Pretreatment Endorectal Magnetic Resonance Imaging and Magnetic Resonance Spectroscopic Imaging Features of Prostate Cancer as Predictors of Response to External Beam Radiotherapy

Tim Joseph, David A. McKenna, Antonio C. Westphalen, Fergus Coakley, Shoujun Zhao, Ying Lu, I. Chow Hsu, Mack Roach, John Kurhanewicz

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Purpose: To evaluate whether pretreatment combined endorectal magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging (MRSI) findings are predictive of outcome in patients who undergo external beam radiotherapy for prostate cancer. Methods and Materials: We retrospectively identified 67 men with biopsy-proven prostate cancer who underwent combined endorectal MRI and MRSI at our institution between January 1998 and October 2003 before whole-pelvis external beam radiotherapy. A single reader recorded tumor presence, stage, and metabolic abnormality at combined MRI and MRSI. Kaplan-Meier survival and Cox univariate and multivariate analyses explored the relationship between clinical and imaging variables and outcome, using biochemical or metastatic failure as endpoints. Results: After a mean follow-up of 44 months (range, 3-96), 6 patients developed both metastatic and biochemical failure, with an additional 13 patients developing biochemical failure alone. Multivariate Cox analysis demonstrated that the only independent predictor of biochemical failure was the volume of malignant metabolism on MRSI (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.29-2.06; p <0.0001). The two independent predictors of metastatic failure were MRI tumor size (HR 1.34, 95% CI 1.03-1.73; p = 0.028) and the finding of seminal vesicle invasion on MRI (HR 28.05, 95% CI 3.96-198.67; p = 0.0008). Conclusions: In multivariate analysis, MRI and MRSI findings before EBRT in patients with prostate cancer are more accurate independent predictors of outcome than clinical variables, and in particular, the findings of seminal vesicle invasion and extensive tumor predict a worse prognosis.

Original languageEnglish (US)
Pages (from-to)665-671
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume73
Issue number3
DOIs
StatePublished - Mar 1 2009
Externally publishedYes

Fingerprint

pretreatment
magnetic resonance
radiation therapy
Prostatic Neoplasms
Radiotherapy
cancer
Magnetic Resonance Imaging
predictions
hazards
confidence
tumors
Multivariate Analysis
Seminal Vesicles
Confidence Intervals
intervals
Neoplasms
pelvis
prognosis
abnormalities
metabolism

Keywords

  • Cancer-prostate
  • Magnetic resonance imaging
  • Outcome analysis
  • Radiotherapy
  • Spectroscopy-prostate

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Pretreatment Endorectal Magnetic Resonance Imaging and Magnetic Resonance Spectroscopic Imaging Features of Prostate Cancer as Predictors of Response to External Beam Radiotherapy. / Joseph, Tim; McKenna, David A.; Westphalen, Antonio C.; Coakley, Fergus; Zhao, Shoujun; Lu, Ying; Hsu, I. Chow; Roach, Mack; Kurhanewicz, John.

In: International Journal of Radiation Oncology Biology Physics, Vol. 73, No. 3, 01.03.2009, p. 665-671.

Research output: Contribution to journalArticle

Joseph, Tim ; McKenna, David A. ; Westphalen, Antonio C. ; Coakley, Fergus ; Zhao, Shoujun ; Lu, Ying ; Hsu, I. Chow ; Roach, Mack ; Kurhanewicz, John. / Pretreatment Endorectal Magnetic Resonance Imaging and Magnetic Resonance Spectroscopic Imaging Features of Prostate Cancer as Predictors of Response to External Beam Radiotherapy. In: International Journal of Radiation Oncology Biology Physics. 2009 ; Vol. 73, No. 3. pp. 665-671.
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abstract = "Purpose: To evaluate whether pretreatment combined endorectal magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging (MRSI) findings are predictive of outcome in patients who undergo external beam radiotherapy for prostate cancer. Methods and Materials: We retrospectively identified 67 men with biopsy-proven prostate cancer who underwent combined endorectal MRI and MRSI at our institution between January 1998 and October 2003 before whole-pelvis external beam radiotherapy. A single reader recorded tumor presence, stage, and metabolic abnormality at combined MRI and MRSI. Kaplan-Meier survival and Cox univariate and multivariate analyses explored the relationship between clinical and imaging variables and outcome, using biochemical or metastatic failure as endpoints. Results: After a mean follow-up of 44 months (range, 3-96), 6 patients developed both metastatic and biochemical failure, with an additional 13 patients developing biochemical failure alone. Multivariate Cox analysis demonstrated that the only independent predictor of biochemical failure was the volume of malignant metabolism on MRSI (hazard ratio [HR] 1.63, 95{\%} confidence interval [CI] 1.29-2.06; p <0.0001). The two independent predictors of metastatic failure were MRI tumor size (HR 1.34, 95{\%} CI 1.03-1.73; p = 0.028) and the finding of seminal vesicle invasion on MRI (HR 28.05, 95{\%} CI 3.96-198.67; p = 0.0008). Conclusions: In multivariate analysis, MRI and MRSI findings before EBRT in patients with prostate cancer are more accurate independent predictors of outcome than clinical variables, and in particular, the findings of seminal vesicle invasion and extensive tumor predict a worse prognosis.",
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AU - McKenna, David A.

