Cervical Cancer Regression Measured Using Weekly Magnetic Resonance Imaging During Fractionated Radiotherapy: Radiobiologic Modeling and Correlation With Tumor Hypoxia

Purpose: To measure regression of cancer of the uterine cervix during external beam radiotherapy using magnetic resonance imaging, derive radiobiologic parameters from a mathematical model of tumor regression, and compare these parameters with the pretreatment measurements of tumor hypoxia. Methods and Materials: A total of 27 eligible patients undergoing external beam radiotherapy for cervical cancer underwent weekly magnetic resonance imaging scans. The tumor volume was assessed on each of these scans and the rate of regression plotted. A radiobiologic model was formulated to simulate the effect on tumor regression of the surviving proportion of cells after 2 Gy (SP2 ), the cell clearance constant (clearance of irreparably damaged cells from the tumor [Tc ]), and accelerated repopulation. Nonlinear regression analysis was used to fit the radiobiologic model to the magnetic resonance imaging-derived tumor volumes and to derive the estimates of SP2 and Tc for each patient. These were compared to the pretreatment hypoxia measurements. Results: The initial tumor volume was 8–209 cm3. The relative reduction in volume during treatment was 0.02–0.79. The simulations using representative values of the independent biologic variables derived from published data showed SP2 and Tc to strongly influence the shape of the volume–response curves. Nonlinear regression analysis yielded a median SP2 of 0.71 and median Tc of 10 days. Tumors with a high SP2 >0.71 were significantly more hypoxic at diagnosis (p = 0.02). Conclusion: The results of our study have shown that cervical cancer regresses during external beam radiotherapy, although marked variability is present among patients and is influenced by underlying biologic processes, including cellular sensitivity to radiotherapy and proliferation. Better understanding of the biologic mechanisms might facilitate novel adaptive treatment strategies in future studies. [Copyright &y& Elsevier]