Abstract
Objectives
To analyse the role of DW-MRI in early prediction of pathologically-assessed residual disease in locally-advanced cervical cancer (LACC) treated with neoadjuvant chemoradiotherapy followed by radical surgery.
Methods
Between October 2010–June 2014, 108 women with histologically-proven cervical cancer were screened; 88 were included in this study. Tumour volume (TV) and ADCmean were measured before (baseline-MRI) and after 2 weeks of chemoradiotherapy (early-MRI). According to histopathology, treatment response was classified as complete (CR) or partial (PR). Comparisons were made with Mann-Whitney, Wilcoxon and χ2 tests. ROC curves were generated for statistically significant parameters on univariate analysis.
Results
CR and PR were documented in 40 and 48 patients. At baseline-MRI, TV did not differ between groups. At early-MRI, TV was higher in PR than in CR (p=0.001). ΔTV reduction after treatment was lower in PR than in CR (63.6% vs. 81.1%; p=0.001). At baseline-MRI and early-MRI, ADCmean did not differ between PR and CR. ROC curve showed best cut-off for predicting pathological PR was ΔTV reduction of 73% with sensitivity, specificity, accuracy, NPV, PPV of 73%, 72.5%, 72.7%, 76%, 69%.
Conclusions
TV evaluated before and early after treatment could predict pathological response in LACC. ADCmean did not correlate with treatment outcome.
Key Points
• Early-MRI tumour volume assessment could predict pathological response to nCRT in LACC.
• Best cut-off for predicting pathological PR was ΔTV reduction of 73 %.
• Early-MRI ADC mean measurements did not correlate with treatment outcome.
Similar content being viewed by others
Abbreviations
- ADCmean :
-
Apparent diffusion coefficient mean
- CONSORT:
-
Consolidated standards for reporting trial
- CR:
-
Complete response
- CRT:
-
Chemoradiation
- DW-MR:
-
Diffusion-weighted magnetic resonance
- FIGO:
-
International Federation of Gynecology and Obstetrics
- FN:
-
False negative
- FP:
-
False positive
- FSE:
-
Fast spin-echo
- LACC:
-
Locally advanced cervical cancer
- maxTD:
-
Maximum tumour diameters
- nCRT:
-
Neoadjuvant chemoradiotherapy
- PR:
-
Partial response
- pR0:
-
Absence of any residual tumour
- pR1:
-
Microscopic residual tumour
- pR2:
-
Macroscopic residual tumour
- PRICE:
-
Prospective imaging cervical cancer evaluation during neoadjuvant treatment
- RECIST:
-
Response Evaluation Criteria for Solid Tumours
- ROI:
-
Region of interest
- SE:
-
Spin-echo
- SPSS:
-
Statistical Package for the Social Sciences
- TN:
-
True negative
- TP:
-
True positive
- TV:
-
Tumour volume
- ΔTV:
-
Delta reduction of TV
References
Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63:11–30
Benedet JL, Odicino F, Maisonneuve P et al (2001) Carcinoma of the cervix uteri. J Epidemiol Biostat 6:7–43
McNeil C (1999) New standard of care for cervical cancer sets stage for next questions. J Natl Cancer Inst 91:500–501
Motton S, Houvenaeghel G, Delannes M et al (2010) Results of surgery after concurrent chemoradiotherapy in advanced cervical cancer: comparison of extended hysterectomy and extrafascial hysterectomy. Int J Gynecol Cancer 20:268–275
Touboul C, Uzan C, Mauguen A et al (2010) Prognostic factors and morbidities after completion surgery in patients undergoing initial chemoradiation therapy for locally advanced cervical cancer. Oncologist 15:405–415
Ferrandina G, Margariti PA, Smaniotto D et al (2010) Long-term analysis of clinical outcome and complications in locally advanced cervical cancer patients administered concomitant chemoradiation followed by radical surgery. Gynecol Oncol 119:404–410
Ferrandina G, Gambacorta A, Gallotta V et al (2014) Chemoradiation with concomitant boosts followed by radical surgery in locally advanced cervical cancer: long-term results of the ROMA-2 prospective phase 2 study. Int J Radiat Oncol Biol Phys 90:778–785
