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Lucic S, Spirovski M, Stojanovic D, Peter A, Licina J, Ivanov O, Milenovic N, Lucic MA. 18F-FDG PET/CT- and MRI-Based Locally Advanced Cervical Cancer Early-Response Assessment after Concurrent Chemo- and Radiotherapy-Impact on Patient Outcomes and Survival Prediction. Diagnostics (Basel) 2024; 14:1432. [PMID: 39001322 PMCID: PMC11241414 DOI: 10.3390/diagnostics14131432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 06/29/2024] [Accepted: 07/03/2024] [Indexed: 07/16/2024] Open
Abstract
With one third of patients with locally advanced cervical cancer (LACC) expected to develop cancer recurrence in the first two years after therapy, accurate assessment of the response and timely detection of cancer recurrence after concurrent chemo- and radiotherapy (CCRT) treatment is of great importance. Although there is neither definite consensus about the preferred imaging modality, nor the time interval until the first diagnostic examination after CCRT, the National Comprehensive Cancer Network (NCCN) recommends the use of MRI and 18F-FDG PET/CT as a post-treatment LACC response-assessment imaging tools. In this study, we tried to appraise the early therapy response in LACC patients by both 18F-FDG PET/CT and MRI in regard to the follow-up imaging results and their mutual interrelationship, and to ascertain if the post-treatment 18F-FDG PET/CT and MRI results were related to the progression-free and overall survival rate in women with LACC after CCRT. We also aimed to estimate the early and follow-up diagnostic imaging impact on further therapy management. Based on our results, we concluded that 18F-FDG PET/CT did surpass MRI in the early assessment of therapeutic response in LACC patients after CCRT. Both modalities provided information that may serve as predictive biomarkers of outcome and LACC patients' survival.
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Affiliation(s)
- Silvija Lucic
- Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Oncology Institute of Vojvodina, 21000 Novi Sad, Serbia
| | - Milena Spirovski
- Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Oncology Institute of Vojvodina, 21000 Novi Sad, Serbia
| | | | - Andrea Peter
- Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Oncology Institute of Vojvodina, 21000 Novi Sad, Serbia
| | - Jelena Licina
- Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Oncology Institute of Vojvodina, 21000 Novi Sad, Serbia
| | - Olivera Ivanov
- Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Oncology Institute of Vojvodina, 21000 Novi Sad, Serbia
| | | | - Milos A Lucic
- Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia
- Oncology Institute of Vojvodina, 21000 Novi Sad, Serbia
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Yan Q, Yan X, Yang X, Li S, Song J. The use of PET/MRI in radiotherapy. Insights Imaging 2024; 15:63. [PMID: 38411742 PMCID: PMC10899128 DOI: 10.1186/s13244-024-01627-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/21/2024] [Indexed: 02/28/2024] Open
Abstract
Positron emission tomography/magnetic resonance imaging (PET/MRI) is a hybrid imaging technique that quantitatively combines the metabolic and functional data from positron emission tomography (PET) with anatomical and physiological information from MRI. As PET/MRI technology has advanced, its applications in cancer care have expanded. Recent studies have demonstrated that PET/MRI provides unique advantages in the field of radiotherapy and has become invaluable in guiding precision radiotherapy techniques. This review discusses the rationale and clinical evidence supporting the use of PET/MRI for radiation positioning, target delineation, efficacy evaluation, and patient surveillance.Critical relevance statement This article critically assesses the transformative role of PET/MRI in advancing precision radiotherapy, providing essential insights into improved radiation positioning, target delineation, efficacy evaluation, and patient surveillance in clinical radiology practice.Key points• The emergence of PET/MRI will be a key bridge for precise radiotherapy.• PET/MRI has unique advantages in the whole process of radiotherapy.• New tracers and nanoparticle probes will broaden the use of PET/MRI in radiation.• PET/MRI will be utilized more frequently for radiotherapy.
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Affiliation(s)
- Qi Yan
- Cancer Center, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, China
| | - Xia Yan
- Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Provincial Key Laboratory for Translational Nuclear Medicine and Precision Protection, Taiyuan, China
| | - Xin Yang
- Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Sijin Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, China.
| | - Jianbo Song
- Cancer Center, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan, China.
- Shanxi Provincial Key Laboratory for Translational Nuclear Medicine and Precision Protection, Taiyuan, China.
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Dhesi SS, Frood R, Swift S, Cooper R, Muzumdar S, Jamal M, Scarsbrook A. Prediction of Patient Outcomes in Locally Advanced Cervical Carcinoma Following Chemoradiotherapy-Comparative Effectiveness of Magnetic Resonance Imaging and 2-Deoxy-2-[ 18F]fluoro-D-glucose Imaging. Cancers (Basel) 2024; 16:476. [PMID: 38339229 PMCID: PMC10854890 DOI: 10.3390/cancers16030476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE To evaluate the utility and comparative effectiveness of three five-point qualitative scoring systems for assessing response on PET-CT and MRI imaging individually and in combination, following curative-intent chemoradiotherapy (CRT) in locally advanced cervical cancer (LACC). Their performance in the prediction of subsequent patient outcomes was also assessed; Methods: Ninety-seven patients with histologically confirmed LACC treated with CRT using standard institutional protocols at a single centre who underwent PET-CT and MRI at staging and post treatment were identified retrospectively from an institutional database. The post-CRT imaging studies were independently reviewed, and response assessed using five-point scoring tools for T2WI, DWI, and FDG PET-CT. Patient characteristics, staging, treatment, and follow-up details including progression-free survival (PFS) and overall survival (OS) outcomes were collected. To compare diagnostic performance metrics, a two-proportion z-test was employed. A Kaplan-Meier analysis (Mantel-Cox log-rank) was performed. RESULTS The T2WI (p < 0.00001, p < 0.00001) and DWI response scores (p < 0.00001, p = 0.0002) had higher specificity and accuracy than the PET-CT. The T2WI score had the highest positive predictive value (PPV), while the negative predictive value (NPV) was consistent across modalities. The combined MR scores maintained high NPV, PPV, specificity, and sensitivity, and the PET/MR consensus scores showed superior diagnostic accuracy and specificity compared to the PET-CT score alone (p = 0.02926, p = 0.0083). The Kaplan-Meier analysis revealed significant differences in the PFS based on the T2WI (p < 0.001), DWI (p < 0.001), combined MR (p = 0.003), and PET-CT/MR consensus scores (p < 0.001) and in the OS for the T2WI (p < 0.001), DWI (p < 0.001), and combined MR scores (p = 0.031) between responders and non-responders. CONCLUSION Post-CRT response assessment using qualitative MR scoring and/or consensus PET-CT and MRI scoring was a better predictor of outcome compared to PET-CT assessment alone. This requires validation in a larger prospective study but offers the potential to help stratify patient follow-up in the future.
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Affiliation(s)
- Simran Singh Dhesi
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (S.S.D.); (R.F.); (S.S.); (M.J.)
| | - Russell Frood
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (S.S.D.); (R.F.); (S.S.); (M.J.)
- Leeds Institute of Health Research, Faculty of Medicine & Health, University of Leeds, Leeds LS9 7TF, UK
| | - Sarah Swift
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (S.S.D.); (R.F.); (S.S.); (M.J.)
| | - Rachel Cooper
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds LS9 7TF, UK;
| | - Siddhant Muzumdar
- Department of Radiology, Chelsea & Westminster Hospital, 369 Fulham Rd., London SW10 9NH, UK;
| | - Mehvish Jamal
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (S.S.D.); (R.F.); (S.S.); (M.J.)
| | - Andrew Scarsbrook
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (S.S.D.); (R.F.); (S.S.); (M.J.)
- Leeds Institute of Health Research, Faculty of Medicine & Health, University of Leeds, Leeds LS9 7TF, UK
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Lakhman Y, Aherne EA, Jayaprakasam VS, Nougaret S, Reinhold C. Staging of Cervical Cancer: A Practical Approach Using MRI and FDG PET. AJR Am J Roentgenol 2023; 221:633-648. [PMID: 37459457 PMCID: PMC467038 DOI: 10.2214/ajr.23.29003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
This review provides a practical approach to the imaging evaluation of patients with cervical cancer (CC), from initial diagnosis to restaging of recurrence, focusing on MRI and FDG PET. The primary updates to the International Federation of Gynecology and Obstetrics (FIGO) CC staging system, as well as these updates' relevance to clinical management, are discussed. The recent literature investigating the role of MRI and FDG PET in CC staging and image-guided brachytherapy is summarized. The utility of MRI and FDG PET in response assessment and posttreatment surveillance is described. Important findings on MRI and FDG PET that interpreting radiologists should recognize and report are illustrated. The essential elements of structured reports during various phases of CC management are outlined. Special considerations, including the role of imaging in patients desiring fertility-sparing management, differentiation of CC and endometrial cancer, and unusual CC histologies, are also described. Finally, future research directions including PET/MRI, novel PET tracers, and artificial intelligence applications are highlighted.
