- Email: [email protected]
Relationship of tumour volume to patient survival in carcinoma of the cervix treated by radical radiotherapy
Clinical Oncology (1993) 5:325-329 © 1993 The Royal College of Radiologists
Clinical Oncology
Abstracts Abstracts of Proffered Oncological Papers Presented at the Joint Annual Meeting of the Royal College of Radiologists and the Faculty of Radiologists, at the University of Warwick, 22-23 September, 1993
Cell Kinetics of Cervical Tumours
B. S. Bolger, T. G. Cook, R. P. Symonds, A. B. MacLean and P. D. Stanton, Beatson Oncology Centre, Western Infirmary, Dumbarton Road, Glasgow G l l 6Nt, UK The pre-treatment cell kinetics of 120 cervical tumours were assessed following in vivo labelling with the thymidine analogue bromodeoxyuridine (BrdU). In 89% both static and temporal kinetic parameters could be measured. Through the analysis of multiple biopsies from each tumour, marked intratumour heterogeneity was demonstrated. The median values for the most highly labelled sample analysed for each tumour were: S-phase duration (Ts) 12.1 hours, BrdU labelling index (CLI) 9.5% and potential tumour doubling time 4.4 days. There was a significant elevation in CLI, but no difference in Ts, between tumour and nonneoplastic cervical tissue. There was also a significant elevation in CLI in advanced stage and large size tumours. Although a significant elevation in CLI was found in aneuploid tumours, this is likely to represent the systematic bias of the calculation methods, with no difference being seen between aneuploid and diploid tumours when BrdU labelling was measured without reference to the nuclear DNA content, The majority of these patients were treated with radiotherapy, and cell kinetic data will be correlated with treatment response when adequate follow-up has been achieved.
The Prognostic Significance of Intrinsic Radiosensitivity Testing for Radiotherapy of Cervical Carcinoma
S. E. Davidson 1, C, M. L. West 2 and R. D. Hunter 1, Departments of 1Clinical Oncology and 2 Experimental Radiation Oncology, Christie Hospital NHS Trust, Manchester M20 9BX, UK Intrinsic radiosensitivity as measured by surviving fraction at 2 Gy has been obtained for 88 patients with cervical carcinoma. These patients with disease Stages I to III have all received radical radiotherapy treatment and have at least 2 years' followup. The mean SF2 value was 0.43. Fifty-three patients remained alive and well and the mean SF2 (0.54, P<0.01) for 22 patients who developed local recurrences. Recurrences were grouped as central, (n = 11, SF2 = 0.55) or peripheral (n = 11, SF2 = 0.53) and these tumours were significantly less radiosensitive (P = 0.02, P = 0.01 respectively). The patients were divided into two groups with tumour SF2 values above and below the median of 0.4 and the percentage of recurrence-free individuals was plotted against time. Stages I to III were included in the analysis and patients with radiosensitive tumours had a significantly better local control rate (5 out of 88) than those with radioresistant tumours (17 out of 88) with P = <0.001. The same trend was seen when the data were analysed for each separate stage with P = 0.10, 0.13 and 0.02 respectively for Stages I, II and III disease. For the data set analysed, stage alone did not predict local recurrence (P = 0.28). In vitro radiosensitivity testing is emerging as one of the most significant prognostic factors in patients with carcinoma of the cervix treated by radiotherapy.
