Prognostic Implications of Uterine Cervical Cancer Regression During Chemoradiation Evaluated by the T-Score in the Multicenter EMBRACE I Study

Autor: Jacob Christian Lindegaard, Primoz Petric, Maximilian Paul Schmid, Nicole Nesvacil, Christine Haie-Meder, Lars Ulrik Fokdal, Alina Emiliana Sturdza, Peter Hoskin, Umesh Mahantshetty, Barbara Segedin, Kjersti Bruheim, Fleur Huang, Bhavana Rai, Rachel Cooper, Elzbieta van der Steen-Banasik, Erik Van Limbergen, Bradley Rumwell Pieters, Li-Tee Tan, Remi A. Nout, Astrid Agatha Catharina De Leeuw, Kathrin Kirchheiner, Sofia Spampinato, Ina Jürgenliemk-Schulz, Kari Tanderup, Christian Kirisits, Richard Pötter
Přispěvatelé: University of Zurich, Lindegaard, Jacob Christian, Radiotherapy, CCA - Cancer Treatment and Quality of Life, CCA - Imaging and biomarkers
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Lindegaard, J C, Petric, P, Schmid, M P, Nesvacil, N, Haie-Meder, C, Fokdal, L U, Sturdza, A E, Hoskin, P, Mahantshetty, U, Segedin, B, Bruheim, K, Huang, F, Rai, B, Cooper, R, van der Steen-Banasik, E, Van Limbergen, E, Pieters, B R, Tan, L T, Nout, R A, De Leeuw, A A C, Kirchheiner, K, Spampinato, S, Jürgenliemk-Schulz, I, Tanderup, K, Kirisits, C & Pötter, R 2022, ' Prognostic Implications of Uterine Cervical Cancer Regression During Chemoradiation Evaluated by the T-Score in the Multicenter EMBRACE I Study ', International Journal of Radiation Oncology Biology Physics, vol. 113, no. 2, pp. 379-389 . https://doi.org/10.1016/j.ijrobp.2022.02.005
International Journal of Radiation Oncology Biology Physics, 113(2), 379-389. Elsevier Inc.
ISSN: 0360-3016
Popis: Purpose: A simple scoring system (T-score, TS) for integrating findings from clinical examination and magnetic resonance imaging (MRI) of the primary tumor at diagnosis has shown strong prognostic capability for predicting local control and survival in locally advanced cervical cancer treated with chemoradiation and MRI-guided brachytherapy (BT). The aim was to validate the performance of TS using the multicenter EMBRACE I study and to evaluate the prognostic implications of TS regression obtained during initial chemoradiation. Methods and Materials: EMBRACE I recruited 1416 patients, of whom 1318 were available for TS. Patients were treated with chemoradiation followed by MRI-guided BT. A ranked ordinal scale of 0 to 3 points was used to assess 8 anatomic locations typical for local invasion of cervical cancer. TS was calculated separately at diagnosis (TSD) and at BT (TSBT) by the sum of points obtained from the 8 locations at the 2 occasions. Results: Median TSD and TSBT was 5 and 4, respectively. TS regression was observed in 71% and was an explanatory variable for BT technique (intracavitary vs intracavitary/interstitial) and major dose-volume histogram parameters for BT, such as high-risk clinical target (CTVHR), CTVHR D90 (minimal dose to 90% of the target volume), D2cm3 bladder (minimal dose to the most exposed 2 cm3 of the bladder), and D2cm3 rectum. TS regression (TSBT≤5) was associated with improved local control and survival and with less morbidity compared with patients with TSBT remaining high (>5) despite initial chemoradiation. TS regression was significant in multivariate analysis for both local control and survival when analyzed in consort with already established prognostic parameters related to the patient, disease, and treatment. Conclusions: TS was validated in a multicenter setting and proven to be a strong multidisciplinary platform for integration of clinical findings and imaging with the ability to quantitate local tumor regression and its prognostic implications regarding BT technique, dose-volume histogram parameters, local control, survival, and morbidity.
Databáze: OpenAIRE
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