DCE-MRI was performed in 102 stage IB2-IVA cervical cancer patients to assess tumor perfusion heterogeneity before and during radiation/chemotherapy. FRV represents the total volume of tumor voxels with critically low DCE signal intensity (<2.1 compared with precontrast image, determined by previous receiver operator characteristic analysis). FRVs were correlated with treatment outcome (follow-up: 0.2-9.4, mean 6.8 years) and compared with ATVs (Mann-Whitney, Kaplan-Meier, and multivariate analyses).
Before and during therapy at 2-2.5 and 4-5 weeks of RT, FRVs >20, >13, and聽>5聽cm3, respectively, significantly predicted unfavorable 6-year primary tumor control (p聽= 0.003, 7.3 脳 10鈭?, 2.0 脳 10鈭?) and disease-specific survival (p = 1.9 脳 10鈭?, 2.1聽脳聽10鈭?, 2.5 脳 10鈭?, respectively). The FRVs were superior to the ATVs as early predictors of outcome, and the differentiating power of FRVs increased during treatment.
Our preliminary results suggest that functional tumor heterogeneity can be characterized by DCE-MRI to quantify FRV for predicting ultimate long-term treatment outcome. FRV is a novel functional imaging heterogeneity parameter, superior to ATV, and聽can be clinically translated for personalized early outcome prediction before or as early as 2-5 weeks into treatment.