surgery was performed 8 weeks after the end of CRT. The effect of magnetic resonance guidance on replanning approaches, treatment-related toxicities, and pathologic response were assessed for each patient. Patient outcomes were noted and dosimetric comparisons performed between the 2 arms. Results: Nine patients with LACC treated from May 2018 to November 2018 were retrospectively enrolled and their records compared with the records of an equivalent cohort of randomly selected patients. Five replanning cases were performed in the MRgRT group and 0 in the linear accelerator group. Acute G1–G2 gastrointestinal toxicities were observed in 33.3% of MRgRT patients and in 55.5% of linear accelerator patients; acute G1–G2 genitourinary toxicities in 22.2% and 33.3%, respectively. No G3 toxicity was found except for neutropenia in 2 patients. No differences were observed in pathologic response between the 2 groups. Conclusions: Despite the retrospective nature of the observations and the low number of enrolled patients, the application of MRgRT in LACC appears to be safe and feasible with a favorable toxicity profile and response rates comparable to gold standard, supporting the setup of larger prospective studies to investigate the potentialities of this new technology.

MRI-based radiomics: promise for locally advanced cervical cancer treated with a tailored integrated therapeutic approach

2021 ◽  
pp. 030089162110142
Author(s):  
Concetta Laliscia ◽  
Angiolo Gadducci ◽  
Roberto Mattioni ◽  
Francesca Orlandi ◽  
Sabina Giusti ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Figo Stage ◽  
High Dose ◽  
Advanced Cervical Cancer ◽  
Primary Tumor Site ◽  
Locally Advanced Cervical Cancer ◽  
Sequential Boost

Objective: To assess prognostic factors by analyzing clinical and radiomic data of patients with locally advanced cervical cancer (LACC) treated with definitive concurrent cisplatin-based chemoradiotherapy (CCRT) using magnetic resonance imaging (MRI). Methods: We analyzed radiomic features from MRI in 60 women with FIGO (International Federation of Gynecology and Obstetrics) stage IB2–IVA cervical cancer who underwent definitive CCRT 45–50.4 Gy (in 25–28 fractions). Thirty-nine (65.0%) received EBRT sequential boost (4–20 Gy) on primary tumor site and 56 (93.3%) received high-dose-rate brachytherapy boost (6–28 Gy) (daily fractions of 5–7 Gy). Moreover, 71.7% of patients received dose-dense neoadjuvant chemotherapy for 6 cycles. The gross tumor volume was defined on T2-weighted sequences and 29 features were extracted from each MRI performed before and after CCRT, using dedicated software, and their prognostic value was correlated with clinical information. Results: In univariate analysis, age ⩾60 years and FIGO stage IB2–IIB had significantly better progression-free survival (PFS) ( p = 0.022 and p = 0.009, respectively). There was a trend for significance for worse overall survival (OS) in patients with positive nodes ( p = 0.062). In multivariate analysis, only age ⩾60 years and FIGO stage IB2–IIB reached significantly better PFS ( p = 0.020 and p = 0.053, respectively). In radiomic dataset, in multivariate analysis, pregray level p75 was significantly associated with PFS ( p = 0.047), pre-D3D value with OS ( p = 0.049), and preinformation measure of correlation value with local control ( p = 0.031). Conclusion: The combination of clinical and radiomics features can provide information to predict behavior and prognosis of LACC and to make more accurate treatment decisions.

scholarly journals Intracavitary/Interstitial Applicator Plus Distal Parametrial Free Needle Interstitial Brachytherapy in Locally Advanced Cervical Cancer: A Dosimetric Study

2021 ◽  
Vol 10 ◽  
Author(s):  
Hong-Da Qu ◽  
Dong-Mei Han ◽  
Ning Zhang ◽  
Zhuang Mao ◽  
Guang-Hui Cheng
Keyword(s):  
Cervical Cancer ◽  
Prognostic Factors ◽  
Treatment Plan ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Weight Ratio ◽  
Interstitial Brachytherapy ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Treatment Plans

PurposeTo explore the dosimetric advantage of combining intracavitary/interstitial applicator with distal parametrial free needle interstitial brachytherapy (IC/IS+ISBT DP) based on MRI for locally advanced cervical cancer.Methods and Materials77 IC/IS+ISBT DP treatment plans were developed for 34 patients with locally advanced cervical cancer from June 2016 to January 2020 in this study. We removed the free needles and devised a new IC/ISBT treatment plan based on the same principle. We then compared the dosimetric differences of D90, D98, V100, V150, V200 for HR-CTV (high-risk clinical target volume), D90 for IR-CTV (Intermediate risk-CTV) and D2cc for OARs (organs at risk) between the two groups of treatment plans for the same patient, and the paired T test was performed in parallel. Further, the dosage differences between the two group plans under different parametrial extension widths (the maximum distance of HR-CTV from the vertical direction of the uterine tandem at coronal position) were compared. The survival rate was calculated using the Kaplan-Meier method. Prognostic factors for overall survival (OS) and progression-free survival (PFS) were determined by Cox regression method. RTOG/EORTC criteria were used to grade toxicities.ResultsA total of 297 free needles were used, with a weight ratio of 15.8% ± 0.11, and a mean insertion depth of 6.52cm ± 2.8cm. D90, D98, V100 for HR-CTV, and D90 for IR-CTV for IC/IS+ISBT DP were significantly higher than IC/ISBT for which free needles were removed (p<0.05). And the V200 for HR-CTV and D2cc for bladder, rectum and sigmoid were decreased (p<0.05). When the parametrial extension widths were greater than 3cm, the HR-CTV D90 and the D2CC for rectum, bladder and sigmoid colon for IC/IS-ISBT DP were advantageous compared to IC/ISBT (p<0.05). The 2-yr OS, PFS and local control rate (LC) were 82.3, 66.8, and 93.1%, respectively. Parametrial extension widths was the only statistically prognostic factors for PFS (p = 0.002) on univariate analysis. No grade 3 or 4 Treatment-related toxicities were observed.ConclusionOur institutional experiences showed that IC/IS+ISBT DP is an effective treatment for cervical cancer patients with distal parametrial extension. IC/IS-ISBT DP had dosage advantage and clinical feasibility in locally advanced cervical cancer with distal parametrial extension when the parametrial extension widths were greater than 3cm.

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