Quantitative MR Imaging in Locally Advanced Cervical Cancer

NCT03210428 | Unknown DMC

• 1 other identifier: 57480
• Study Type: observational
• Target: 320
• Locations: 1 country
• Sites: 1

Brief Summary

Hypoxic tumour cells within the primary tumour have shown prognostic importance for local and metastatic disease control in several cancer sites. Radioresistant hypoxic cells diminish the rate of local control, and the hypoxia driven increase in metastatic potential of the tumour and lowers the rate of distant disease control. DCE MR imaging has been used to quantify the extent of poor perfusion regions within cervical tumours and it has been shown to be a surrogate of hypoxia. Furthermore, a number of studies have demonstrated that DCE MR is predictive of disease failure in cervix cancer. The EMBRACE II study will implement an imaging sub-study, which will evaluate the value of quantitative MR imaging to identify patients at increased risk of disease recurrence (local, nodal and systemic).

Conditions

Neoplasms; Functional Magnetic Resonance Imaging; Radiotherapy

Outcome Measures

Primary Outcomes (1)

• Disease control measure

  To evaluate the sensitivity and specificity of dynamic contrast enhanced (DCE-MRI) to identify patients who have increased risk of disease recurrence (local, nodal, systemic) after radio-chemotherapy of cervix cancer

  5 years

Secondary Outcomes (1)

• Radiomics

  5 years

Eligibility Criteria

• Age: 18 Years+
• Sex: female
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Yearly, each EMBRACE II centre is expected to enrol 10-20 patients. The inclusion for the imaging protocol in a given centre is expected to be 70% of patients enrolled in EMBRACE II. We expect that at least 8 institutions will enrol 10 patients per year, which will result in minimum 80 patients per year, and thereby at least 320 patients within the 4-year study period. This number is sufficient to meet the required number of patients for the hypotheses in the overall patient population (sample size 196 patients) and in the high-risk patients (sample size 248 patients )

You may qualify if:

• Patients without previous record of allergic reaction to infusion of protocol related contrast media (Gadolinium-based)
• Patients with sufficient kidney function according to local regulations
• Patient informed consent

You may not qualify if:

• According to EMBRACE II protocol
• Patients with active infection or severe medical condition

Sponsors & Collaborators

• Aarhus University Hospital: lead
• The Netherlands Cancer Institute: collaborator

Study Sites (1)

Aarhus University Hospital

Aarhus, 8000, Denmark

RECRUITING

Related Publications (33)

• Mayr NA, Huang Z, Wang JZ, Lo SS, Fan JM, Grecula JC, Sammet S, Sammet CL, Jia G, Zhang J, Knopp MV, Yuh WT. Characterizing tumor heterogeneity with functional imaging and quantifying high-risk tumor volume for early prediction of treatment outcome: cervical cancer as a model. Int J Radiat Oncol Biol Phys. 2012 Jul 1;83(3):972-9. doi: 10.1016/j.ijrobp.2011.08.011. Epub 2011 Dec 28.

  PMID: 22208967 BACKGROUND

• Mayr NA, Wang JZ, Zhang D, Grecula JC, Lo SS, Jaroura D, Montebello J, Zhang H, Li K, Lu L, Huang Z, Fowler JM, Wu DH, Knopp MV, Yuh WT. Longitudinal changes in tumor perfusion pattern during the radiation therapy course and its clinical impact in cervical cancer. Int J Radiat Oncol Biol Phys. 2010 Jun 1;77(2):502-8. doi: 10.1016/j.ijrobp.2009.04.084. Epub 2009 Sep 21.

  PMID: 19775824 BACKGROUND

• Andersen EK, Hole KH, Lund KV, Sundfor K, Kristensen GB, Lyng H, Malinen E. Dynamic contrast-enhanced MRI of cervical cancers: temporal percentile screening of contrast enhancement identifies parameters for prediction of chemoradioresistance. Int J Radiat Oncol Biol Phys. 2012 Mar 1;82(3):e485-92. doi: 10.1016/j.ijrobp.2011.05.050. Epub 2011 Oct 17.

  PMID: 22014954 BACKGROUND

• Loncaster JA, Carrington BM, Sykes JR, Jones AP, Todd SM, Cooper R, Buckley DL, Davidson SE, Logue JP, Hunter RD, West CM. Prediction of radiotherapy outcome using dynamic contrast enhanced MRI of carcinoma of the cervix. Int J Radiat Oncol Biol Phys. 2002 Nov 1;54(3):759-67. doi: 10.1016/s0360-3016(02)02972-3.