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Affiliation(s)
- Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Emily A Aherne
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Vetri Sudar Jayaprakasam
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, Montpellier, France
- Pinkcc Lab, IRCM, Montpellier, France
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, QC, Canada
- Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, QC, Canada
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Anghel B, Serboiu C, Marinescu A, Taciuc IA, Bobirca F, Stanescu AD. Recent Advances and Adaptive Strategies in Image Guidance for Cervical Cancer Radiotherapy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1735. [PMID: 37893453 PMCID: PMC10608436 DOI: 10.3390/medicina59101735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
The standard of care for locally advanced cervical cancer is external beam radiotherapy (EBRT) with simultaneous chemotherapy followed by an internal radiation boost. New imaging methods such as positron-emission tomography and magnetic resonance imaging have been implemented into daily practice for better tumor delineation in radiotherapy planning. The method of delivering radiation has changed with technical advances in qualitative imaging and treatment delivery. Image-guided radiotherapy (IGRT) plays an important role in minimizing treatment toxicity of pelvic radiation and provides a superior conformality for sparing the organs at risk (OARs) such as bone marrow, bowel, rectum, and bladder. Similarly, three-dimensional image-guided adaptive brachytherapy (3D-IGABT) with computed tomography (CT) or magnetic resonance imaging (MRI) has been reported to improve target coverage and reduce the dose to normal tissues. Brachytherapy is a complementary part of radiotherapy treatment for cervical cancer and, over the past 20 years, 3D-image-based brachytherapy has rapidly evolved and established itself as the gold standard. With new techniques and adaptive treatment in cervical cancer, the concept of personalized medicine is introduced with an enhanced comprehension of the therapeutic index not only in terms of volume (three-dimensional) but during treatment too (four-dimensional). Current data show promising results with integrated IGRT and IGABT in clinical practice and, therefore, better local control and overall survival while reducing treatment-related morbidity. This review gives an overview of the substantial impact that occurred in the progress of image-guided adaptive external beam radiotherapy and brachytherapy.
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Affiliation(s)
- Beatrice Anghel
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.); (I.-A.T.); (F.B.); (A.D.S.)
- Department of Radiation Oncology, Sanador Oncology Centre, 010991 Bucharest, Romania
| | - Crenguta Serboiu
- Department of Histology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andreea Marinescu
- Radiology and Imaging Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Iulian-Alexandru Taciuc
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.); (I.-A.T.); (F.B.); (A.D.S.)
- Nuclear Medicine Department, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Florin Bobirca
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.); (I.-A.T.); (F.B.); (A.D.S.)
- General Surgery Department, Cantacuzino Clinical Hospital, 73206 Bucharest, Romania
| | - Anca Daniela Stanescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.); (I.-A.T.); (F.B.); (A.D.S.)
- Department of Obstetrics and Gynecology, St. John Emergency Hospital, Bucur Maternity, 040292 Bucharest, Romania
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Ditto A, Leone Roberti Maggiore U, Evangelisti G, Bogani G, Chiappa V, Martinelli F, Raspagliesi F. Diagnostic Accuracy of Magnetic Resonance Imaging in the Pre-Operative Staging of Cervical Cancer Patients Who Underwent Neoadjuvant Treatment: A Clinical–Surgical–Pathologic Comparison. Cancers (Basel) 2023; 15:cancers15072061. [PMID: 37046722 PMCID: PMC10093554 DOI: 10.3390/cancers15072061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Magnetic resonance imaging (MRI) has been proven to ensure high diagnostic accuracy in the identification of vaginal, parametrial, and lymph node involvement in patients affected by cervical cancer (CC), thus playing a crucial role in the preoperative staging of the disease. This study aims to compare the accuracy of MRI for the preoperative staging of patients with CC who underwent neoadjuvant treatment (NAT) or direct surgery. Retrospective data analysis of 126 patients with primary CC International Federation of Gynecology and Obstetrics stage IB3-IIB who underwent NAT before radical surgery (NAT group = 94) or received surgical treatment alone (control arm = 32) was prospectively performed. All enrolled patients were clinically assessed with both a pelvic examination and MRI before surgical treatment. Data from the clinical examination were compared with the histopathological findings to assess the accuracy of MRI for staging purposes after NAT or before direct surgery. MRI showed an overall accuracy of 46.1%, proving it to be not superior to pelvic and physical examination. The overall MRI accuracy for the evaluation of parametrial, vaginal, and lymph node status was 65.8%, 79.4%, and 79.4%, respectively. In the NAT group, the accuracy for the detection of parametrial, lymph node, and vaginal involvement was lower than the control group; however, the difference was not significant (p ≥ 0.05). The overall accuracy of MRI for the preoperative staging of CC after NAT is shown to be not unsatisfactory. The limits of MRI staging are especially evident when dealing with pre-treated patients.
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Weyl A, Chollet C, Gabiache E, Cancès-Lauwers V, Gallo F, Martinez A, Courbon F, Leguevaque P, Brenot Rossi I, Jalaguier A, Lambaudie E, Chantalat E, Motton S. PET-MRI for evaluation of response to radiochemotherapy in patients with locally advanced cervical cancer. Int J Gynecol Cancer 2023; 33:676-682. [PMID: 36822657 DOI: 10.1136/ijgc-2022-003958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE We aimed to analyze the diagnostic test accuracy of positron emission tomography and a magnetic resonance imaging scan (PET-MRI) fusion in evaluating tumor response after radiochemotherapy in patients with locally advanced cervical cancer. METHODS Patients treated at two institutes between January 2008 and December 2016 were studied retrospectively. Re-evaluation by positron emission tomography (PET) and magnetic resonance imaging (MRI) was performed in a non-concurrent way 4-8 weeks after treatment. A nuclear medicine doctor and a radiologist (subsequently referred as "radiologists"), both experts in gynecological oncology, re-examined the post-treatment MRI and positron emission tomography-computed tomography (PET-CT) separately, and then performed a fusion of these examinations. In this study we describe this "a posteriori fusion methodology", with two levels, enabling limitation of anatomical shifts. The gold standard was anatomical pathology analysis of the surgical specimen, since all patients underwent surgery following this radiological re-evaluation. The radiologists' degree of certainty in their diagnoses, and the impact of fusion on their diagnostic confidence were assessed by the radiologists, using two Likert judgment scales. They also adjudicated on possible changes of interpretation after the fusion. RESULTS Thirty-one patients were included. The PET-MRI fusion has a sensitivity of 79% and a specificity of 90%. The positive predictive value (PPV) was 94%, and the negative predictive value (NPV) was 69%. In 45% of cases (n=13), radiologists reported an improvement in their degree of certainty in their diagnosis using a Likert judgment scale, due to inspecting the PET and MRI fused. A change in interpretation of tumor response was observed using a Likert judgment scale in 31% of cases. CONCLUSION PET-MRI fusion improves the radiologist's own diagnostic confidence in assessing response to concurrent radiochemotherapy in locally advanced cervical cancer. More studies using a latest generation hybrid system will be necessary to further compare to MRI and PET-CT.
