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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

  • Magnetic Resonance
  • Published:
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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.

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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

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to B. Gui.

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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

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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

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  • DOI: https://doi.org/10.1007/s00330-017-5233-x

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