DCE-MRI-Derived Measures of Tumor Hypoxia and Interstitial Fluid Pressure Predict Outcomes in Cervical Carcinoma

Purpose: The poor outcome of locally advanced cervical cancer has been associated with extensive hypoxia and high interstitial fluid pressure (IFP) in the primary tumor. In the present study, measures of tumor hypoxia and IFP were provided using dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) and related to the treatment outcomes. Methods and Materials: The data from 54 cervical cancer patients treated with concurrent cisplatin-based chemoradiotherapy were studied. A low-enhancing tumor volume (LETV) and peritumoral fluid flow velocity (nu(0)) were used as measures of tumor hypoxia and IFP, respectively. Results: Poor disease-free survival and overall survival were associated with large LETV and high nu(0). The multivariate analysis results suggested that the prognostic power of nu(0) and LETV is independent of established clinical prognostic factors and that the prognostic power of nu(0) is strong compared with that of LETV. The outcomes was especially poor for patients with a high nu(0) combined with a large LETV and especially good for those with a low nu(0) combined with a small LETV, with 5-year disease-free survival and overall survival of 13% versus 100%, respectively. Conclusions: The outcome of locally advanced cervical carcinoma seems to be influenced strongly by the tumor IFP and to a lesser extent by tumor hypoxia. DCE-MRI might have the power to provide important biomarkers for the outcome of cervical cancer. (C) 2018 Elsevier Inc. All rights reserved.