Grigsby PW, Perez CA, Chao KS, Elbendary A, Herzog TJ, Rader JS, Mutch DGLack of effect of tumor size on the prognosis of carcinoma of the uterine cervix Stage IB and IIA treated with preoperative irradiation and surgery. Int J Radiat Oncol Biol Phys 45: 645-651
The purpose of this analysis was to evaluate the prognostic significance of cervical tumor size in patients with Stages Ib and IIa carcinoma of the cervix treated with preoperative irradiation and radical or conservative hysterectomy.
This study is a retrospective analysis of 177 patients. One hundred forty-one patients had Stage Ib and 36 patients had Stage IIa carcinoma of the cervix. All patients were treated with preoperative irradiation and surgery. Radiation therapy consisted of external pelvic irradiation and intracavitary brachytherapy; total doses ranged from 30 to 60 Gy to the pelvic sidewall and 60 to 70 Gy to point A. Surgery consisting of radical hysterectomy and lymph node dissection or a conservative hysterectomy and lymph node dissection was performed 4 to 6 weeks after completion of irradiation.
The 5-year progression-free survivals were 80% for Stage Ib and 63% for Stage IIa (p = 0.03). The 5-year cumulative pelvic failure rates for Stage Ib were 16% for tumors <3 cm and 9% for tumors >3 cm (p = 0.90). The 5-year cumulative pelvic failure rates for Stage IIa were 22% for tumors <3 cm and 22% for tumors >3 cm (p = 0.75). The corresponding cumulative distant metastasis failure rates at 5 years for Stage Ib were 21% for tumors <3 cm and 21% for tumors >3 cm (p = 0.60). For patients with Stage IIa disease, the 5-year cumulative distant metastasis rates were 33% for tumors <3 cm and 36% for tumors >3 cm (p = 0.70). A multivariate analysis was performed to evaluate prognostic factors for the endpoint of progression-free survival. The variables that were analyzed were patient age, tumor histology, tumor size, clinical stage, point A and pelvic lymph node irradiation dose, and cervical tumor status and pelvic lymph node status at the time of hysterectomy. The variables that were found to be of independent significance for progression-free survival by multivariate analysis were pelvic lymph node irradiation dose (p <0.001), pelvic lymph node status at the time of hysterectomy (p = 0.01), and clinical stage (p = 0.02). Cervical tumor size at the time of diagnosis and the presence of tumor cells in the cervix in the hysterectomy specimen was not an independent prognostic factor by multivariate analysis. The overall severe complication rate was 11% for all patients.
For this population of patients treated with preoperative irradiation and surgery, pelvic lymph node status at the time of hysterectomy and the preoperative irradiation dose to the pelvic lymph nodes are independent predictors of progression-free survival and the development of distant metastasis. The pretreatment cervical tumor size is of less importance for predicting progression-free survival and the development of distant metastasis but clinical stage is an important prognostic variable. These results are in contrast with those of surgery or irradiation alone, in which primary tumor size is a critical prognostic factor for all outcome parameters.
Available from: Alan Jackson
- "Tumour size is an important factor in staging some solid tumours, selecting treatment options, and in predicting clinical outcome (Edge et al, 2010). However, for some solid tumours, size has little relevance to tumour stage and the link between pretreatment tumour size and outcome is complex, with no clear relationship between the two (Grigsby et al, 1999; Foulkes et al, 2008; Klatte et al, 2008). Tumour function may also predict outcome, particularly in the setting of novel adjuvant therapies. "
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ABSTRACT: There is limited evidence that imaging biomarkers can predict subsequent response to therapy. Such prognostic and/or predictive biomarkers would facilitate development of personalised medicine. We hypothesised that pre-treatment measurement of the heterogeneity of tumour vascular enhancement could predict clinical outcome following combination anti-angiogenic and cytotoxic chemotherapy in colorectal cancer (CRC) liver metastases.
Ten patients with 26 CRC liver metastases had two dynamic contrast-enhanced MRI (DCE-MRI) examinations before starting first-line bevacizumab and FOLFOX-6. Pre-treatment biomarkers of tumour microvasculature were computed and a regression analysis was performed against the post-treatment change in tumour volume after five cycles of therapy. The ability of the resulting linear model to predict tumour shrinkage was evaluated using leave-one-out validation. Robustness to inter-visit variation was investigated using data from a second baseline scan.
In all, 86% of the variance in post-treatment tumour shrinkage was explained by the median extravascular extracellular volume (v(e)), tumour enhancing fraction (E(F)), and microvascular uniformity (assessed with the fractal measure box dimension, d(0)) (R(2)=0.86, P<0.00005). Other variables, including baseline volume were not statistically significant. Median prediction error was 12%. Equivalent results were obtained from the second scan.
Traditional image analyses may over-simplify tumour biology. Measuring microvascular heterogeneity may yield important prognostic and/or predictive biomarkers.
Available from: Rodney Hicks
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ABSTRACT: The aims of this study were to determine, firstly, the relationship between FIGO stage and various tumor parameters determined by magnetic resonance imaging (MRI), and, secondly, whether any of these parameters were predictors of lymph node metastases as determined by fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) in cervical cancer patients referred for radiotherapy. In 70 consecutive patients, both PET and MRI visualized all primary tumors except for one previously removed by cone biopsy. While clinical diameter and MRI-derived diameter showed a significant relationship between these two measurements (r = 0.70; P < 0.001) there was a large variability in MRI diameter for each FIGO stage and wide overlap. The average volume of primary cervical tumor on MRI was 60 cc (5-256). In FIGO stages, I, II, III and IV, uterine body involvement was present in 58%, 73%, 88%, and 100% of 19, 30, 16, and 5 patients, respectively (Ptrend= 0.015). Node positivity on FDG PET was present in 11% of patients without uterine body extension, but increased to 75% in those with uterine involvement. Average tumor volume in node-negative patients was 49 cc (5-186). Average tumor volume in node-positive patients was 69 cc (8-256). There was a significant association between nodal involvement and both FIGO stage (P = 0.018) and uterine body involvement (P < 0.001), but tumor volume and longitudinal MRI diameter were not statistically significant in unifactor predictors of nodal involvement. In multivariate analysis only uterine body extension, however, was independently related to the risk of nodal involvement. In conclusion, MRI provides noninvasive tumor size evaluation and can also demonstrate invasion of the uterine body that appears to be associated with an increased risk of nodal metastasis. This may provide clinically important prognostic information not available from current FIGO staging.
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