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Affiliation(s)
- Ariane Weyl
- Gynecologic Surgery, CHU Toulouse, Toulouse, Occitanie, France
| | | | - Erwan Gabiache
- Nuclear Medicine, Cancer University Institute Toulouse Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
| | | | | | | | - Frederic Courbon
- Nuclear Medicine, Cancer University Institute Toulouse Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
| | | | | | - Aurélie Jalaguier
- Paoli-Calmettes Institute, Marseille, Provence-Alpes-Côte d'Azu, France
| | | | - Elodie Chantalat
- Gynecologic Surgery, Centre Hospitalier Universitaire de Toulouse, Toulouse, Midi-Pyrénées, France
| | - Stephanie Motton
- Gynecologic Surgery, Centre Hospitalier Universitaire de Toulouse, Toulouse, Midi-Pyrénées, France
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Conte C, Della Corte L, Pelligra S, Bifulco G, Abate B, Riemma G, Palumbo M, Cianci S, Ercoli A. Assessment of Salvage Surgery in Persistent Cervical Cancer after Definitive Radiochemotherapy: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020192. [PMID: 36837394 PMCID: PMC9967015 DOI: 10.3390/medicina59020192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
Background and Objectives: The standard treatment approach in locally advanced cervical cancer (LACC) is exclusive concurrent chemoradiation therapy (RTCT). The risk of local residual disease after six months from RTCT is about 20-30%. It is directly related to relapse risk and poor survival, such as in patients with recurrent cervical cancer. This systematic review aims to describe studies investigating salvage surgery's role in persistent/recurrent disease in LACC patients who underwent definitive RTCT. Materials and Methods: Studies were eligible for inclusion when patients had LACC with radiologically suspected or histologically confirmed residual disease after definitive RTCT, diagnosed with post-treatment radiological workup or biopsy. Information on complications after salvage surgery and survival outcomes had to be reported. The methodological quality of the articles was independently assessed by two researchers with the Newcastle-Ottawa scale. Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed, Scopus, Cochrane, Medline, and Medscape databases in May 2022. We applied no language or geographical restrictions but considered only English studies. We included studies containing data about postoperative complications and survival outcomes. Results: Eleven studies fulfilled the inclusion criteria and all were retrospective observational studies. A total of 601 patients were analyzed concerning the salvage surgery in LACC patients for persistent/recurrent disease after RTCT treatment. Overall, 369 (61.4%) and 232 (38.6%) patients underwent a salvage hysterectomy (extrafascial or radical) and pelvic exenteration (anterior, posterior, or total), respectively. Four hundred and thirty-nine (73%) patients had histologically confirmed the residual disease in the salvage surgical specimen, and 109 patients had positive margins (overall range 0-43% of the patients). The risk of severe (grade ≥ 3) postoperative complications after salvage surgery is 29.8% (range 5-57.5%). After a median follow-up of 38 months, the overall RR was about 32% with an overall death rate of 40% after hysterectomy or pelvic exenteration with or without lymphadenectomy. Conclusions: There is heterogeneity between the studies both in their design and results, therefore the effect of salvage surgery on survival and recurrence cannot be adequately estimated. Future homogeneous studies with an appropriately selected population are needed to analyze the safety and efficacy of salvage hysterectomy or pelvic exenteration in patients with residual tumors after definitive RTCT.
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Affiliation(s)
- Carmine Conte
- Department of General Surgery and Medical-Surgical Specialties, Institute of Obstetrics and Ginecology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95125 Catania, Italy
- Correspondence: ; Tel.: +39-3290-275-147
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Silvia Pelligra
- Department of Woman and Child Health and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giuseppe Bifulco
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Biagio Abate
- Department of General Surgery and Medical-Surgical Specialties, Institute of Obstetrics and Ginecology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95125 Catania, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, 81100 Naples, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical-Surgical Specialties, Institute of Obstetrics and Ginecology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95125 Catania, Italy
| | - Stefano Cianci
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98121 Messina, Italy
| | - Alfredo Ercoli
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98121 Messina, Italy
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Ciulla S, Celli V, Aiello AA, Gigli S, Ninkova R, Miceli V, Ercolani G, Dolciami M, Ricci P, Palaia I, Catalano C, Manganaro L. Post treatment imaging in patients with local advanced cervical carcinoma. Front Oncol 2022; 12:1003930. [PMID: 36465360 PMCID: PMC9710522 DOI: 10.3389/fonc.2022.1003930] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/26/2022] [Indexed: 10/29/2023] Open
Abstract
Cervical cancer (CC) is the fourth leading cause of death in women worldwide and despite the introduction of screening programs about 30% of patients presents advanced disease at diagnosis and 30-50% of them relapse in the first 5-years after treatment. According to FIGO staging system 2018, stage IB3-IVA are classified as locally advanced cervical cancer (LACC); its correct therapeutic choice remains still controversial and includes neoadjuvant chemo-radiotherapy, external beam radiotherapy, brachytherapy, hysterectomy or a combination of these modalities. In this review we focus on the most appropriated therapeutic options for LACC and imaging protocols used for its correct follow-up. We explore the imaging findings after radiotherapy and surgery and discuss the role of imaging in evaluating the response rate to treatment, selecting patients for salvage surgery and evaluating recurrence of disease. We also introduce and evaluate the advances of the emerging imaging techniques mainly represented by spectroscopy, PET-MRI, and radiomics which have improved diagnostic accuracy and are approaching to future direction.
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Affiliation(s)
- S Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - V Celli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - A A Aiello
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - S Gigli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - R Ninkova
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - V Miceli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - G Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - M Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - P Ricci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - I Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Rome, Italy
| | - C Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - L Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
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Jacobsen MC, Beriwal S, Dyer BA, Klopp AH, Lee SI, McGinnis GJ, Robbins JB, Rauch GM, Sadowski EA, Simiele SJ, Stafford RJ, Taunk NK, Yashar CM, Venkatesan AM. Contemporary image-guided cervical cancer brachytherapy: Consensus imaging recommendations from the Society of Abdominal Radiology and the American Brachytherapy Society. Brachytherapy 2022; 21:369-388. [PMID: 35725550 DOI: 10.1016/j.brachy.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/15/2022] [Accepted: 04/24/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To present recommendations for the use of imaging for evaluation and procedural guidance of brachytherapy for cervical cancer patients. METHODS An expert panel comprised of members of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease Focused Panel and the American Brachytherapy Society jointly assessed the existing literature and provide data-driven guidance on imaging protocol development, interpretation, and reporting. RESULTS Image-guidance during applicator implantation reduces rates of uterine perforation by the tandem. Postimplant images may be acquired with radiography, computed tomography (CT), or magnetic resonance imaging (MRI), and CT or MRI are preferred due to a decrease in severe complications. Pre-brachytherapy T2-weighted MRI may be used as a reference for contouring the high-risk clinical target volume (HR-CTV) when CT is used for treatment planning. Reference CT and MRI protocols are provided for reference. CONCLUSIONS Image-guided brachytherapy in locally advanced cervical cancer is essential for optimal patient management. Various imaging modalities, including orthogonal radiographs, ultrasound, computed tomography, and magnetic resonance imaging, remain integral to the successful execution of image-guided brachytherapy.
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Affiliation(s)
- Megan C Jacobsen
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX
| | - Sushil Beriwal
- Allegheny Health Network, Department of Radiation Oncology, Pittsburgh, PA; Varian Medical Systems, Palo Alto, CA
| | - Brandon A Dyer
- Legacy Health, Department of Radiation Oncology, Portland, OR
| | - Ann H Klopp
- The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX
| | - Susanna I Lee
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | - Gwendolyn J McGinnis
- The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX
| | | | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Department of Abdominal Imaging, Houston, TX
| | | | - Samantha J Simiele
- The University of Texas MD Anderson Cancer Center, Department of Radiation Physics, Houston, TX
| | - R Jason Stafford
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX
| | - Neil K Taunk
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA
| | - Catheryn M Yashar
- University of California San Diego, Department of Radiation Oncology, San Diego, CA
| | - Aradhana M Venkatesan
- The University of Texas MD Anderson Cancer Center, Department of Abdominal Imaging, Houston, TX.