  PMID: 12377328 BACKGROUND

• Takayama Y, Ohno T, Kishimoto R, Kato S, Yoneyama R, Kandatsu S, Tsujii H, Obata T. Prediction of early response to radiotherapy of uterine carcinoma with dynamic contrast-enhanced MR imaging using pixel analysis of MR perfusion imaging. Magn Reson Imaging. 2009 Apr;27(3):370-6. doi: 10.1016/j.mri.2008.07.007. Epub 2008 Sep 2.

  PMID: 18768283 BACKGROUND

• Semple SI, Harry VN, Parkin DE, Gilbert FJ. A combined pharmacokinetic and radiologic assessment of dynamic contrast-enhanced magnetic resonance imaging predicts response to chemoradiation in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys. 2009 Oct 1;75(2):611-7. doi: 10.1016/j.ijrobp.2009.04.069.

  PMID: 19735887 BACKGROUND

• Mayr NA, Yuh WT, Zheng J, Ehrhardt JC, Magnotta VA, Sorosky JI, Pelsang RE, Oberley LW, Hussey DH. Prediction of tumor control in patients with cervical cancer: analysis of combined volume and dynamic enhancement pattern by MR imaging. AJR Am J Roentgenol. 1998 Jan;170(1):177-82. doi: 10.2214/ajr.170.1.9423627.

  PMID: 9423627 BACKGROUND

• Mayr NA, Yuh WT, Magnotta VA, Ehrhardt JC, Wheeler JA, Sorosky JI, Davis CS, Wen BC, Martin DD, Pelsang RE, Buller RE, Oberley LW, Mellenberg DE, Hussey DH. Tumor perfusion studies using fast magnetic resonance imaging technique in advanced cervical cancer: a new noninvasive predictive assay. Int J Radiat Oncol Biol Phys. 1996 Oct 1;36(3):623-33. doi: 10.1016/s0360-3016(97)85090-0.

  PMID: 8948347 BACKGROUND

• Mayr NA, Yuh WT, Arnholt JC, Ehrhardt JC, Sorosky JI, Magnotta VA, Berbaum KS, Zhen W, Paulino AC, Oberley LW, Sood AK, Buatti JM. Pixel analysis of MR perfusion imaging in predicting radiation therapy outcome in cervical cancer. J Magn Reson Imaging. 2000 Dec;12(6):1027-33. doi: 10.1002/1522-2586(200012)12:63.0.co;2-5.

  PMID: 11105046 BACKGROUND

• Mannelli L, Patterson AJ, Zahra M, Priest AN, Graves MJ, Lomas DJ, Tan LT, Crawford R, Brenton J, Sala E. Evaluation of nonenhancing tumor fraction assessed by dynamic contrast-enhanced MRI subtraction as a predictor of decrease in tumor volume in response to chemoradiotherapy in advanced cervical cancer. AJR Am J Roentgenol. 2010 Aug;195(2):524-7. doi: 10.2214/AJR.09.3437.

  PMID: 20651213 BACKGROUND

• Zahra MA, Tan LT, Priest AN, Graves MJ, Arends M, Crawford RA, Brenton JD, Lomas DJ, Sala E. Semiquantitative and quantitative dynamic contrast-enhanced magnetic resonance imaging measurements predict radiation response in cervix cancer. Int J Radiat Oncol Biol Phys. 2009 Jul 1;74(3):766-73. doi: 10.1016/j.ijrobp.2008.08.023. Epub 2008 Nov 18.

  PMID: 19019563 BACKGROUND

• Gong QY, Brunt JN, Romaniuk CS, Oakley JP, Tan LT, Roberts N, Whitehouse GH, Jones B. Contrast enhanced dynamic MRI of cervical carcinoma during radiotherapy: early prediction of tumour regression rate. Br J Radiol. 1999 Dec;72(864):1177-84. doi: 10.1259/bjr.72.864.10703475.

  PMID: 10703475 BACKGROUND

• Andersen EK, Kristensen GB, Lyng H, Malinen E. Pharmacokinetic analysis and k-means clustering of DCEMR images for radiotherapy outcome prediction of advanced cervical cancers. Acta Oncol. 2011 Aug;50(6):859-65. doi: 10.3109/0284186X.2011.578586.

