Clinical Research Papers:

Appropriate magnetic resonance imaging techniques for gross tumor volume delineation in external beam radiation therapy of locally advanced cervical cancer

Yingqiu Song _, Beth Erickson, Xiaojian Chen, Guiling Li, Gang Wu, Eric Paulson, Paul Knechtges and Li X. Allen

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Oncotarget. 2018; 9:10100-10109. https://doi.org/10.18632/oncotarget.24071

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Yingqiu Song1,2, Beth Erickson1, Xiaojian Chen1, Guiling Li2, Gang Wu2, Eric Paulson1, Paul Knechtges3 and X. Allen Li1

1Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

2Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

3Radiology, Medical College of Wisconsin, Milwaukee, WI, USA

Correspondence to:

X. Allen Li, email: [email protected]

Keywords: cervical cancer; MRI for radiation planning; gross tumor volume delineation; external beam radiation therapy

Received: October 11, 2017     Accepted: November 26, 2017     Published: January 06, 2018


Background: Accurate delineation of the gross tumor volumes (GTV) is a prerequisite for precise radiotherapy planning and delivery. Different MRI sequences have different advantages and limitations in their ability to discriminate primary cervical tumor from normal tissue. The purpose of this work is to determine appropriate MRI techniques for GTV delineation for external-beam radiation therapy of locally advanced cervical cancer (LACC).

Materials and Methods: GTVs were delineated on the MRI, CT, and PET images acquired for 23 LACC patients in treatment positions to obtain GTVs on CT (GTV-CT), on various MRI sequences including T1 (GTV-T1), T2 (GTV-T2), T1 with fat suppression and contrast (GTV-T1F+), DWI-ADC (GTV-ADC) and on PET were generated using the threshold of 40% of maximum SUV (GTV-SUV40%) as well as SUV of 2.5 (GTV-SUV2.5). MRI, CT and PET were registered for comparison. The GTVs defined by MRI were compared using the overlap ratio (OR) and relative volume ratio (RVR). The union of GTV-T2 and GTV-ADC was generated to represent the MRI-based GTV (GTV-MRI).

Results: The differences between GTV-T2 and other MRI GTVs are significant (P < 0.05). The average ORs for GTV-T1, GTV-T1F+, and GTV-ADC related to GTV-T2 were 86.3%, 81.6%, and 61.6% with the corresponding average RVRs 113.8%, 112.3% and 77.2%, respectively. There is no significant difference between GTV-T1 and GTV-T1F+. GTV-ADC was generally smaller than GTV-T2, however, encompassed suspicious regions that are uncovered in GTV-T2 (up to 16% of GTV-T2) because of different imaging mechanisms. There was significant difference between GTV-MRI, GTV-SUV2.5, GTV-SUV40%, and GTV-CT. On average, GTV-MRI is 18.4% smaller than GTV-CT.

Conclusions: MRI provides improved visualization of disease over CT or PET for cervical cancer. The GTV from the union of GTV-T2 and GTV-ADC provides a reasonable GTV including tumor region defined anatomically and functionally with MRI and substantially reduces the conventional GTV defined on CT.

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