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11
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Federico A, Anchora LP, Gallotta V, Fanfani F, Cosentino F, Turco LC, Bizzarri N, Legge F, Teodorico E, Macchia G, Valentini V, Scambia G, Ferrandina G. Clinical Impact of Pathologic Residual Tumor in Locally Advanced Cervical Cancer Patients Managed by Chemoradiotherapy Followed by Radical Surgery: A Large, Multicenter, Retrospective Study. Ann Surg Oncol 2022; 29:4806-4814. [PMID: 35355131 PMCID: PMC9246767 DOI: 10.1245/s10434-022-11583-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exclusive chemoradiation (E-CT/RT) represents the standard of treatment for locally advanced cervical cancer (LACC). Chemoradiation (CT/RT) followed by radical surgery (RS) may play a role for patients with a suboptimal response to CT/RT or in low-income countries with limited access to radiotherapy. Histologic assessment of residual tumor after CT/RT and RS allows accurate definition of prognostic categories. METHODS Data on patients with FIGO stages 1B2 to 4A cervical cancer managed by CT/RT and RS from June 1996 to March 2020 were retrospectively analyzed. Pathologic response on the cervix was defined as complete (pCR), microscopic (persistent tumor foci ≤ 3 mm) (pmicroR), or macroscopic (persistent tumor foci > 3 mm) (pmacroR). Lymph node (LN) residual tumor was classified as absent or present. RESULTS The 701 patients in this study underwent CT/RT and RS. Of the 701 patients, 293 (41.8%) had pCR, 188 (26.8%) had pmicroR, and 220 (31.4%) had pMacroR. Residual tumor was found in the pelvic lymph nodes of 66 (9.4%) patients and the aortic lymph nodes of 29 (4.1%) patients. The 5-year DFS and OS were respectively 86.6% and 92.5% in the pCR cases, 80.3% and 89.1% in the pmicroR cases, and 56.2% and 68.8% in the pmacroR cases. Among the patients with lymph node residual tumor, the 5-year DFS and OS were respectively 16.7% and 40% in the pCR cases, 35.4% and 53.3% in the pmicroR cases, and 31.7% and 31.1% in the pmacroR cases. Cervical residual tumor,, positive pelvic LNs, and positive aortic LNs were associated with worse DFS and OS in both the uni- and multivariate analyses. CONCLUSIONS Persistence of pathologic residual tumor on the cervix and LNs after CT/RT are reliable predictors of survival for LACC patients undergoing CT/RT and adjuvant surgery.
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Affiliation(s)
- Alex Federico
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Luigi Pedone Anchora
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Valerio Gallotta
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Luigi Carlo Turco
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Nicolo' Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Legge
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Elena Teodorico
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Vincenzo Valentini
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC di Radioterapia, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
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12
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Kilcoyne A, Gottumukkala RV, Kang SK, Akin EA, Hauck C, Hindman NM, Huang C, Khanna N, Paspulati R, Rauch GM, Said T, Shinagare AB, Stein EB, Venkatesan AM, Maturen KE. ACR Appropriateness Criteria® Staging and Follow-up of Primary Vaginal Cancer. J Am Coll Radiol 2021; 18:S442-S455. [PMID: 34794599 DOI: 10.1016/j.jacr.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/30/2022]
Abstract
Primary vaginal cancer is rare, comprising 1% to 2% of gynecologic malignancies and 20% of all malignancies involving the vagina. More frequently, the vagina is involved secondarily by direct invasion from malignancies originating in adjacent organs or by metastases from other pelvic or extrapelvic primary malignancies. Data on the use of imaging in vaginal cancer are sparse. Insights are derived from the study of imaging in cervical cancer and have reasonable generalizability to vaginal cancer due to similar tumor biology. Given the trend toward definitive chemoradiation for both cancers in all but early stage lesions, principles of postchemoradiation tumor response evaluation are largely analogous. Accordingly, many of the recommendations outlined here are informed by principles translated from the literature on cervical cancer. For pretreatment assessment of local tumor burden and in the case of recurrent vaginal cancer, MRI is the preferred imaging modality. PET/CT has demonstrated utility for the detection of nodal metastatic and unexpected distant metastatic disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Aoife Kilcoyne
- Panel Vice Chair, Massachusetts General Hospital, Boston, Massachusetts.
| | | | - Stella K Kang
- Panel Chair, New York University Medical Center, New York, New York
| | - Esma A Akin
- The George Washington University Medical Center, Washington, District of Columbia; ABNM Board Member; and IAC Board Member
| | - Carlin Hauck
- Sutter Medical Center Sacramento, Sacramento, California
| | - Nicole M Hindman
- Associate Chair, Diversity & Health Equity, MR Safety Officer, and Director, Female Pelvic Imaging, New York University Medical Center, New York, New York; and Fellow Rep., Board of the Society for Advanced Body Imaging
| | - Chenchan Huang
- New York University Langone Medical Center, New York, New York
| | - Namita Khanna
- Emory University, Atlanta, Georgia; Society of Gynecologic Oncology
| | | | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tamer Said
- Program Director, Family Medicine Residency Program, University Hospitals Cleveland Medical Center, Cleveland, Ohio; and Primary care physician
| | - Atul B Shinagare
- Chief, Abdominal Imaging and Intervention, Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Erica B Stein
- Director, Body CT, University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Katherine E Maturen
- Specialty Chair, University of Michigan, Ann Arbor, Michigan; and Member, Society of Abdominal Radiology Board of Directors
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13
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Jang W, Song JS. [Uterine Cervical Cancer: Emphasis on Revised FIGO Staging 2018 and MRI]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:1083-1102. [PMID: 36238389 PMCID: PMC9432380 DOI: 10.3348/jksr.2021.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/05/2021] [Accepted: 09/17/2021] [Indexed: 11/15/2022]
Abstract
Uterine cervical cancer is a common gynecological cancer prevalent in Korea. Early detection, precise diagnosis, and appropriate treatment can affect its prognosis. Imaging approaches play an important role in staging, treatment planning, and follow-up. MRI specifically provides the advantage of assessing tumor size and disease severity with high soft tissue contrast. The revised version of the International Federation of Gynecology and Obstetrics (FIGO) staging system has been introduced in 2018, which incorporates subdivided primary tumor size and lymph node metastasis. In this review, the staging of uterine cervical cancer based on previous studies, the recently revised FIGO staging, and various post-treatment images are primarily described using MRI.
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14
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Paraaortic Lymph Nodal Staging & Evaluation of Treatment Outcome by 18–Fluorodeoxyglucose PET (Positron Emission Tomography) in Advanced Cervical Cancer: Final Results of a Prospective Observational Cohort Study. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00565-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Wan Q, Yan W, Liu Y, Lin Y, Lu Z. Prognostic value of post-radiation serum squamous cell carcinoma antigen and primary tumor regression for cervical squamous cell carcinoma. Cancer Biomark 2021; 29:327-335. [PMID: 32716344 DOI: 10.3233/cbm-190934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In this study, we determined the prognostic values of magnetic resonance imaging (MRI)-based primary tumor regression and serum squamous cell carcinoma antigen (SSCC-Ag) levels 4 weeks after definitive radiotherapy (RT) in cervical squamous cell carcinoma (CSCC) patients. METHODS This was a retrospective study involving 218 patients with histologically confirmed CSCC (stages IB-IVA). All the patients received definitive RT. Pre- and post-RT pelvic MRI and SSCC-Ag levels were measured. Locoregional control (LRC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were evaluated, and possible OS prognostic factors were analyzed. RESULTS The median follow-up time was 25.57 (1.73-58.93) months. Thirty-six and 68 patients died and experienced recurrence, respectively, and the primary tumors of 130 (59.6%) and 88 (40.4%) patients exhibited complete response (CR) and non-CR, respectively. The 3-year OS, DFS, LRC, and DMFS rates were significantly higher in the CR than in the non-CR patients (85.2% vs. 67.9%, 78.9% vs. 39.0%, 93.4% vs. 63.8%, and 83.4% vs. 54.5%, respectively; p< 0.05). The 3-year OS, DFS, LRC, and DMFS rates were significantly lower in the patients with high post-RT SSCC-Ag levels than in those with low post-RT SSCC-Ag levels (38.0% vs. 83.9%, 21.2% vs. 66.3%, 73.0% vs. 84.9%, and 26.5% vs. 79.0%, respectively; p<0.05). Multivariate analyses indicated that SSCC-Ag levels were an independent OS predictor (HR: 5.749, 95% CI: 2.598-12.723, p< 0.001). CONCLUSION Post-RT SSCC-Ag levels are OS independent prognostic factors in CSCC patients receiving RT. Timely and optimized treatment plans for CSCC patients after 4 weeks of RT are necessary when patients with persistent tumor and/or positive SSCC-Ag.
