Serviks Kanserinde Prognostik Kriterlerin Tedavi Sonrası Erken Radyolojik Cevaba Etkisi

Yıl 2019, , 154 - 159, 30.09.2019

Cenk Ahmet Şen

https://doi.org/10.34087/cbusbed.547980

Öz

Amaç: Serviks
kanseri tanısıyla kliniğimizde tedavi uygulanan hastalarda bilinen prognostik
faktörlerin, erken dönem radyolojik tümör yanıtı ile olan ilişkisini belirlemek
amaçlandı.

Gereç-Yöntem: Kliniğimizde
definitif radyoterapi ve eş zamanlı kemoterapi uygulanan 26 hastanın eksternal
pelvik radyoterapi ve brakiterapi öncesi ve sonrasında çekilen manyetik
rezonans (MR) ve pozitron emisyon tomografisi-bilgisayarlı tomografi (PET-CT)
tetkikleri ile gözlenen radyolojik klinik cevabın/tümör yanıtının prognostik
kriterler ile ilişkisi retrospektif olarak değerlendirildi.

Bulgular: Tedavi
öncesi ve sonrası MR ve PET-CT tetkiklerindeki tümör çapı ve SUVmax değeri
ölçüm yüzde farkları karşılaştırıldığında; MR’da % 50’nin altında yanıt
alınanlarda sigara varlığı (p=0,07) ve başlangıç tümör çapının 2 cm’nin
üzerinde olması (p=0,01) ile istatistiksel anlamlı ilişki mevcuttu. PET-CT’de
ise SUVmax değişim oranı % 50’nin altında yanıtlı hastalarda skuamoz hücreli
karsinom dışı histoloji (p=0,03) ve mesane invazyonu varlığı (p=0,06) açısından
istatistiksel açıdan anlamlı bir ilişki saptandı. 

Sonuç: Serviks kanserinde bilinen prognostik
kriterlerden bazıları tedaviye bağlı erken dönem tümör cevabı ile ilişkili olabilir.

Anahtar Kelimeler

serviks kanseri, prognostik krterler, radyolojik cevap, radyoterapi

The Effect of Prognostic Criteria on the Early Radiological Response After Radiotherapy in Cervical Cancer

Öz

Objective: The aim of this study was to determine the relationship
between known prognostic factors and early radiological tumor response in
patients with cervical cancer.

Methods: In our clinic, magnetic resonance (MR) and positron emission
tomography-computed tomography (PET-CT) were performed before and after
external pelvic radiotherapy and brachytherapy to 26 patients who  performed definitive radiotherapy and
concurrent chemotherapy. The relationship of radiological clinical response /
tumor response with prognostic criteria was evaluated retrospectively.

Results: When the measurement percentage differences between tumor
diameter and SUVmax value were compared in pre- and post-treatment MR and
PET-CT tests; there was a statistically significant correlation between the
presence of cigarette smoking (p = 0.07) and initial tumor diameter over 2 cm
(p = 0.01) in patients with MR responses are under 50%. In PET-CT, there was a statistically
significant relationship in patients with SUVmax change rate less than 50%, in
terms of squamous cell carcinoma histology (p = 0.03) and bladder invasion (p =
0.06).

Conclusion: Some of the known
prognostic criteria in cervical cancer may be associated with early term tumor
response to treatment.

