HC 030031 Mammography use among Medicare beneficiaries after
Mammography use among Medicare beneficiaries after elimination of cost sharing.
Simon, K., Soni, A., Cawley, J., 2017. The impact of health insurance on preventive care and health behaviors: evidence from the first two years of the ACA Medicaid ex-pansions. J. Policy Anal. Manage. 36, 390–417.
The Henry J Kaiser Family Foundation, 2018. Status of State Action on the Medicaid Expansion Decision.
U.S. Preventive Services Task Force, 2014. Archived Final Recommendation Statement: Breast Cancer Screening USPSTF Program Oﬃce, Rockville, MD.
U.S. Preventive Services Task Force, 2018. U.S. Preventive Services Task Force. USPSTF Program Oﬃce, Rockville, Maryland.
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Physics and Imaging in Radiation Oncology
journal homepage: www.elsevier.com/locate/phro
Original Research Article
Cervical cancer apparent HC 030031 coefficient values during external beam T radiotherapy
Peter de Boera,b, , Stefano Mandijac, Anita M. Werensteijn-Honingha, Cornelis A.T. van den Bergc, Astrid A.C. de Leeuwa, Ina M. Jürgenliemk-Schulza a Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands b Department of Radiation Oncology, Amsterdam University Medical Centres (Amsterdam UMC) – University of Amsterdam (UvA), The Netherlands c Centre for Image Sciences, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
Background and purpose: Apparent diffusion coefficient (ADC) reflects micro-enviromental changes and therefore might be useful in predicting recurrence prior to brachytherapy. The purpose of this study is to evaluate change in ADC of the primary tumour and pathologic lymph nodes during treatment and to correlate this with clinical outcome.
Material and methods: Twenty patients were included who received chemoradiation for locally advanced cervical cancer between July 2016 and November 2017. All patients underwent magnetic resonance imaging (MRI) prior to treatment, and three MRIs in weeks 1/2, 3 and 4 of treatment, including T2 and diffusion weighted imaging (b-values 0, 200, 800 s/mm2) for determining an ADC-map. Primary tumour was delineated on T2 and ADC-map and pathologic lymph nodes were delineated only on ADC-map.
Conclusions: ADC values can be acquired using T2-based tumour delineations unless there are substantial shifts between ADC-mapping and T2 acquisition. It remains plausible that ΔADC is a predictor for response to EBRT. However, the correlation in this study was not statistically significant.
Cervical cancer is a major global problem as it is the fourth most common cancer in women, with an incidence of 528,000 women/year and causing 266,000 deaths in 2012 . About 40% of the patients are diagnosed with locally advanced disease (LACC), for whom chemor-adiation (CRT) is considered the standard curative care [2–4]. During the last decades, MRI-guided adaptive brachytherapy has resulted in an approximately 20% improvement in 5-year local control (LC) [5–10]. However, opportunities remain for further improving LC, especially for patients with primary tumours > 30 cm3 at the time of brachytherapy
and for FIGO stage IIIA–IVA, as reported LC for the latter group is only 71–79% after 5 years [5,11]. Data published by the EMBRACE-group revealed the crucial importance of 90% tumour coverage with an adequate brachytherapy dose (≥85 Gy) for achieving LC [12,13]. A further step in LC might be achieved by determining which tumours are at risk of local recurrence and might benefit from further dose escala-tion at the time of brachytherapy.
In western countries, T2-weighted MRI with its superior soft tissue contrast compared to CT, is widely used for evaluating tumour spread in the staging of cervical cancer [14,15]. For tissue characterisation, such as differentiation between residual tumour and radiation-induced
Corresponding author at: Dept. of Radiation Oncology, Amsterdam UMC, UvA, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail address: [email protected] (P. de Boer).
2405-6316/ © 2019 The Authors. Published by Elsevier B.V. on behalf of European Society of Radiotherapy & Oncology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).
Fig. 1. Delineation of a 53-year old women with FIGO stage IIB cervical cancer. Delineation of the primary tumour on ADC-map in pink is visualised in A, while in B the tumour is delineated on T2 weighted imaging (red). In C delineation of a pa-thological lymph node on ADC-map is shown (purple), and in F (green). Additionally three re-ference volumes (S1–3) were created in smooth muscle: S1 within the high dose EBRT (45 Gy) area (image D, yellow), S2 well below the caudal border of the planned radiotherapy field (image E, blue), and S3 (image F, orange) within the uninvaded part of the uterine corpus. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)