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Affiliation(s)
- Quan Wan
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Wangxiang Yan
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Yonghong Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Yanzhu Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Zhiyuan Lu
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
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16
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Jacquot A, Chauleur C, Russel-Robillard AS, Tinquaut F, Sotton S, Magne N, Etievent G. MRI accuracy and interobserver agreement in locally advanced cervix carcinoma. Br J Radiol 2021; 94:20210197. [PMID: 34233471 DOI: 10.1259/bjr.20210197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The main standard of care for locally advanced cervix carcinoma (LACC) is radiochemotherapy (RCT) followed by brachytherapy. A surgical approach may still be discussed based on pelvic MRI-derived residual tumour evaluation. As no interobserver agreement study has ever been conducted to our knowledge, the aim of the present study was to report on pelvic MRI accuracy and interobserver agreement in LACC. METHODS We carried out a retrospective study in a French university hospital. Medical records of all consecutive patients treated with curative intent for LACC by RCT followed by brachytherapy and completion pelvic surgery between January 2014 and January 2020 were reviewed. Local response was assessed through pelvis MRI and histological analysis after completion surgery. MRI data were independently evaluated by two radiologists with varying experience. The two main interobserving criteria we used were complete response and residual tumour. RESULTS 23 patients fulfilled the inclusion criteria. Agreement between the junior and senior radiologist was moderate to strong. Indeed, regarding main criteria, κ was 0.65 for complete response and 0.57 for residual tumour. Interestingly, the present study shows a lower sensitivity whatever the radiologists than in the international literature. CONCLUSION The present study highlights a low interobserver variability regarding pelvic MRI in the assessment of RCT followed by brachytherapy in LACC. Yet, sensitivity was lower than in literature. ADVANCES IN KNOWLEDGE Radiology is part of treatment decision-making, the issue of heterogeneity regarding radiologists' training and experience to cancer (sensitivity and specificity) turns essential, so does MRI accuracy.
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Affiliation(s)
- Amalia Jacquot
- Department of Radiology, Saint-Étienne Teaching Hospital (CHU), Saint-Étienne, France
| | - Céline Chauleur
- Department of Gynaecology and Obstetrics, Saint-Étienne Teaching Hospital (CHU), Saint-Étienne, France.,Jean Monnet University, Saint-Etienne, France
| | | | - Fabien Tinquaut
- Department of Research and teaching, Lucien Neuwith Cancer Centre (ICLN), Saint-Etienne, France
| | - Sandrine Sotton
- Department of Research and teaching, Lucien Neuwith Cancer Centre (ICLN), Saint-Etienne, France
| | - Nicolas Magne
- Jean Monnet University, Saint-Etienne, France.,Department of Research and teaching, Lucien Neuwith Cancer Centre (ICLN), Saint-Etienne, France.,Department of Radiotherapy, Lucien Neuwirth Cancer Centre (ICLN), Saint-Étienne, France
| | - Guillaume Etievent
- Department of Radiology, Lucien Neuwirth Cancer Centre (ICLN), Saint-Étienne, France
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The significance of post-radiotherapy parametrial involvement and the necessity of parametrial resection in locally-recurrent or persistent cervical cancer developed after radiotherapy. J Gynecol Obstet Hum Reprod 2021; 50:102190. [PMID: 34171530 DOI: 10.1016/j.jogoh.2021.102190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/12/2021] [Accepted: 06/19/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To retrospectively evaluated the prognostic significance of post-radiotherapy parametrial involvement (PMI), the necessity of parametrial resection, and the optimal salvage surgery in locally recurrent or persistent cervical cancer developed after radiotherapy. METHODS Patients who developed recurrent or persistent cervical cancer in a previously irradiated field and were subsequently treated with salvage surgery were identified, and the prognostic impact of post-radiotherapy PMI on patient's survival was first investigated. Then, the optimal salvage surgery for patients with post-radiotherapy PMI as well as the predictors for post-radiotherapy PMI were evaluated. RESULTS A total of 60 patients underwent salvage surgery for recurrent or persistent diseases. Of these, 21 (35.0%) showed post-radiotherapy PMI (PMI-group). Patients in PMI-group showed significantly shorter progression-free survival (PFS) than those in non-PMI-group (p = 0.01). In both PMI-group and non-PMI-group, PFS was affected by the completeness of salvage surgery. In non-PMI-group, less radical surgery achieved similar therapeutic efficacy to more radical surgery (3-year PFS rates: 62.5% versus 54.1%, p = 0.91). In contrast, in PMI-group, not less radical surgery but more radical surgery achieved curative therapeutic efficacy (3-year PFS rate: 0% versus 28.9%). Maximum tumor diameter, deep stromal invasion, and LVSI were found to be predictors of post-radiotherapy PMI. CONCLUSION Post-radiotherapy PMI is an indicator of short survival after salvage surgery in patients with locally recurrent or persistent cervical cancer developed after radiotherapy. Both less radical and more radical surgery have curative therapeutic efficacies in patients without post-radiotherapy PMI, if the tumor could be resected with an adequate surgical margin. Thus, hysterectomy type should be tailored to the risk for post-radiotherapy PMI.
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18
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Staging, recurrence and follow-up of uterine cervical cancer using MRI: Updated Guidelines of the European Society of Urogenital Radiology after revised FIGO staging 2018. Eur Radiol 2021; 31:7802-7816. [PMID: 33852049 DOI: 10.1007/s00330-020-07632-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/31/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The recommendations cover indications for MRI examination including acquisition planes, patient preparation, imaging protocol including multi-parametric approaches such as diffusion-weighted imaging (DWI-MR), dynamic contrast-enhanced imaging (DCE-MR) and standardised reporting. The document also underscores the value of whole-body 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) and highlights potential future methods. METHODS In 2019, the ESUR female pelvic imaging working group reviewed the revised 2018 FIGO staging system, the up-to-date clinical management guidelines, and the recent imaging literature. The RAND-UCLA Appropriateness Method (RAM) was followed to develop the current ESUR consensus guidelines following methodological steps: literature research, questionnaire developments, panel selection, survey, data extraction and analysis. RESULTS The updated ESUR guidelines are recommendations based on ≥ 80% consensus among experts. If ≥ 80% agreement was not reached, the action was indicated as optional. CONCLUSIONS The present ESUR guidelines focus on the main role of MRI in the initial staging, response monitoring and evaluation of disease recurrence. Whole-body FDG-PET plays an important role in the detection of lymph nodes (LNs) and distant metastases. KEY POINTS • T2WI and DWI-MR are now recommended for initial staging, monitoring of response and evaluation of recurrence. • DCE-MR is optional; its primary role remains in the research setting. • T2WI, DWI-MRI and whole-body FDG-PET/CT enable comprehensive assessment of treatment response and recurrence.
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Gennigens C, De Cuypere M, Hermesse J, Kridelka F, Jerusalem G. Optimal treatment in locally advanced cervical cancer. Expert Rev Anticancer Ther 2021; 21:657-671. [PMID: 33472018 DOI: 10.1080/14737140.2021.1879646] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Locally advanced cervical cancer (LACC) (International Federation of Gynecology and Obstetrics (FIGO) 2009/2018 - stages IB2-IVA/IB3-IVA, respectively) is treated using a multimodal approach that includes chemoradiotherapy followed by brachytherapy.Areas covered: This review provides an overview of the progress made over the past decade in the treatment of LACC. Prognostic factors, FIGO classification and the role of imaging staging will be discussed. Efficacy of external-beam radiotherapy, brachytherapy and chemotherapy will be detailed. Indications for para-aortic staging lymphadenectomy and adjuvant hysterectomy, as well as follow-up and special population, will be covered.Expert opinion: The initial workup is one of the most crucial steps in the optimal care of patients, which should be realized by a multidisciplinary expert team. With the implementation of modern conformal radiotherapy techniques, the local control rate has been optimized. Nevertheless, 40% of patients experience recurrence with distant metastasis and a dismal prognosis. Currently, a clear benefit of neo- and adjuvant chemotherapy has not been established. The future likely involves (1) improved selection of patients for whom treatment intensification is justified, (2) a combination of new drugs with chemoradiation that are currently being tested in trials, and (3) the development of tailored treatment based on molecular characteristics.