Anahtar Kelimeler

Cervical cancer, prognostic criteria, radiological response, radiotherapy

Kaynakça

• 1. American Cancer Society 2018, Uterine cervix, Cancer Facts & Figures 2018, page 25
• 2. Kurtoğlu E, AG Ayşenur. Cervical cancer epidemiology, Turkiye Klinikleri J Gynecol Obst-Special Topics 2014;7(4):1-4
• 3. Parkin DM, Bray F, et al. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.
• 4. National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology, Version 2. 2019, October 12. 2018, Cervical Cancer, https://www.nccn.org, Erişim tarihi: 12.11.2018
• 5. Viani GA, Manta GB, et al. Brachytherapy for cervix cancer: low-dose rate or high-dose rate brachytherapy - a meta-analysis of clinical trials. J Exp Clin Cancer Res. 2009 Apr 5;28:47
• 6. Endo D, Todo Y, et al. Prognostic factors for patients with cervical cancer treated with concurrent chemoradiotherapy: a retrospective analysis in a Japanese cohort. J Gynecol Oncol. 2015 Jan;26(1):12-18
• 7. Wang SC, Lin LC, et al. Radiographic number of positive pelvic lymph nodes as a prognostic factor in cervical cancer treated with definitive concurrent chemoradiotherapy or intensity-modulated radiotherapy. Front Oncol.2018 Nov 30;8:546
• 8. Asher D, Padgett KR, et al. Magnetic Resonance-guided External Beam Radiation and Brachytherapy for a Patient with Intact Cervical Cancer. Cureus. 2018 May 4;10(5)
• 9. Balleyguier C, Sala E, et al. Staging of uterine cervical cancer with MRI: guidelines of the European Society of Urogenital Radiology. Eur Radiol 2001;21:1102–1110
• 10. Siegel CL, Andreotti RF, et al. ACR appropriateness criteria(R) pretreatment planning of invasive cancer of the cervix. J Am Coll Radiol 2012;9:395–402
• 11. Vincens E, Balleyguier C, et al. Accuracy of magnetic resonance imaging in predicting residual disease in patients treated for stage IB2/II cervical carcinoma with chemoradiation therapy: correlation of radiologic findings with surgicopathologic results. Cancer 2008;113:2158–2165
• 12. Sala E, Rockall AG, et al. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology 2013;266:717-740 13. Balleyguier C, Sala E, et al. Staging of uterine cervical cancer with MRI: Guidelines of the European Society of Urogenital Radiology. Eur Radiol 2011;21:1102-1110
• 14. Sala E, Micco M, et al. Complementary prognostic value of pelvic MRI and whole-body FDG PET/CT in the pretreatment assessment of patients with cervical cancer. Int J Gynecol Oncol 2015;25:1461-1467
• 15. WHO handbook for reporting results of cancer treatment. World Health Organization Offset Publication No. 48, Geneva; 1979
• 16. Therasse P, Arbuck SG, et al. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst. 2000;92:205–216
• 17. Eisenhauer EA, Therasse P, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–247
• 18. Schwartz LH, Bogaerts J, et al. Evaluation of lymph nodes with RECIST 1.1. Eur J Cancer. 2009;45:261–267 19. Nishino M, Gargano M, et al. Optimizing immune-related tumor response assessment: does reducing the number of lesions impact response assessment in melanoma patients treated with ipilimumab? J Immunother Cancer. 2014;2:17
• 20. Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30:52–60
• 21. Grigsby PW. The contribution of new imaging techniques in staging cervical cancer. Gynecol Oncol. 2007 Oct;107(1 Suppl 1):S10-2. Epub 2007 Aug 28
• 22. Rockall AG, Cross S, et al. The role of FDG-PET/CT in gynaecological cancers. Cancer Imaging. 2012 Mar 5;12:49-65 23. Kido A, Fujimoto K, et al. Advanced MRI in malignant neoplasms of the uterus. J Magn Reson Imaging. 2013 Feb;37(2):249-64
• 24. Sala E, Wakely S, et al. MRI of Malignant Neoplasms of the Uterine Corpus and Cervix. AJR 2007;188:1577–1587
• 25. Amendola MA, Hricak H, et al. Utilization of diagnostic studies in the pretreatment evaluation of invasive cervical cancer in the United States: results of intergroup protocol ACRIN 6651/GOG 183. J of Clin Oncol 2005;23:7454–7459
• 26. Mezrich R. Magnetic resonance imaging applications in uterine cervical cancer. Magn Resonance Imag Clin North Am 1994;2(2):211-43
• 27. Wang YT, Li YC, et al. Can Diffusion-weighted Magnetic Resonance Imaging Predict Survival in Patients with Cervical Cancer? A Meta-Analysis. Eur J Radiol. 2016 Dec;85(12):2174-2181
• 28. Takeshi K, Katsuyuki K, et al. Definitive radiotherapy combined with high – dose – rate brachytherapy for stage III carcinoma of the uterine cervix: Retrospective analysis of prognostic factors concerning patient characteristicks and treatment parameters. Int J Radiation Oncology Biol Phys 1998; 41(2):319-327
• 29. Dubben HH, Thames HD, et al. Tumor volume: A basic and specific response predictor in radiotherapy. Radiother Oncol 1998; 47: 167-174
• 30. Teke F, Yöney A, et al. Evaluation of outcome and prognostic factors in 739 patients with uterine cervix carcinoma: a single institution experience. Contemp Oncol (Pozn). 2015;19(2):130-136
• 31. Grimard L, Genest P, et al. Prognostic significance of endometrial extension in carcinoma of the cervix. Gynecol Oncol 1988; 31(2): 301-309
• 32. Mitani Y, Yukinari S, et al. Carcinomatous infiltration into the uterine body in carcinoma of the uterine cervix. Am J Obstet Gynecol 1964; 89: 984–989
• 33. Yamashita H, Nakagawa K, et al. Treatment results and prognostic analysis of radical radiotherapy for locally advanced cancer of the uterine cervix. Br J Radiol. 2005 Sep;78(933):821-826
• 34. Gauthier P, Gore I, et al. Identification of histopathologic risk groups in stage IB squamous cell carcinoma of the cervix. Obstet Gynecol 1985;66:569–574
• 35. Wiggins DL, Granai CO, et al. Tumor angiogenesis as a prognostic factor in servical carcinoma. Gynecol Oncol 1995; 56 :353- 356
• 36. Yokoi E, Mabuchi S, et al. Impact of histological subtype on survival in patients with locally advanced cervical cancer that were treated with definitive radiotherapy: adenocarcinoma/adenosquamous carcinoma versus squamous cell carcinoma. J Gynecol Oncol. 2017 Mar;28(2):e19
• 37. Haensgen G, Krause U, et al. Tumor hypoxia, p53, and prognosis in cervical cancers. Int J Radiat Oncol Biol Phys. 2001 Jul 15;50(4):865-872
• 38. Grinsky T, Pejovic-Lenfant MH, et al. Prognostic value of hemoglobin concentrations and blood transfusions in advanced carcinoma of cervix treated by radiation therapy: Results of a retrospective study of 386 patients. Int J Radiation Oncology Biol Phys 1989; 16(1): 37-42
• 39. Delaloye JF, Pampallona S, et al. Younger age as a bad prognostic factor in patients with carcinoma of the cervix. Eur J Obstet Gynecol Reprod Biol 1996:64(2):201–205
• 40. Dattoli MJ, Gretz HF 3rd, et al. Analysis of multiple prognostic factors in patients with stage IB cervical cancer: age as a major determinant. Int J Radiat Oncol Biol Phys. 1989 Jul;17(1):41-47
• 41. Grigsby PW, Perez CA, et al. Adenocarcinoma of the uterine cervix: Lack of evidence for a poor prognosis. Radiother Oncol 1988; 12(4): 289-296
• 42. Fyles A, Keane TJ, et al. The effect of treatment duration in the local control of cervix cancer. Radiother Oncol 1993; 28(2): 179-180