  PMID: 21767185 BACKGROUND

• Mayr NA, Wang JZ, Zhang D, Montebello JF, Grecula JC, Lo SS, Fowler JM, Yuh WT. Synergistic effects of hemoglobin and tumor perfusion on tumor control and survival in cervical cancer. Int J Radiat Oncol Biol Phys. 2009 Aug 1;74(5):1513-21. doi: 10.1016/j.ijrobp.2008.09.050. Epub 2009 Mar 13.

  PMID: 19286329 BACKGROUND

• Huang Z, Yuh KA, Lo SS, Grecula JC, Sammet S, Sammet CL, Jia G, Knopp MV, Wu Q, Beauchamp NJ 3rd, Yuh WT, Wang R, Mayr NA. Validation of optimal DCE-MRI perfusion threshold to classify at-risk tumor imaging voxels in heterogeneous cervical cancer for outcome prediction. Magn Reson Imaging. 2014 Dec;32(10):1198-205. doi: 10.1016/j.mri.2014.08.039. Epub 2014 Aug 29.

  PMID: 25179141 BACKGROUND

• Torheim T, Malinen E, Kvaal K, Lyng H, Indahl UG, Andersen EK, Futsaether CM. Classification of dynamic contrast enhanced MR images of cervical cancers using texture analysis and support vector machines. IEEE Trans Med Imaging. 2014 Aug;33(8):1648-56. doi: 10.1109/TMI.2014.2321024. Epub 2014 Apr 29.

  PMID: 24802069 BACKGROUND

• Donaldson SB, Buckley DL, O'Connor JP, Davidson SE, Carrington BM, Jones AP, West CM. Enhancing fraction measured using dynamic contrast-enhanced MRI predicts disease-free survival in patients with carcinoma of the cervix. Br J Cancer. 2010 Jan 5;102(1):23-6. doi: 10.1038/sj.bjc.6605415. Epub 2009 Nov 17.

  PMID: 19920831 BACKGROUND

• Mayr NA, Yuh WT, Jajoura D, Wang JZ, Lo SS, Montebello JF, Porter K, Zhang D, McMeekin DS, Buatti JM. Ultra-early predictive assay for treatment failure using functional magnetic resonance imaging and clinical prognostic parameters in cervical cancer. Cancer. 2010 Feb 15;116(4):903-12. doi: 10.1002/cncr.24822.

  PMID: 20052727 BACKGROUND

• Kim JH, Kim CK, Park BK, Park SY, Huh SJ, Kim B. Dynamic contrast-enhanced 3-T MR imaging in cervical cancer before and after concurrent chemoradiotherapy. Eur Radiol. 2012 Nov;22(11):2533-9. doi: 10.1007/s00330-012-2504-4. Epub 2012 Jun 1.

  PMID: 22653283 BACKGROUND

• Boss EA, Massuger LF, Pop LA, Verhoef LC, Huisman HJ, Boonstra H, Barentsz JO. Post-radiotherapy contrast enhancement changes in fast dynamic MRI of cervical carcinoma. J Magn Reson Imaging. 2001 Apr;13(4):600-6. doi: 10.1002/jmri.1084.

  PMID: 11276105 BACKGROUND

• Chen YB, Hu CM, Chen GL, Hu D, Liao J. Staging of uterine cervical carcinoma: whole-body diffusion-weighted magnetic resonance imaging. Abdom Imaging. 2011 Oct;36(5):619-26. doi: 10.1007/s00261-010-9642-4.

  PMID: 20730423 BACKGROUND

• Liu Y, Bai R, Sun H, Liu H, Wang D. Diffusion-weighted magnetic resonance imaging of uterine cervical cancer. J Comput Assist Tomogr. 2009 Nov-Dec;33(6):858-62. doi: 10.1097/RCT.0b013e31819e93af.

  PMID: 19940650 BACKGROUND

• Naganawa S, Sato C, Kumada H, Ishigaki T, Miura S, Takizawa O. Apparent diffusion coefficient in cervical cancer of the uterus: comparison with the normal uterine cervix. Eur Radiol. 2005 Jan;15(1):71-8. doi: 10.1007/s00330-004-2529-4. Epub 2004 Nov 5.