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Affiliation(s)
| | | | | | - Frédéric Kridelka
- Department of Obstetrics and Gynecology, CHU Liège and Liège University, Liège, Belgium
| | - Guy Jerusalem
- Department of Medical Oncology, CHU Liège and Liège University, Liège, Belgium
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Prognosis impact of posttreatment pelvic MRI in patients treated for stage IB2-IIB cervical cancer with chemoradiation therapy. Eur J Surg Oncol 2020; 47:1103-1110. [PMID: 33160780 DOI: 10.1016/j.ejso.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the performances of systematic posttreatment pelvic magnetic resonance imaging (PPMRI) in predicting prognosis of patients treated with chemoradiation therapy (CRT) for locally advanced cervical cancer (LACC). MATERIALS AND METHODS Multi-institutional data from 216 patients presenting FIGO IB2-IIB cervical cancer for which PPMRI was performed following CRT were retrospectively reviewed. Incomplete response was defined as the identification of persistent lesion on PPMRI. Primary endpoints were patients' 5-year recurrence free (RFS) and overall (OS) survivals. Secondary endpoint was the identification of residual histologic disease on hysterectomy specimens when completion surgery was performed. RESULTS PPMRI identified an incomplete response in 102 (47.2%) cases. A 70% or more reduction in tumor size on PPMRI was identified as the best predictive cut-off for recurrence (37.7% sensitivity and 78.7% specificity) and death (50% sensitivity and 77.9% specificity) with significant impact on those risks (HRa: 0.42; 95%CI: 0.23-0.77 and HRa: 0.18; 95%CI: 0.06-0.50, respectively). Completion hysterectomy was performed in 117 (54.4%) cases, with histologic residual disease in 55 (47.4%). PPMRI demonstrated 74.5% sensitivity and 50.8% specificity in predicting residual disease. Although survival of patients with complete response at PPMRI was not impacted by completion hysterectomy, it significantly increased 5-year RFS and OS of those with incomplete response: 38.7% vs. 65.3% (p < 0.001) and 63% vs. 82.9% (p = 0.038), respectively. CONCLUSION A 70% or more reduction of in tumor size on PPMRI following CRT in patients with LACC is predictive of RFS and OS. PPMRI could help triaging patients who could benefit from completion hysterectomy.
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21
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Radiomics in cervical cancer: Current applications and future potential. Crit Rev Oncol Hematol 2020; 152:102985. [DOI: 10.1016/j.critrevonc.2020.102985] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022] Open
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Perrone AM, Dondi G, Coe M, Ferioli M, Telo S, Galuppi A, De Crescenzo E, Tesei M, Castellucci P, Nanni C, Fanti S, Morganti AG, De Iaco P. Predictive Role of MRI and 18F FDG PET Response to Concurrent Chemoradiation in T2b Cervical Cancer on Clinical Outcome: A Retrospective Single Center Study. Cancers (Basel) 2020; 12:E659. [PMID: 32178252 PMCID: PMC7139894 DOI: 10.3390/cancers12030659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 02/06/2023] Open
Abstract
Tumor response in locally advanced cervical cancer (LACC) is generally evaluated with MRI and PET, but this strategy is not supported by the literature. Therefore, we compared the diagnostic performance of these two techniques in the response evaluation to concurrent chemoradiotherapy (CCRT) in LACC. Patients with cervical cancer (CC) stage T2b treated with CCRT and submitted to MRI and PET/CT before and after treatment were enrolled in the study. All clinical, pathological, therapeutic, radiologic and follow-up data were collected and examined. The radiological response was analyzed and compared to the follow-up data. Data of 40 patients with LACC were analyzed. Agreement between MRI and PET/CT in the evaluation response to therapy was observed in 31/40 (77.5%) of cases. The agreement between MRI, PET/CT and follow-up data showed a Cohen kappa coefficient of 0.59 (95% CI = 0.267-0.913) and of 0.84 (95% CI = 0.636-1.00), respectively. Considering the evaluation of primary tumor response, PET/CT was correct in 97.5% of cases, and MRI in 92.5% of cases; no false negative cases were observed. These results suggest the use of PET/CT as a unique diagnostic imaging tool after CCRT, to correctly assess residual and progression disease.
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Affiliation(s)
- Anna Myriam Perrone
- Gynecologic Oncology Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (G.D.); (E.D.C.); (M.T.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
| | - Giulia Dondi
- Gynecologic Oncology Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (G.D.); (E.D.C.); (M.T.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
| | - Manuela Coe
- Department of Specialized, Diagnostic, and Experimental Medicine, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Martina Ferioli
- Radiotherapy Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Silvi Telo
- Nuclear Medicine Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (S.T.); (P.C.); (C.N.)
| | - Andrea Galuppi
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
- Radiotherapy Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Eugenia De Crescenzo
- Gynecologic Oncology Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (G.D.); (E.D.C.); (M.T.); (P.D.I.)
| | - Marco Tesei
- Gynecologic Oncology Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (G.D.); (E.D.C.); (M.T.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
| | - Paolo Castellucci
- Nuclear Medicine Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (S.T.); (P.C.); (C.N.)
| | - Cristina Nanni
- Nuclear Medicine Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (S.T.); (P.C.); (C.N.)
| | - Stefano Fanti
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
- Nuclear Medicine Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (S.T.); (P.C.); (C.N.)
| | - Alessio G. Morganti
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
- Radiotherapy Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Pierandrea De Iaco
- Gynecologic Oncology Unit, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (G.D.); (E.D.C.); (M.T.); (P.D.I.)
- Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR) University of Bologna, 40138 Bologna, Italy; (A.G.); (S.F.); (A.G.M.)
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Jajodia A, Mahawar V, Chaturvedi AK, Rao A, Singla R, Mitra S, Goyal S, Kesan S, Pasricha S, Maheshwari U, Tripathi R, Babu Koyyala VP. Role of ADC values in assessing clinical response and identifying residual disease post-chemo radiation in uterine cervix cancer. Indian J Radiol Imaging 2020; 29:404-411. [PMID: 31949343 PMCID: PMC6958886 DOI: 10.4103/ijri.ijri_339_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/08/2019] [Accepted: 11/26/2019] [Indexed: 01/31/2023] Open
Abstract
Objectives: To evaluate the role of apparent diffusion coefficient (ADC) values in assessing response after chemo-radiotherapy in cervix cancer and investigate the utility of ADC as a tool to identify residual disease, after the treatment completion. Methods: A prospective study was done in 100 patients with histopathologically proven cancer of uterine cervix who were classified as either complete response (CR) or residual disease posttreatment. MRI was done pretreatment and after 6 weeks post-treatment with chemo-radiation. 53 patients among the cohort also underwent a fluoro-deoxy glucose positron-emission computed tomography (FDG-PET CT). ADC values, change in ADC values, and metabolic activity obtained from FDG-PET CT were correlated with clinical outcome, and statistical analysis was done to determine the better tool for assessing response evaluation between ADC and PET-CT. Results: Residual lesions have notably lower ADC value than that of posttreatment changes. The mean ADC values of residual tumors: 1.26 ± 0.238 × 10−3 mm2/s and mean ADC values of lesions due to posttreatment changes: 1.540 ± 0.218 × 10−3 mm2/s (statistically significant difference between malignant and posttreatment lesions, P < 0.05). ADC has 67% sensitivity, 83% specificity, 35% positive predictive values (PPV), 95% negative predictive values (NPV), and 81% accuracy in differentiating residual disease from post treatment changes. PPV, NPV, sensitivity, and specificity with PET-CT were 93%, 89%, 98%, and 73%, respectively. PPV, NPV, sensitivity, and specificity of contrast MRI were 16%, 91%, 58%, and 59%, respectively. Conclusion: Diffusion imaging differentiates residual cervix malignancies from post treatment changes based on ADC values and can be a promising and evocative biomarker. Complimentary use of ADC and PET/CT may increase diagnostic confidence.
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Affiliation(s)
- Ankush Jajodia
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Vivek Mahawar
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Arvind K Chaturvedi
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Avinash Rao
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Rishu Singla
- Department of Radiology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Swarupa Mitra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Sumit Goyal
- Department of Medical Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Sikha Kesan
- Department of Obstetrics and Gynecology, KEM Hospital, Mumbai, Maharashtra, India
| | - Sunil Pasricha
- Department of Histopathology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Udip Maheshwari
- Department of Medical Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Rupal Tripathi
- Department of Research, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
| | - Venkata Pradeep Babu Koyyala
- Department of Medical Oncology, Rajiv Gandhi Cancer Hospital and Research Institute, Sector 5, Rohini, Delhi, India
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Bian H, Liu F, Chen S, Li G, Song Y, Sun M, Dong H. Intravoxel incoherent motion diffusion-weighted imaging evaluated the response to concurrent chemoradiotherapy in patients with cervical cancer. Medicine (Baltimore) 2019; 98:e17943. [PMID: 31725650 PMCID: PMC6867768 DOI: 10.1097/md.0000000000017943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
To evaluate the application of multiple b values diffusion-weighted imaging based on biexponential signal decay model to predict the response to concurrent chemoradiotherapy in cervical cancer patients.This prospective study enrolled 28 patients (mean age: 50.89 ± 10.70 years) with cervical cancer confirmed by biopsy who received concurrent chemoradiotherapy. Pelvic magnetic resonance scans were performed 2 weeks before, 7 days and 21 days after the initiation of therapy, and 1 month after the end of the treatment. Diffusion-weighted imaging with b values of 0, 50, 450, and 850 s/mm were performed, and tumor volume, means of tumor apparent diffusion coefficient (ADC)min, ADCmean, ADCslow, ADCfast, and Ffast were measured.Pretreatment ADCmin and ADCslow of good outcome group were significantly higher than those of poor outcome group (P < .05). At the 7th day of the treatment, Ffast and its change rate of good outcome group were significantly higher than those of poor outcome group (P < .05). At the 7th day and 21st day of the treatment, Ffast showed a slowly increasing tendency with no significant difference compared with pretreatment value in poor outcome group (P < .05). One month post-treatment, only ADCslow change rate was significantly higher in good outcome group than that in poor outcome group.Intravoxel incoherent motion-related ADC values could be utilized to better predict the outcome of cervical cancer chemoradiotherapy.
