J Gynecol Oncol.  2010 Mar;21(1):18-23. 10.3802/jgo.2010.21.1.18.

Clinical significance of tumor volume and lymph node involvement assessed by MRI in stage IIB cervical cancer patients treated with concurrent chemoradiation therapy

• Lee DW
• Kim YT
• Kim JH
• Kim S
• Kim SW
• Nam EJ
• Kim JW

• KMID: 2173505
• DOI: http://doi.org/10.3802/jgo.2010.21.1.18

Abstract

OBJECTIVE
The purpose of this study was to evaluate the prognostic significance of tumor volume assessed by pretreatment MRI in stage IIB cervical cancer patients with concurrent chemoradiation therapy. METHODS: A retrospective chart review was performed on seventy five patients with cervical cancer who were treated with concurrent weekly cisplatin (40 mg/m2) and radiotherapy between January 2000 and April 2007. Potential prognostic factors were age, chemotherapy numbers, histology, tumor diameter and volume, lymph node (LN) involvement and pretreatment squamous cell carcinoma antigen (SCC-Ag) levels. RESULTS: The median follow-up time was 55 months (range, 8 to 104 months). The median tumor size and volume (range) were 4.5 cm (2 to 10) and 33.1 mL (4.2 to 392.7), respectively. Pelvic LN enlargement rate was 58.7%. Para-aortic LN enlargement rate was 14.7%. Using multivariate analysis, a tumor volume (>33 mL, p=0.025), pelvic LN enlargement (p=0.044) revealed a significantly unfavorable outcome on overall survival. PFS was influenced by tumor histology (p<0.001), pelvic LN enlargement (p=0.015) and pretreatment SCC-Ag levels (p=0.018). We found that 22 (29.3%) patients had recurrences and 14 (18.7%) patients died of disease. The 5-year overall survival rate was 80.6% (standard error, 4.9%) and 5-year PFS rate was 71.3% (standard error, 5.3%). CONCLUSION: Tumor volume and pelvic LN involvement showed possibility to predict overall survival in patient with stage IIB cervical cancer. Optimal tumor volume and pelvic LN assessment by pretreatment MRI might be helpful to predict treatment outcome.

Keyword

Cervical neoplasms; Chemoradiation therapy; MRI; Tumor volume

MeSH Terms

Antigens, Neoplasm
Carcinoma, Squamous Cell
Cisplatin
Follow-Up Studies
Humans
Lymph Nodes
Multivariate Analysis
Recurrence
Retrospective Studies
Serpins
Survival Rate
Treatment Outcome
Tumor Burden
Uterine Cervical Neoplasms
Antigens, Neoplasm
Cisplatin
Serpins

Figure

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  Fig. 1 Overall survival curves for (A) pelvic LN involvement (left, p=0.044) and (B) tumor volume (right, p=0.025). PN: pelvic lymph node.

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