A1 Refereed original research article in a scientific journal
Vaginal recurrence of endometrial cancer: MRI characteristics and correlation with patient outcome after salvage radiation therapy
Authors: Steiner Aida, Alban Gabriela, Cheng Teresa, Kapur Tina, Bay Camden, McLaughlin Pierre-Yves, King Martin, Tempany Clare, Lee Larissa J
Publisher: SPRINGER
Publication year: 2020
Journal: Abdominal Radiology
Journal name in source: ABDOMINAL RADIOLOGY
Journal acronym: ABDOM RADIOL
Volume: 45
Issue: 4
First page : 1122
Last page: 1131
Number of pages: 10
ISSN: 2366-004X
eISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-020-02453-2
Web address : https://link.springer.com/article/10.1007/s00261-020-02453-2
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/46735080
Purpose To evaluate MRI characteristics in vaginal recurrence of endometrial cancer (EC) including tumor volume shrinkage during salvage radiotherapy, and to identify imaging features associated with survival. Methods Patients with vaginal recurrence of EC treated with external beam radiotherapy (EBRT) followed by brachytherapy (BT), and with available pelvic MRI at two time points: baseline and/or before BT were retrospectively identified from 2004 to 2017. MRI features including recurrence location and tissue characteristics on T2- and T1-weighted images were evaluated at baseline only. Tumor volumes were measured both at baseline and pre-BT. Survival rates and associations were evaluated by Cox regression and Fisher's exact test, respectively. Results Sixty-two patients with 36 baseline and 50 pre-BT pelvic MRIs were included (24/62 with both MRIs). Vaginal recurrence of EC was most commonly located in the vaginal apex (27/36, 75%). Tumors with a post-contrast enhancing peripheral rim or low T2 signal rim at baseline showed longer recurrence-free survival (RFS) (HR 0.2, 95% CI 0.1-0.9, P < 0.05 adjusted for histology; HR 0.2, 95% CI 0.1-0.8, P < 0.05, respectively). The median tumor shrinkage at pre-BT was 69% (range 1-99%). Neither absolute tumor volumes nor volume regression at pre-BT were associated with RFS. Lymphovascular space invasion (LVSI) at hysterectomy and adjuvant RT were associated with recurrence involving the distal vagina (both P < 0.05). Conclusion Vaginal recurrences with rim enhancement at baseline MRI predicted improved RFS, while tumor volume shrinkage at pre-BT did not. Distal vaginal recurrence was more common in patients with LVSI and adjuvant RT at EC diagnosis.
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