Relationship of Tumour Volume to Patient Survival in Carcinoma of the Cervix Treated by Radical Radiotherapy
C. D. Collins, O. Constant, I. Fryatt, P. R. Blake and C. A. Parsons, Departments of Radiology and Radiotherapy, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK In carcinoma of the cervix the size of the tumour as measured by inspection and palpation is often used as an indirect way of expressing tumour volume. In this retrospective study tumour volume was calculated by two different methods from the staging CT scans obtained of 20 patients with this disease treated by radical radiotherapy in 1987. The aim of the study was to establish the nature of the relationship between the true turnout volume and tumour volume obtained by measuring the maximum dimensions in each plane ('cuboid' volume), to identify if any particular dimension exerted an undue influence on 5-year patient survival and to quantify the difference in tumour volume with early and late clinical and radiological staging. Significant correlation between the product of height x width x depth and true volume was demonstrated (r = 0.983). A multivariate analysis of survival demonstrated a significantly increased relative risk for positive noded (P <0.03) and tumour depth >3.8 cms (P <0.04) or tumour width >5.0 cms (P <0.03). A significant difference (P <0.02) between the median tumour volumes for early and late staging was present irrespective of the method used to calculate volume. This study demonstrates that 'cuboid' tumour volume can be a good reflection of true tumour volume; in addition, positive nodes, tumour depth and tumour width are significant determinants of survival. Age, Socio-economic Status and Survival from Cancer of the Cervix in the West of Scotland 1980-1987
R. P. Symonds, D. W. Lamont, M. M. Brodie, N. J. Nwabineli and C. R. Gillis, Beatson Oncology Centre, Western Infirmary, Dumbarton Road, Glasgow G l l 6NT, UK The aim of this study was to determine if younger women suffering from carcinoma of the cervix in the West of Scotland had a higher case of fatality in the study period 1980-1987. The effect of socioeconomic status on inqidence of this di_sease and survival after treatment was atso examined. It was a population based study and a total of 1588 case sheets were examined, of all patients resident within the five West of Scotland Health Boards forming the catchment area of the Beatson Oncology Centre, Glasgow. Age and socio-economic status had no impact on prognosis if the analysis was controlled for stage at presentation, treatment type and tumour grade. Tumour histology, date of treatment and being a Health Board resident had no significant effect on survival, independent of other variables. However, a strong correlation was found between socio-economic status and the incidence of cervival cancer in the West of Scotland. The more socially deprived are almost three times more likely than the most affluent to develop this disease. They are also more likely to die of this condition. Within the Greater Glasgow Health Board, the 5-year survival for patients of above average affluence was 59% compared with 52% for those of less than average affluence. Survival of younger patients was superior to
Clinical Oncology
Abstracts Abstracts of Proffered Oncological Papers Presented at the Joint Annual Meeting of the Royal College of Radiologists and the Faculty of Radiologists, at the University of Warwick, 22-23 September, 1993
Cell Kinetics of Cervical Tumours
B. S. Bolger, T. G. Cook, R. P. Symonds, A. B. MacLean and P. D. Stanton, Beatson Oncology Centre, Western Infirmary, Dumbarton Road, Glasgow G l l 6Nt, UK The pre-treatment cell kinetics of 120 cervical tumours were assessed following in vivo labelling with the thymidine analogue bromodeoxyuridine (BrdU). In 89% both static and temporal kinetic parameters could be measured. Through the analysis of multiple biopsies from each tumour, marked intratumour heterogeneity was demonstrated. The median values for the most highly labelled sample analysed for each tumour were: S-phase duration (Ts) 12.1 hours, BrdU labelling index (CLI) 9.5% and potential tumour doubling time 4.4 days. There was a significant elevation in CLI, but no difference in Ts, between tumour and nonneoplastic cervical tissue. There was also a significant elevation in CLI in advanced stage and large size tumours. Although a significant elevation in CLI was found in aneuploid tumours, this is likely to represent the systematic bias of the calculation methods, with no difference being seen between aneuploid and diploid tumours when BrdU labelling was measured without reference to the nuclear DNA content, The majority of these patients were treated with radiotherapy, and cell kinetic data will be correlated with treatment response when adequate follow-up has been achieved.