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Affiliation(s)
| | | | - Sha Chen
- Department of Ultrasound, Cangzhou Central Hospital, Cangzhou, Hebei, China
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Balcacer P, Shergill A, Litkouhi B. MRI of cervical cancer with a surgical perspective: staging, prognostic implications and pitfalls. Abdom Radiol (NY) 2019; 44:2557-2571. [PMID: 30903231 DOI: 10.1007/s00261-019-01984-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
LEARNING OBJECTIVES Magnetic resonance imaging (MRI) of the pelvis is the most reliable imaging modality for staging, treatment planning, and follow-up of cervical cancer; and its findings may now be incorporated into the International Federation of Gynecology and Obstetrics Federation (FIGO) 2018 clinical staging of cervical cancer. It is imperative that radiologists are familiar with the imaging appearance of the different stages of cervical cancer as well as the post-treatment changes and imaging pitfalls given the respective clinical manifestations, treatment regimens, and prognosis of an accurate diagnosis. In addition to the different stages of cervical cancer, we address the imaging techniques for diagnosis, staging and treatment implications as well as the changes of the new FIGO staging system. BACKGROUND The use of MRI to diagnose and stage cervical cancer is steadily increasing and the new FIGO stagi ng system, previously based on clinical examination, now allows the staging or change of staging based on the imaging findings. MRI can evaluate the extent of disease because of its excellent contrast resolution for pelvic tissues and organs, high accuracy and detailed elaboration of the cervical/uterovaginal anatomy. CONTENT Relevant anatomy, including normal MRI appearance of the cervix, parametria and pelvic ligaments; different stages of cervical cancer on MRI with prognostic and therapeutic implications; MRI sequences, other imaging modalities used in the staging and follow-up, treatment of different stages and the appearance of the cervix and cervical cancer post-treatment. Since clinical implications and therapeutic strategies for cervical cancer treatment vary tremendously according to degree of tumor extension, familiarity with relevant MRI techniques and findings is essential for radiologists. It is important that radiologists interpreting pelvic MRI are aware with the different stages of cervical cancer to provide useful information regarding treatment and prognosis. Pitfalls regarding the interpretation of tumor extension can interfere with an accurate diagnosis and have significant therapeutic implications.
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Abstract
FDG-PET/CT has an established role in the initial staging of locally advanced cervical cancers, particularly in evaluation of nodal disease and distant metastases. It is common practice to perform FDG-PET/CT 3 months postcompletion of chemoradiotherapy as it can predict outcome and be used to tailor management, including adjuvant therapy and follow-up. It is also routinely used prior to pelvic exenterative surgery to ensure there is no disease outside the pelvis. There is growing evidence that FDG-PET-derived parameters are prognostic and could potentially be used to tailor therapy. This review outlines the use of FDG-PET/CT imaging in cervical cancer.
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Affiliation(s)
- Nemi Gandy
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Mubarik A Arshad
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Won-Ho E Park
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Andrea G Rockall
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK; Imperial College London Cancer Imaging Centre, Department of Surgery & Cancer, Hammersmith Hospital, London, UK
| | - Tara D Barwick
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK; Imperial College London Cancer Imaging Centre, Department of Surgery & Cancer, Hammersmith Hospital, London, UK.
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27
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Zhang J, Tian W, Bu X, Wang X, Tian F, Wu L. Diagnostic significance of magnetic resonance imaging in patients with cervical cancer after brachytherapy: a meta-analysis. Acta Radiol 2019; 60:670-676. [PMID: 30149749 DOI: 10.1177/0284185118791199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with uterine cervical cancer suffer high mortality. Accurate detection of a residual tumor by magnetic resonance imaging (MRI) during and after directed brachytherapy (BCT) is crucial for the success of cancer treatment and is a significant predictor of patient survival. PURPOSE To determine the diagnostic significance of MRI in detecting residual tumor tissue after BCT. MATERIAL AND METHODS The Web of Knowledge, Cochrane Library, and PubMed were systematically searched (January 1997 to December 2016) for post-brachytherapy MRI studies that measured residual tumors in patients with uterine cervical cancer. All data were analyzed using the Meta-Disc 1.4 program. RESULTS Four clinical studies consisting of 163 patients (147 of whom were included in the present analysis) who were diagnosed with uterine cervical cancer according to the International Federation of Gynecology and Obstetrics (FIGO) staging system were included in the study. All the patients received BCT and underwent MRI detection of residual tumors tissue. In studies where the accuracy of MRI detection was confirmed by histological tests or gynecological tests, the summary estimates of specificity, sensitivity, positive predictive value, negative predictive value, and accuracy were 88.5%, 83.5%, 53.5%, 97.1%, and 84.3%, respectively. CONCLUSION MRI-directed BCT is commonly used for cervical cancer patients. Based on our investigation of four independent studies, MRI showed better prediction of positive results than negative results in patients with cervical cancer after BCT. However, more data on the greater numbers of patients are needed to establish the accuracy of MRI detection of cervical cancer after BCT.
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Affiliation(s)
- Ji Zhang
- 1 Department of Radiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, PR China
| | - Weizhong Tian
- 1 Department of Radiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, PR China
| | - Xinhua Bu
- 2 Department of Gynaecology and Obstetrics, Taizhou People's Hospital, Taizhou, Jiangsu Province, PR China
| | - Xiulan Wang
- 1 Department of Radiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, PR China
| | - Fangzheng Tian
- 1 Department of Radiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, PR China
| | - Linyun Wu
- 3 Taizhou Polytechnic College, Taizhou, Jiangsu Province, PR China
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Rajasooriyar C, Lin MY, Kalra R, Lim A, Narayan K. The role of positron emission tomography in the selection of patients for salvage hysterectomy following chemoradiotherapy for locally advanced cervical cancer. Int J Gynecol Cancer 2019; 29:266-271. [PMID: 30630887 DOI: 10.1136/ijgc-2018-000088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Patients selection for salvage hysterectomy following chemoradiotherapy of cervical cancer is vital to avoid significant morbidity. The purpose of this study was to describe the role of post-treatment F18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography scanning (FDG-PET/CT) in patient selection for salvage hysterectomy. METHODS This was a retrospective analysis of 49 patients with cervical cancer treated between January 1996 and December 2012 who were candidates for salvage hysterectomy. RESULTS Three groups were defined based on institutional treatment guidelines, as experience in using post-treatment FDG-PET/CT to guide management evolved. Group 1 consisted of 15 patients who underwent planned hysterectomy based on clinical, cytological, or histological suspicion. Of these, only three (20%) patients had residual disease on histology. Group 2 consisted of 13 patients who had post-treatment FDG-PET/CT 3-6 months after the completion of chemoradiotherapy due either to suspicion of recurrence on examination or patients thought to be at high risk of recurrence at the primary site. Of these, eight patients had hysterectomy and four patients showed positive histology for residual tumor. Group 3 had 21 patients who showed isolated FDG uptake at the primary site on first FDG-PET/CT scanning at 6 months. A subsequent FDG-PET/CT scan after 3 months showed disease progression in seven and complete metabolic response in 14, and surgery was avoided in all patients. CONCLUSION FDG-PET/CT scanning at 6 months after radiotherapy is a good tool for assessing treatment response in patients with cervical cancer. In patients with persistent uptake on 6 months post-treatment FDG-PET/CT, repeat imaging at a 3-month interval helps in selecting patients for salvage hysterectomy.