  PMID: 15538578 BACKGROUND

• Kilickesmez O, Bayramoglu S, Inci E, Cimilli T, Kayhan A. Quantitative diffusion-weighted magnetic resonance imaging of normal and diseased uterine zones. Acta Radiol. 2009 Apr;50(3):340-7. doi: 10.1080/02841850902735858.

  PMID: 19235579 BACKGROUND

• Charles-Edwards EM, Messiou C, Morgan VA, De Silva SS, McWhinney NA, Katesmark M, Attygalle AD, DeSouza NM. Diffusion-weighted imaging in cervical cancer with an endovaginal technique: potential value for improving tumor detection in stage Ia and Ib1 disease. Radiology. 2008 Nov;249(2):541-50. doi: 10.1148/radiol.2491072165.

  PMID: 18936313 BACKGROUND

• McVeigh PZ, Syed AM, Milosevic M, Fyles A, Haider MA. Diffusion-weighted MRI in cervical cancer. Eur Radiol. 2008 May;18(5):1058-64. doi: 10.1007/s00330-007-0843-3. Epub 2008 Jan 12.

  PMID: 18193428 BACKGROUND

• Xue HD, Li S, Sun F, Sun HY, Jin ZY, Yang JX, Yu M. Clinical application of body diffusion weighted MR imaging in the diagnosis and preoperative N staging of cervical cancer. Chin Med Sci J. 2008 Sep;23(3):133-7. doi: 10.1016/s1001-9294(09)60027-4.

  PMID: 18853846 BACKGROUND

• Hoogendam JP, Klerkx WM, de Kort GA, Bipat S, Zweemer RP, Sie-Go DM, Verheijen RH, Mali WP, Veldhuis WB. The influence of the b-value combination on apparent diffusion coefficient based differentiation between malignant and benign tissue in cervical cancer. J Magn Reson Imaging. 2010 Aug;32(2):376-82. doi: 10.1002/jmri.22236.

  PMID: 20677265 BACKGROUND

• Kundu S, Chopra S, Verma A, Mahantshetty U, Engineer R, Shrivastava SK. Functional magnetic resonance imaging in cervical cancer: current evidence and future directions. J Cancer Res Ther. 2012 Jan-Mar;8(1):11-8. doi: 10.4103/0973-1482.95167.

  PMID: 22531506 BACKGROUND

• Gladwish A, Milosevic M, Fyles A, Xie J, Halankar J, Metser U, Jiang H, Becker N, Levin W, Manchul L, Foltz W, Han K. Association of Apparent Diffusion Coefficient with Disease Recurrence in Patients with Locally Advanced Cervical Cancer Treated with Radical Chemotherapy and Radiation Therapy. Radiology. 2016 Apr;279(1):158-66. doi: 10.1148/radiol.2015150400. Epub 2015 Oct 27.

  PMID: 26505922 BACKGROUND

• Harry VN, Semple SI, Gilbert FJ, Parkin DE. Diffusion-weighted magnetic resonance imaging in the early detection of response to chemoradiation in cervical cancer. Gynecol Oncol. 2008 Nov;111(2):213-20. doi: 10.1016/j.ygyno.2008.07.048. Epub 2008 Sep 6.

  PMID: 18774597 BACKGROUND

• Somoye G, Harry V, Semple S, Plataniotis G, Scott N, Gilbert FJ, Parkin D. Early diffusion weighted magnetic resonance imaging can predict survival in women with locally advanced cancer of the cervix treated with combined chemo-radiation. Eur Radiol. 2012 Nov;22(11):2319-27. doi: 10.1007/s00330-012-2496-0. Epub 2012 Jun 1.

  PMID: 22653281 BACKGROUND

• Marconi DG, Fregnani JH, Rossini RR, Netto AK, Lucchesi FR, Tsunoda AT, Kamrava M. Pre-treatment MRI minimum apparent diffusion coefficient value is a potential prognostic imaging biomarker in cervical cancer patients treated with definitive chemoradiation. BMC Cancer. 2016 Jul 28;16:556. doi: 10.1186/s12885-016-2619-0.

  PMID: 27469349 BACKGROUND

Related Links

• EMBRACE study webpage

MeSH Terms

Conditions

Neoplasms

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Medical Physicist

Study Record Dates

• First Submitted: July 3, 2017
• First Posted: July 7, 2017
• Study Start: October 18, 2018
• Primary Completion: September 1, 2021
• Study Completion: September 1, 2023
• Last Updated: February 17, 2020

Record last verified: 2020-02

Locations

DK (1)