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Value of magnetic resonance and 18FDG PET-CT in predicting tumor response and resectability of primary locally advanced cervical cancer after treatment with intensity-modulated arc therapy: a prospective pathology-matched study

Katrien Vandecasteele UGent, LOUKE DELRUE UGent, Bieke Lambert UGent, Amin Makar UGent, Kathleen Lambein UGent, Hannelore Denys UGent, PHILIPPE TUMMERS UGent, Rudy Van den Broecke UGent, Geert Villeirs UGent and Gert De Meerleer UGent (2012) INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER. 22(4). p.630-637
abstract
Objective: To report on the value of magnetic resonance imaging (MRI) and 2-deoxy-2-[18] fluoro-D-glucose positron emission tomography computed tomography ((18)FDG PET-CT) in predicting resectability and pathological response of primary locally advanced cervical cancer after neoadjuvant intensity-modulated arc therapy (IMAT) with or without cisplatin (C). Methods and Materials: Twenty-seven patients with International Federation of Gynecology and Obstetrics stages IB2 to IVA cervical cancer were treated with IMAT-C followed by extrafascial hysterectomy (EH). All patients received MRI and (18)FDG PET-CT after IMAT-C. The end points of this study were to: 1. Assess the ability of MRI to predict negative surgical margins (R0). 2. Assess the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI in predicting the following situation at the EH specimen: "no residual disease or minimal microscopically visible residual tumor." 3. Assess the sensitivity, specificity, PPV, and NPV value of (18)FDG PET-CT in predicting "no residual viable tumor cells" at the EH specimen. Results: An R0 resection was obtained in all patients. None of the EH specimens contained macroscopically visible tumor. In 13 patients, no viable tumor cells were found and only 14 had residual microscopic disease. Twenty-four of 27 MRIs were able to correctly predict R0 resection. A negative MRI was 100% predictive for the end point "R0 resection." The specificity and NPV of MRI (end point 2) were 74% and 100%, respectively. No sensitivity or PPV could be calculated. The sensitivity, specificity, PPV, and NPV of (18)FDG PET-CT were 29%, 62%, 44%, and 44%, respectively (end point 3). Conclusions: A negative MRI after IMAT-C predicts 100% correctly for R0 resection. The role of (18)FDG PET-CT in predicting viable tumor cells at EH specimen is at least debatable.
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alternative title
Value of magnetic resonance and (18)FDG PET-CT in predicting tumor response and resectability of primary locally advanced cervical cancer after treatment with intensity-modulated arc therapy : a prospective pathology-matched study
year
type
journalArticle (original)
publication status
published
subject
keyword
Locally advanced cervical cancer, MRI, Tumor response, Prediction, (18)FDG PET-CT, POSITRON-EMISSION-TOMOGRAPHY, GYNECOLOGIC MALIGNANCIES, F-18 FLUORODEOXYGLUCOSE, CHEMOTHERAPY, RADIATION-THERAPY, HYSTERECTOMY, RESIDUAL DISEASE, RADIOTHERAPY, CARCINOMA, CHEMORADIATION
journal title
INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER
Int. J. Gynecol. Cancer
volume
22
issue
4
pages
630 - 637
Web of Science type
Article
Web of Science id
000303546100018
JCR category
OBSTETRICS & GYNECOLOGY
JCR impact factor
1.941 (2012)
JCR rank
29/77 (2012)
JCR quartile
2 (2012)
ISSN
1048-891X
DOI
10.1097/IGC.0b013e3182428925
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2028798
handle
http://hdl.handle.net/1854/LU-2028798
date created
2012-02-13 17:14:29
date last changed
2015-02-02 13:52:02
@article{2028798,
  abstract     = {Objective: To report on the value of magnetic resonance imaging (MRI) and 2-deoxy-2-[18] fluoro-D-glucose positron emission tomography computed tomography ((18)FDG PET-CT) in predicting resectability and pathological response of primary locally advanced cervical cancer after neoadjuvant intensity-modulated arc therapy (IMAT) with or without cisplatin (C). 