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AU - Coakley, Fergus

AU - Zhao, Shoujun

AU - Lu, Ying

AU - Hsu, I. Chow

AU - Roach, Mack

AU - Kurhanewicz, John

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N2 - Purpose: To evaluate whether pretreatment combined endorectal magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging (MRSI) findings are predictive of outcome in patients who undergo external beam radiotherapy for prostate cancer. Methods and Materials: We retrospectively identified 67 men with biopsy-proven prostate cancer who underwent combined endorectal MRI and MRSI at our institution between January 1998 and October 2003 before whole-pelvis external beam radiotherapy. A single reader recorded tumor presence, stage, and metabolic abnormality at combined MRI and MRSI. Kaplan-Meier survival and Cox univariate and multivariate analyses explored the relationship between clinical and imaging variables and outcome, using biochemical or metastatic failure as endpoints. Results: After a mean follow-up of 44 months (range, 3-96), 6 patients developed both metastatic and biochemical failure, with an additional 13 patients developing biochemical failure alone. Multivariate Cox analysis demonstrated that the only independent predictor of biochemical failure was the volume of malignant metabolism on MRSI (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.29-2.06; p <0.0001). The two independent predictors of metastatic failure were MRI tumor size (HR 1.34, 95% CI 1.03-1.73; p = 0.028) and the finding of seminal vesicle invasion on MRI (HR 28.05, 95% CI 3.96-198.67; p = 0.0008). Conclusions: In multivariate analysis, MRI and MRSI findings before EBRT in patients with prostate cancer are more accurate independent predictors of outcome than clinical variables, and in particular, the findings of seminal vesicle invasion and extensive tumor predict a worse prognosis.

AB - Purpose: To evaluate whether pretreatment combined endorectal magnetic resonance imaging (MRI) and magnetic resonance spectroscopic imaging (MRSI) findings are predictive of outcome in patients who undergo external beam radiotherapy for prostate cancer. Methods and Materials: We retrospectively identified 67 men with biopsy-proven prostate cancer who underwent combined endorectal MRI and MRSI at our institution between January 1998 and October 2003 before whole-pelvis external beam radiotherapy. A single reader recorded tumor presence, stage, and metabolic abnormality at combined MRI and MRSI. Kaplan-Meier survival and Cox univariate and multivariate analyses explored the relationship between clinical and imaging variables and outcome, using biochemical or metastatic failure as endpoints. Results: After a mean follow-up of 44 months (range, 3-96), 6 patients developed both metastatic and biochemical failure, with an additional 13 patients developing biochemical failure alone. Multivariate Cox analysis demonstrated that the only independent predictor of biochemical failure was the volume of malignant metabolism on MRSI (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.29-2.06; p <0.0001). The two independent predictors of metastatic failure were MRI tumor size (HR 1.34, 95% CI 1.03-1.73; p = 0.028) and the finding of seminal vesicle invasion on MRI (HR 28.05, 95% CI 3.96-198.67; p = 0.0008). Conclusions: In multivariate analysis, MRI and MRSI findings before EBRT in patients with prostate cancer are more accurate independent predictors of outcome than clinical variables, and in particular, the findings of seminal vesicle invasion and extensive tumor predict a worse prognosis.

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