Evaluation The Value Of 3D Power Doppler Sonography In Predicting Clinical Response To Neoadjuvant Chemotherapy For Cervical Carcinoma

Background:Cervical cancer is one of the common malignant tumors among women,which is the second most common malignancies in both of incidence and mortality rates in worldwide.The number of new cases in China accounts for about one-third of that across the world.The patient population is getting younger in recent years.Overall,it' s one of the most severe diseases that afflict women,especially younger ones.Neoadjuvant chemotherapy(NACT) in cervical cancer belong to the area of complementary treatment.When used before surgery or radiotherapy,it often decreases the loading of the tumor,lowers potential surgical risks,reduces micro-metastatic disease,suppresses independent prognosis factors,all of which help patients maintain their sexual functions after treatment and improve the quality of life.At present,NACT has been mostly applied in locally advanced cervical cancer(LACC),and gradually becomes the top choice for middle-aged and young patients.On the other hand,resently reproductive function reservation was proposed in the management of cervical cancer of stage Ib and with diameter less than 2cm.However,due to the existence of diversities among tumors and patients,the outcome of NACT varied greatly between individuals. The therapeutic effect and survival rate of NACT followed by radical hysterectomy depends on tumor response to NACT.Therefore,a capability of predicting clinical response to NACT of cervical cancer is highly desirable.For malignant tumor,tissue hypoxia contributes to its insensitivity to chemotherapeutic drugs.It's helpful to determine the oxygen level in tumor before making a treatment plan.The gold standard method for measuring oxygen level is by using oxygen electrodes.It' s an invasive diagnosis method,which limits its popularity.. It's also applicable to infer the oxygen shortage from low perfusion in microcirculation detected by special MRI and PET imaging.However,the high cost and the potential allergy caused by contrast agents restrict their wide application.3D Doppler ultrasound used in our study is a new technology,which integrates three technologies:the famed "dynamic angiography" technology - power Doppler ultrasound,3D volume sampling technology and Virtual organ computer aided analysis method(VOCAL).It has the advantage of integrity,objectivity,quantification and visibility,and it is complementary to conventioal two-dimensional ultrasound.In theory, 3D Doppler ultrasound is useful for precisely quantifying the volume of blood flow and the number of blood vessels,and monitoring the change of blood and flow in the period of chemotherapy.Since it's non-invasive,safe and cheap,3D Power Doppler ultrasound has great potential in its application.However,the clinical application of this new technology is not heavily reported in either Chinese or foreign journals.Only a few literatures available described the different characteristic of blood flow between benign and malignant tumors.Still now,using this new technology in the field of predicting and monitoring the response to NACT in cervical cancer has not been reported yet.In previous literatures,which concerned predicting the therapeutic effect of chemotherapy in cervical cancer by ultrasound,tow-dimensional hemodynamics parameters,such as Resistance Index(RI),Pulse Index(PI) and so on.But the value of these parameters remains controversial.In this study,Voluson Expert 730 3D power Doppler ultrasound and VOCAL of GE Company were used to detect pre-treatment ultrasound vascular parameters in patients who underwent NACT.Investigate the relationship between pre-treatment ultrasound blood flow parameters and the therapeutic effect of NACT,and thereby find out ultrasound vascular parameters that can be used to predict the therapeutic effect of NACT.For each patient,serial ultrasound hemodynamics and vascular parameters were measured during chemotherapy,and the vascular response mode to chemotherapy was established.This information provided the basis of individualized treatment for individual patient,who presented different sensitivity to chemotherapy.Objective:To investigate the relationship between VL,FI and clinical response to NACT in cervical carcinoma in order to find ultrasound predictable parameters.Methods:Prospective analysis was carried out in a total of 45 patients with stageⅠb -Ⅱa cervical cancers,who underwent NACT between Jan 2008 and Match 2009 in Women' s Hospital,School of Medicine,Zhejiang University.Hemodynamical and vascular flow parameters of tumors were measured and calculated both before and periodically during NACT treatment using conventional speatral Doppler and three-dimensional Power Doppler.The relationship between ultrasound parameters,chemotherapy response and clinical-pathological parameters of cervical carcinoma were analyzed.Results:1,MG was significant different between squamous and insquamous carcinoma, with the former having lower value than the latter(p=0.015);VI,FI and VFI showed significant positive correlation with tumor size(P=0.004,P=0.000, P=0.016 ),and VI,VFI also showed positive correlation with peripheral serum SCC level(P=0.000,P=0.011).2,Each ultrasound parameter showed no significant difference whether lymph node metastasis or not,vessel thrombus or not,stroma invasion≥outer 1/3 or not.3,Single logistic regression picked FI measured before treatment as the only significant predictor of patient response to NACT from various ultrasound and clinical pathological parameters(p<0.05),with a relative risk of 6.855. Multiple stepwise logistic regressions also picked FI with a relative risk of 4.785.4,ROC curve showed FI at the threshold of 35.848 before treatment had a sensitivity of 80.0%and a specificity of 73.3%(AUC 0.792,p=0.002).Further analysis indicated that FI was negatively correlated with the percent of tumor remain after NACT treatment(R=0.191,P=0.005).5,The absolute percentage change of VI was useful to monitor the change of vascular flow.There was a dramatic increase or decrease in the response group as early as 3 weeks after the first NACT treatment(p=0.001),while this phenomenon could not be found in the non-response group.So we suggestedⅥcould serve as an additional confirmation of our prediction of patient response based on FI before treatment.Conclusion:1,Three-dimensional power Doppler,as a non-invasive method,is capable of predicting cervical tumor response to NACT treatment.2,FI before treatment in response group is statistically higher than that in non-response group,.Moreover,FI is negatively correlated with the percent of tumor remain volume after NACT treatment.So FI could be used as an important indicator for predicting the response of NACT.3,In the first 3 weeks after chemotherapy,the style ofⅥchange in response group has a dramatic increase or decrease while non- response group has not, which let us know the NACT results in advanced.