Early Alteration in Apparent Diffusion Coefficient and Tumor Volume in Cervical Cancer Treated with Chemoradiotherapy or Radiotherapy: Incremental Prognostic Value over Pretreatment Assessments

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Figures

Figure1

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Figure 1: Box plots of %ADC increase and %Volume reduction in patients with and without

disease recurrences

Box plots summarize (A) %ADC increase and (B) %Volume reduction in patients with and without

disease recurrences. ADC = apparent diffusion coefficient.

16

Figure2

(A)%ADCincrease,disease-freesurvival

(B)%ADCincrease,overallsurvival

%ADCinc「ease~median

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21

Figure 2: Kaplan-Meier curve analysis by %ADC increase and %Volume reduction

The figures (A) and (B) show Kaplan-Meier curves in patients stratified by the median (33%)

of %ADC increase for prediction of disease-free survival and overall survival, respectively. The

figures (C) and (D) show Kaplan-Meier curves in patients stratified by the median (72%)

of %Volume reduction for prediction of disease-free survival and overall survival, respectively.

ADC = apparent diffusion coefficient.

17

Figure3

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a」

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011

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Pr

um

e+pre-ADC Pre-Volume+pre-ADC Pr

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ton +%Vo

umer

+%A

DCi

crease

Figure 3: Global chi-square analysis

The figure shows a global chi-square analysis which puts focus on the incremental value

of %Volume reduction and %ADC increase.

ADC = apparent diffusion coefficient.

18

Figure4

A.

ADCbeforetreatment

.ADCduringtreatment

比's'

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C.T2WIbeforetreatment D

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.T2WIa

rtreatment

Figure 4: A case of a patient who had no disease recurrences

The figures show images of a patient with FIGO stage IIIB who had no disease recurrences. The

figures (A) and (B) show ADCs of a tumor (red region of interest) before (0.89 mm2/sec) and during

(1.26 mm2/sec) treatment, respectively. Therefore, a %ADC increase was 42%, which was higher

than the median of %ADC increases. T2WIs before (Figure C) and during (Figure D) treatment

demonstrated decrease (%Volume reduction = 57%) of the tumor volume (white arrow). In a T2WI

after treatment (Figure E), a complete response to treatment was confirmed. During a follow up of 7

years, the patient had no disease recurrences.

ADC

apparent

diffusion

coefficient;

T2WI

International Federation of Gynecology and Obstetrics

T2

weighted

image;

FIGO

19

Supplementary Table 1. Imaging results

Parameter

ADC

Pre-ADC (mm2/sec)

Mid-ADC (mm2/sec)

%ADC increase (%)

Tumor volume

Pre-Volume (ml)

Mid-Volume (ml)

%Volume reduction (%)

ADC = apparent diffusion coefficient.

Value

0.95±0.12

1.27±0.13

35±18

63±57

19±20

69±19

20

SupplementaryFigure1

lcancerp

st

dw

hd

eCCRTor

ybetweenSeptember2007andJanuary2018

n=153

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,n=3

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,n=38

sw

hstageI

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lcancerwhohadMRI

sbeforeandd

gtreatment

n=112

sb

et

,n=4

wupl

,n=S

lstudyp

n=103

Supplementary Figure 1: Study flow chart

CCRT = concurrent chemoradiotherapy; MRI = magnetic resonance imaging.

21

SupplementaryFigure2

lbeamr

ntherapy:50-50.4Gy

r土 boost5.4-10.

8Gy

36

Brach

:12-24Gy

(Nob

n=5)

Day0

Pre-treatmentMRI

Day25士4.

Mid-treatmentMRI

Supplementary Figure 2: Treatment regimen

CDDP = cisplatin; PTX = paclitaxel; MRI = magnetic resonance imaging.

Ti

me(

da

22

SupplementaryFigure3

A.

ADCbeforetreatment

.ADCduringtreatment

.T2WIbeforetreatment

.T2WIduringtreatment

.T2WIa

rtreatment

.CT1yeara

rtreatment

Supplementary Figure 3: A case of a patient who had a disease recurrence

The figures show images of a patient with FIGO stage IIIB who had a disease recurrence. The

figures (A) and (B) show ADCs of a tumor (red region of interest) before (0.92 mm2/sec) and during

(1.07 mm2/sec) treatment, respectively. Therefore, a %ADC increase was 16%, which was lower

than the median of %ADC increases. T2WIs before (Figure C) and during (Figure D) treatment

demonstrated decrease (%Volume reduction = 53%) of the tumor volume (white arrow). A T2WI

after treatment (figure E) shows a complete response to treatment. In the figure (F), a CT image one

year after treatment reveals a disease recurrence (green arrow).

ADC = apparent diffusion coefficient; T2WI = T2 weighted image; FIGO = International Federation

of Gynecology and Obstetrics

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