Gallotta V, Ferrandina G, Chiantera V et al (2015) Laparoscopic Radical Hysterectomy After Concomitant Chemoradiation in Locally Advanced Cervical Cancer: A Prospective Phase II Study. J Minim Invasive Gynecol 22:877–883
Sala E, Rockall AG, Freeman SJ et al (2013) The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology 266:717–740
Zannoni GF, Vellone VG, Carbone A (2008) Morphological effects of radiochemotherapy on cervical carcinoma: a morphological study of 50 cases of hysterectomy specimens after neoadjuvant treatment. Int J Gynecol Pathol 27:274–281
Fu C, Feng X, Bian D et al (2015) Simultaneous changes of magnetic resonance diffusion-weighted imaging and pathological microstructure in locally advanced cervical cancer caused by neoadjuvant chemotherapy. J Magn Reson Imaging 42:427–435
Zhu L, Zhu L, Shi H et al (2016) Evaluating early response of cervical cancer under concurrent chemo-radiotherapy by intravoxel incoherent motion MR imaging. BMC Cancer 16:79
Liu Y, Sun H, Bai R, Ye Z (2015) Time-window of early detection of response to concurrent chemoradiation in cervical cancer by using diffusion-weighted MR imaging: a pilot study. Radiat Oncol 10:185
Himoto Y, Fujimoto K, Kido A et al (2014) Assessment of the early predictive power of quantitative magnetic resonance imaging parameters during neoadjuvant chemotherapy for uterine cervical cancer. Int J Gynecol Cancer 24:751–757
Harry VN, Semple SI, Gilbert FJ, Parkin DE (2008) Diffusion-weighted magnetic resonance imaging in the early detection of response to chemoradiation in cervical cancer. Gynecol Oncol 111:213–220
Kuang F, Yan Z, Wang J, Rao Z (2014) The value of diffusion-weighted MRI to evaluate the response to radiochemotherapy for cervical cancer. Magn Reson Imaging 32:342–349
Fu C, Bian D, Liu F et al (2012) The value of diffusion-weighted magnetic resonance imaging in assessing the response of locally advanced cervical cancer to neoadjuvant chemotherapy. Int J Gynecol Cancer 22:1037–1043
Schreuder SM, Lensing R, Stoker J, Bipat S (2015) Monitoring treatment response in patients undergoing chemoradiotherapy for locally advanced uterine cervical cancer by additional diffusion-weighted imaging: A systematic review. J Magn Reson Imaging 42:572–594
Gui B, Valentini AL, Micco M et al (2016) Cervical cancer response to neoadjuvant chemoradiotherapy: MRI assessment compared with surgery. Acta Radiol 57:1123–1131
Fu ZZ, Peng Y, Cao LY et al (2015) Value of apparent diffusion coefficient (ADC) in assessing radiotherapy and chemotherapy success in cervical cancer. Magn Reson Imaging 33:516–524
Inoue C, Fujii S, Kaneda S et al (2014) Apparent diffusion coefficient (ADC) measurement in endometrial carcinoma: effect of region of interest methods on ADC values. J Magn Reson Imaging 40:157–161
Funding
The authors state that this work has not received any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Guarantor
The scientific guarantor of this publication is Prof. Anna Lia Valentini.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise.
Informed consent
Written informed consent was obtained from all subjects (patients) in this study.
Ethical approval
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects have been previously reported in another article (‘Prospective multimodal imaging assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery. The PRICE study: the role of ultrasound’ ), which included the same patient population, analysing exclusively US parameters, as part of a multimodal study.
Methodology
• prospective
• diagnostic or prognostic study
• performed at one institution
Rights and permissions
About this article
Cite this article
Valentini, A.L., Miccò, M., Gui, B. et al. The PRICE study: The role of conventional and diffusion-weighted magnetic resonance imaging in assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery. Eur Radiol 28, 2425–2435 (2018). https://doi.org/10.1007/s00330-017-5233-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-017-5233-x