Pulsatility Index and Hypoxia Inducible Factor-1α Expression Predict the Clinical Response after External Radiation in Patients with Stage IIB to IVA Cervical Cancer

Document Type: Research Articles

Authors

1 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, dr. Hasan Sadikin Hospital/Faculty of Medicine, Padjajaran University, Bandung, Indonesia.

2 Deparment of Radiotherapy, dr. Hasan Sadikin Hospital/Faculty of Medicine, Padjajaran University, Bandung, Indonesia.

3 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Sanglah Hospital/Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.

Abstract

Objective: To evaluate the ability of pulsatility index (PI), resistance index (RI), and hypoxia inducible
factor-1α (HIF-1α) expression in predicting the clinical response after radiation in patients with cervical cancer.
Methods: A prospective cohort was carried on in Department of Obstetric and Gynecology Dr. Hasan Sadikin Hospital/
Faculty of Medicine, Padjadjaran University, during the period of July 2017 to March 2018 which include 51 samples
with stage IIB to IVA cervical cancer. Tumor perfusion and oxygenation were evaluated using color Doppler ultrasound
indices (pulsatility index and resistance index) and the expression of hypoxia inducible factor-1α (HIF-1α). The clinical
response was assessed 2 months after external radiation. Result: Among 51 patients, 31 patients demonstrated good
response and 20 patients demonstrated poor response to radiation. The mean value of PI was significantly lower in patients who demonstrated good response as compared to patients with poor response (0.84±0.916 vs. 1.70±1.260, p = 0.004). The mean value of RI did not differ significantly (0.29±0.112 vs. to 0.36±0.189 p =0.173). HIF-1α expression was significantly lower in patients who demonstrated good response as compared to patients with poor response (1.83±1.529 vs. 6.55±2.625, p = 0.0001). In multivariate model, PI and HIF-1α expression both predicted the clinical response after radiation. Conclusion: PI and HIF-1α expression predict the clinical response after radiation in patients with cervical cancer.

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