The Prognostic Significance of Intrinsic Radiosensitivity Testing for Radiotherapy of Cervical Carcinoma
S. E. Davidson 1, C, M. L. West 2 and R. D. Hunter 1, Departments of 1Clinical Oncology and 2 Experimental Radiation Oncology, Christie Hospital NHS Trust, Manchester M20 9BX, UK Intrinsic radiosensitivity as measured by surviving fraction at 2 Gy has been obtained for 88 patients with cervical carcinoma. These patients with disease Stages I to III have all received radical radiotherapy treatment and have at least 2 years' followup. The mean SF2 value was 0.43. Fifty-three patients remained alive and well and the mean SF2 (0.54, P<0.01) for 22 patients who developed local recurrences. Recurrences were grouped as central, (n = 11, SF2 = 0.55) or peripheral (n = 11, SF2 = 0.53) and these tumours were significantly less radiosensitive (P = 0.02, P = 0.01 respectively). The patients were divided into two groups with tumour SF2 values above and below the median of 0.4 and the percentage of recurrence-free individuals was plotted against time. Stages I to III were included in the analysis and patients with radiosensitive tumours had a significantly better local control rate (5 out of 88) than those with radioresistant tumours (17 out of 88) with P = <0.001. The same trend was seen when the data were analysed for each separate stage with P = 0.10, 0.13 and 0.02 respectively for Stages I, II and III disease. For the data set analysed, stage alone did not predict local recurrence (P = 0.28). In vitro radiosensitivity testing is emerging as one of the most significant prognostic factors in patients with carcinoma of the cervix treated by radiotherapy.
Relationship of Tumour Volume to Patient Survival in Carcinoma of the Cervix Treated by Radical Radiotherapy
C. D. Collins, O. Constant, I. Fryatt, P. R. Blake and C. A. Parsons, Departments of Radiology and Radiotherapy, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK In carcinoma of the cervix the size of the tumour as measured by inspection and palpation is often used as an indirect way of expressing tumour volume. In this retrospective study tumour volume was calculated by two different methods from the staging CT scans obtained of 20 patients with this disease treated by radical radiotherapy in 1987. The aim of the study was to establish the nature of the relationship between the true turnout volume and tumour volume obtained by measuring the maximum dimensions in each plane ('cuboid' volume), to identify if any particular dimension exerted an undue influence on 5-year patient survival and to quantify the difference in tumour volume with early and late clinical and radiological staging. Significant correlation between the product of height x width x depth and true volume was demonstrated (r = 0.983). A multivariate analysis of survival demonstrated a significantly increased relative risk for positive noded (P <0.03) and tumour depth >3.8 cms (P <0.04) or tumour width >5.0 cms (P <0.03). A significant difference (P <0.02) between the median tumour volumes for early and late staging was present irrespective of the method used to calculate volume. This study demonstrates that 'cuboid' tumour volume can be a good reflection of true tumour volume; in addition, positive nodes, tumour depth and tumour width are significant determinants of survival. Age, Socio-economic Status and Survival from Cancer of the Cervix in the West of Scotland 1980-1987
R. P. Symonds, D. W. Lamont, M. M. Brodie, N. J. Nwabineli and C. R. Gillis, Beatson Oncology Centre, Western Infirmary, Dumbarton Road, Glasgow G l l 6NT, UK The aim of this study was to determine if younger women suffering from carcinoma of the cervix in the West of Scotland had a higher case of fatality in the study period 1980-1987. The effect of socioeconomic status on inqidence of this di_sease and survival after treatment was atso examined. It was a population based study and a total of 1588 case sheets were examined, of all patients resident within the five West of Scotland Health Boards forming the catchment area of the Beatson Oncology Centre, Glasgow. Age and socio-economic status had no impact on prognosis if the analysis was controlled for stage at presentation, treatment type and tumour grade. Tumour histology, date of treatment and being a Health Board resident had no significant effect on survival, independent of other variables. However, a strong correlation was found between socio-economic status and the incidence of cervival cancer in the West of Scotland. The more socially deprived are almost three times more likely than the most affluent to develop this disease. They are also more likely to die of this condition. Within the Greater Glasgow Health Board, the 5-year survival for patients of above average affluence was 59% compared with 52% for those of less than average affluence. Survival of younger patients was superior to