Risk of recurrence after chemoradiotherapy identified by multimodal MRI and 18F-FDG-PET/CT in locally advanced cervical cancer

Kjersti Skipar; Tord Hompland; Kjersti Vassmo Lund; Ayca Løndalen; Eirik Malinen; Gunnar B Kristensen; Kristina Lindemann; Esten S Nakken; Kjersti Bruheim; Heidi Lyng

doi:10.1016/j.radonc.2022.09.002

Risk of recurrence after chemoradiotherapy identified by multimodal MRI and 18F-FDG-PET/CT in locally advanced cervical cancer

Radiother Oncol. 2022 Nov:176:17-24. doi: 10.1016/j.radonc.2022.09.002. Epub 2022 Sep 14.

Authors

Affiliations

¹ Department of Radiation Biology, Oslo University Hospital, Oslo, Norway; Department of Oncology, Telemark Hospital Trust, Skien, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway.
² Department of Radiation Biology, Oslo University Hospital, Oslo, Norway.
³ Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
⁴ Department of Medical Physics, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway.
⁵ Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway.
⁶ Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁷ Department of Oncology, Oslo University Hospital, Oslo, Norway.
⁸ Department of Radiation Biology, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway. Electronic address: Heidi.Lyng@rr-research.no.

PMID: 36113778
DOI: 10.1016/j.radonc.2022.09.002

Abstract

Background and purpose: MRI, applying dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) sequences, and 18F-fluorodeoxyglucose (18F-FDG) PET/CT provide information about tumor aggressiveness that is unexploited in treatment of locally advanced cervical cancer (LACC). We investigated the potential of a multimodal combination of imaging parameters for classifying patients according to their risk of recurrence.

Materials and methods: Eighty-two LACC patients with diagnostic MRI and FDG-PET/CT, treated with chemoradiotherapy, were collected. Thirty-eight patients with MRI only were included for validation of MRI results. Endpoints were survival (disease-free, cancer-specific, overall) and tumor control (local, locoregional, distant). K^trans, reflecting vascular function, apparent diffusion coefficient (ADC), reflecting cellularity, and standardized uptake value (SUV), reflecting glucose uptake, were extracted from DCE-MR, DW-MR and FDG-PET images, respectively. By applying an oxygen consumption and supply-based method, ADC and K^trans parametric maps were voxel-wise combined into hypoxia images that were used to determine hypoxic fraction (HF).

Results: HF showed a stronger association with outcome than the single modality parameters. This association was confirmed in the validation cohort. Low HF identified low-risk patients with 95% precision. Based on the 50th SUV-percentile (SUV₅₀), patients with high HF were divided into an intermediate- and high-risk group with high and low SUV₅₀, respectively. This defined a multimodality biomarker, HF/SUV₅₀. HF/SUV₅₀ increased the precision of detecting high-risk patients from 41% (HF alone) to 57% and showed prognostic significance in multivariable analysis for all endpoints.

Conclusion: Multimodal combination of MR- and FDG-PET/CT-images improves classification of LACC patients compared to single modality images and clinical factors.

Keywords: Cervical cancer; Hypoxia; Multimodal imaging; Prognostic biomarkers; SUV.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Chemoradiotherapy
Diffusion Magnetic Resonance Imaging
Female
Fluorodeoxyglucose F18*
Humans
Magnetic Resonance Imaging / methods
Positron Emission Tomography Computed Tomography
Positron-Emission Tomography / methods
Radiopharmaceuticals
Tomography, X-Ray Computed / methods
Uterine Cervical Neoplasms* / diagnostic imaging
Uterine Cervical Neoplasms* / therapy

Substances

Fluorodeoxyglucose F18
Radiopharmaceuticals