Assessment of cervical vascularization density in patients with locally advanced squamous cell cervical carcinoma evaluated in colour Doppler and power Doppler functions

Adam Tomalczyk,Bartłomiej Tomasik,Jacek Fijuth,Malgorzata Moszynska-Zielinska,Leszek Gottwald

doi:10.1007/s00404-021-06161-0

Abstract

PurposeThe aim of the prospective study was to assess changes during treatment and prognostic significance of cervical vascularization density in patients with cervical squamous cell carcinoma (SCC) staged II B and III B and to find relationship of cervical vascularization density with tumour diameter, grading, staging and age of patients.MethodsThe study group included 50 patients who underwent transvaginal Doppler ultrasonography prior to chemoradiotherapy, after external beam radiation therapy (EBRT) and 6 weeks after HDR brachytherapy. The colour Doppler (CD) vascularity index (CDVI) and the power Doppler (PD) vascularity index (PDVI) in cervical tumour were examined.ResultsCDVI and PDVI values decreased significantly during radiotherapy (0.13 (95% CI 0.09–0.16); 0.09 (95% CI 0.07–0.11) and 0.05 (95% CI 0.03–0.06) for CDVI (p < 0.001) and 0.26 (95% CI 0.22–0.31); 0.18 (95% CI 0.14–0.22) and 0.08 (95% CI 0.06–0.11) for PDVI (p < 0.001)). No statistically significant associations of CDVI and PDVI with tumour diameter, grading, staging and age of patients were found. The higher (above median) CDVI values before EBRT were associated with better OS (p = 0.041). The higher (above median) PDVI values before EBRT were associated with superior DFS (p = 0.011) and OS (p < 0.001). DFS and OS did not differ significantly regarding CDVI and PDVI values after EBRT and after the treatment.ConclusionsIn the study group, cervical vascularization density evaluated in CD and PD functions did not depend on tumour diameter, grading, staging and age of patients and decreased during radiotherapy. The prognosis for our patients with CDVI and PDVI before the treatment above the median value was better than compared to patients with these parameters below the median value.

Highlights

In locally advanced cervical squamous cell carcinoma (SCC), the treatment of choice is chemoradiotherapy, and the prognosis depends on a number of factors related to the biology of the tumour and the general condition of patients [1, 2]
In the study group, cervical vascularization density evaluated in colour Doppler (CD) and power Doppler (PD) functions did not depend on tumour diameter, grading, staging and age of patients and decreased during radiotherapy
The prognosis for our patients with CD vascularity index (CDVI) and PD vascularity index (PDVI) before the treatment above the median value was better than compared to patients with these parameters below the median value

Summary

Introduction

In locally advanced cervical squamous cell carcinoma (SCC), the treatment of choice is chemoradiotherapy, and the prognosis depends on a number of factors related to the biology of the tumour and the general condition of patients [1, 2]. Despite continuous improvement of radiotherapy techniques and progress in systemic treatment, the results of treatment in these patients are still unsatisfactory. Stag‐ ing, histology and grading are parameters which characterise tumour evaluated in clinical practice [2, 3]. Other parameters which will help to identify patients with better and worse prognosis are being searched [3, 4]. Tumour angiogenesis is the production of new tumour vessels. It has gained much attention in oncology in recent

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