Methods and Materials: Twenty-seven patients with International Federation of Gynecology and Obstetrics stages IB2 to IVA cervical cancer were treated with IMAT-C followed by extrafascial hysterectomy (EH). All patients received MRI and (18)FDG PET-CT after IMAT-C. The end points of this study were to: 
1. Assess the ability of MRI to predict negative surgical margins (R0). 
2. Assess the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI in predicting the following situation at the EH specimen: {\textacutedbl}no residual disease or minimal microscopically visible residual tumor.{\textacutedbl} 
3. Assess the sensitivity, specificity, PPV, and NPV value of (18)FDG PET-CT in predicting {\textacutedbl}no residual viable tumor cells{\textacutedbl} at the EH specimen. 
Results: An R0 resection was obtained in all patients. None of the EH specimens contained macroscopically visible tumor. In 13 patients, no viable tumor cells were found and only 14 had residual microscopic disease. Twenty-four of 27 MRIs were able to correctly predict R0 resection. A negative MRI was 100\% predictive for the end point {\textacutedbl}R0 resection.{\textacutedbl} The specificity and NPV of MRI (end point 2) were 74\% and 100\%, respectively. No sensitivity or PPV could be calculated. The sensitivity, specificity, PPV, and NPV of (18)FDG PET-CT were 29\%, 62\%, 44\%, and 44\%, respectively (end point 3). 
Conclusions: A negative MRI after IMAT-C predicts 100\% correctly for R0 resection. The role of (18)FDG PET-CT in predicting viable tumor cells at EH specimen is at least debatable.},
  author       = {Vandecasteele, Katrien and DELRUE, LOUKE and Lambert, Bieke and Makar, Amin and Lambein, Kathleen and Denys, Hannelore and TUMMERS, PHILIPPE and Van den Broecke, Rudy and Villeirs, Geert and De Meerleer, Gert},
  issn         = {1048-891X},
  journal      = {INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER},
  keyword      = {Locally advanced cervical cancer,MRI,Tumor response,Prediction,(18)FDG PET-CT,POSITRON-EMISSION-TOMOGRAPHY,GYNECOLOGIC MALIGNANCIES,F-18 FLUORODEOXYGLUCOSE,CHEMOTHERAPY,RADIATION-THERAPY,HYSTERECTOMY,RESIDUAL DISEASE,RADIOTHERAPY,CARCINOMA,CHEMORADIATION},
  language     = {eng},
  number       = {4},
  pages        = {630--637},
  title        = {Value of magnetic resonance and 18FDG PET-CT in predicting tumor response and resectability of primary locally advanced cervical cancer after treatment with intensity-modulated arc therapy: a prospective pathology-matched study},
  url          = {http://dx.doi.org/10.1097/IGC.0b013e3182428925},
  volume       = {22},
  year         = {2012},
}

Chicago
Vandecasteele, Katrien, LOUKE DELRUE, Bieke Lambert, Amin Makar, Kathleen Lambein, Hannelore Denys, Philippe Tummers, Rudy Van den Broecke, Geert Villeirs, and Gert De Meerleer. 2012. “Value of Magnetic Resonance and 18FDG PET-CT in Predicting Tumor Response and Resectability of Primary Locally Advanced Cervical Cancer After Treatment with Intensity-modulated Arc Therapy: a Prospective Pathology-matched Study.” International Journal of Gynecological Cancer 22 (4): 630–637.
APA
Vandecasteele, Katrien, DELRUE, L., Lambert, B., Makar, A., Lambein, K., Denys, H., Tummers, P., et al. (2012). Value of magnetic resonance and 18FDG PET-CT in predicting tumor response and resectability of primary locally advanced cervical cancer after treatment with intensity-modulated arc therapy: a prospective pathology-matched study. INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, 22(4), 630–637.
Vancouver
1.
Vandecasteele K, DELRUE L, Lambert B, Makar A, Lambein K, Denys H, et al. Value of magnetic resonance and 18FDG PET-CT in predicting tumor response and resectability of primary locally advanced cervical cancer after treatment with intensity-modulated arc therapy: a prospective pathology-matched study. INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER. 2012;22(4):630–7.
MLA
Vandecasteele, Katrien, LOUKE DELRUE, Bieke Lambert, et al. “Value of Magnetic Resonance and 18FDG PET-CT in Predicting Tumor Response and Resectability of Primary Locally Advanced Cervical Cancer After Treatment with Intensity-modulated Arc Therapy: a Prospective Pathology-matched Study.” INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER 22.4 (2012): 630–637. Print.