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Affiliation(s)
- Chrishanthi Rajasooriyar
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia .,Department of Clinical Oncology, Teaching Hospital, Jaffna, Sri Lanka
| | - Ming-Yin Lin
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rashi Kalra
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Andrew Lim
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kailash Narayan
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Kalash R, Glaser SM, Rangaswamy B, Horne ZD, Kim H, Houser C, Beriwal S. Use of Functional Magnetic Resonance Imaging in Cervical Cancer Patients With Incomplete Response on Positron Emission Tomography/Computed Tomography After Image-Based High-Dose-Rate Brachytherapy. Int J Radiat Oncol Biol Phys 2018; 102:1008-1013. [DOI: 10.1016/j.ijrobp.2018.01.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/15/2022]
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30
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Gui B, Miccò M, Valentini AL, Cambi F, Pasciuto T, Testa A, Autorino R, Zannoni GF, Rufini V, Gambacorta MA, Giordano A, Scambia G, Manfredi R. Prospective multimodal imaging assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery—the “PRICE“ study 2: role of conventional and DW-MRI. Eur Radiol 2018; 29:2045-2057. [DOI: 10.1007/s00330-018-5768-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/09/2018] [Accepted: 09/14/2018] [Indexed: 12/22/2022]
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Thomeer MG, Vandecaveye V, Braun L, Mayer F, Franckena-Schouten M, de Boer P, Stoker J, Van Limbergen E, Buist M, Vergote I, Hunink M, van Doorn H. Evaluation of T2-W MR imaging and diffusion-weighted imaging for the early post-treatment local response assessment of patients treated conservatively for cervical cancer: a multicentre study. Eur Radiol 2018; 29:309-318. [PMID: 29943182 PMCID: PMC6291430 DOI: 10.1007/s00330-018-5510-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 03/28/2018] [Accepted: 04/20/2018] [Indexed: 01/08/2023]
Abstract
Objectives To compare MR imaging with or without DWI and clinical response evaluation (CRE) in the local control evaluation of cervical carcinoma after radiotherapy. Methods In a multicentre university setting, we prospectively included 107 patients with primary cervical cancer treated with radiotherapy. Sensitivity and specificity for CRE and MR imaging (with pre-therapy MR imaging as reference) (2 readers) were evaluated using cautious and strict criteria for identifying residual tumour. Nested logistic regression models were constructed for CRE, subsequently adding MR imaging with and without DWI as independent variables, as well as the pre- to post-treatment change in apparent diffusion coefficient (delta ADC). Results Using cautious criteria, CRE and MR imaging with DWI (reader 1/reader 2) have comparable high specificity (83% and 89%/95%, respectively), whereas MR imaging without DWI showed significantly lower specificity (63%/53%) than CRE. Using strict criteria, CRE and MR imaging with DWI both showed very high specificity (99% and 92%/95%, respectively), whereas MR imaging without DWI showed significantly lower specificity (89%/77%) than CRE. All sensitivities were not significantly different. Addition of MR imaging with DWI to CRE has statistically significant incremental value in identifying residual tumour (reader 1: estimate, 1.06; p = 0.001) (reader 2: estimate, 0.62; p = 0.02). Adding the delta ADC did not have significant incremental value in detecting residual tumour. Conclusions DWI significantly increases the specificity of MR imaging in the detection of local residual tumour. Furthermore, MR imaging with DWI has significant incremental diagnostic value over CRE, whereas adding the delta ADC has no incremental diagnostic value. Key Points • If MR imaging is used for response evaluation, DWI should be incorporated • MR imaging with DWI has diagnostic value comparable/complementary to clinical response evaluation • Inter-reader agreement is moderate to fair for two experienced radiologist readers • Quantitative measurements of ADC early post-therapy have limited diagnostic value
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Affiliation(s)
- Maarten G Thomeer
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. .,Department of Radiology, Erasmus Medical Center Rotterdam, P.O Box 2040, 3015, CE, Rotterdam, The Netherlands.
| | | | - Loes Braun
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frenchey Mayer
- Department of Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Peter de Boer
- Department of Radiotherapy, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Van Limbergen
- Department of Radiotherapy, University Hospitals Leuven, Leuven, Belgium
| | - Marrije Buist
- Department of Gynecology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ignace Vergote
- Department of Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Myriam Hunink
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Helena van Doorn
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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Shi D, Liang Z, Zhang C, Zhang H, Liu X. The effect of surgery on the survival status of patients with locally advanced cervical cancer after radiotherapy/chemoradiotherapy: a meta-analysis. BMC Cancer 2018; 18:308. [PMID: 29558900 PMCID: PMC5859532 DOI: 10.1186/s12885-018-4232-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/15/2018] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND To determine the effect of surgery on the survival status of patients with locally advanced cervical cancer after radiotherapy/chemoradiotherapy. METHODS PubMed, Web of Science, ProQuest and Medline were searched using the key words "cervical cancer", "locally advanced disease", "radiotherapy" and "surgery or hysterectomy". Eight articles were selected and analysed using the STATA 12.0 software package. The log hazard ratio (HR) and its standard error for overall survival were calculated to assess the effect of surgery on patients with locally advanced cervical cancer after radiotherapy/chemoradiotherapy. RESULTS In total, 2176 patients with locally advanced cervical cancer were identified. The pooled HR for overall survival was 1.13 (95% confidence interval (CI) 0.906-1.409), and there were no differences among the eight manuscripts (z = 1.08, p = 0.278). In the subgroup analysis, the pooled HR for overall survival was 1.169 (95% CI 0.924-1.480), and no differences among patients with stage IB-IIB disease were found in six articles (z = 1.30, p = 0.193). There was no publication bias regarding overall survival or stage IB-IIB disease. CONCLUSIONS This meta-analysis suggested that surgery had no effect on overall survival after radiotherapy/chemoradiotherapy; therefore, it is not recommended for patients with locally advanced cervical cancer.
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Affiliation(s)
- Dan Shi
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhenzhen Liang
- Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Cheng Zhang
- Department of Cardiology department, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Huaiyu Zhang
- Department of Gastrointestinal Colorectal and anal surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xiaodong Liu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China.
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Mongula JE, Bakers FCH, Vöö S, Lutgens L, van Gorp T, Kruitwagen RFPM, Slangen BFM. Positron emission tomography-magnetic resonance imaging (PET-MRI) for response assessment after radiation therapy of cervical carcinoma: a pilot study. EJNMMI Res 2018; 8:1. [PMID: 29292485 PMCID: PMC5748389 DOI: 10.1186/s13550-017-0352-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/14/2017] [Indexed: 01/05/2023] Open
Abstract
Background Advanced stage cervical cancer is primarily treated by radiotherapy. Local tumor control is a prerequisite for cure. Imaging after treatment is controversial. Positron emission tomography (PET) combined with computer tomography (PET-CT) shows great promise for detecting metastases. On the other hand, magnetic resonance imaging (MRI) is superior in depicting anatomical details. The combination of PET-MRI could result in more accurate evaluation of cervical cancer treatment outcome. The aim of this pilot study is to share our initial experience with PET-MRI in the evaluation of treatment response in cervical cancer after radiation treatment. Methods Ten patients with cervical carcinoma (FIGO ≥IB2) were prospectively evaluated. Eleven weeks (median; range 8–15 weeks) after radiation therapy, treatment response was evaluated by PET-MRI. The PET, MRI, and combined PET-MRI images were evaluated for the presence of local residual tumor and metastasis. Diagnostic performance was assessed by area under the receiver operator characteristic (ROC) curve for evaluation of local residual tumor. The readers were blinded for outcome data. Local residual disease, metastasis, diagnostic confidence, and change of opinion were scored on a 5-point Likert scale. The reference standard consisted of pathology and/or follow-up according to the clinical guidelines. Results Three out of ten patients had local residual abnormalities suggestive for tumor residue after radiation treatment. The availability of both PET and MRI resulted in an increase in diagnostic confidence in 80–90% of all patients. Change of opinion was observed in 70% and change of policy in 50%, especially in the group with residual tumor. The diagnostic accuracy increased significantly for the radiologist if PET-MRI was combined (AUC .54 versus .83). Conclusions PET-MRI shows promise for evaluation of treatment response after radiation for cervical cancer, especially increasing diagnostic confidence, while potentially increasing diagnostic performance.
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Affiliation(s)
- J E Mongula
- Department of Obstetrics and Gynecology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Postbus 5800, 6202, Maastricht, AZ, The Netherlands.
| | - F C H Bakers
- Department of Radiology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S Vöö
- Department of Nuclear Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L Lutgens
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - T van Gorp
- Department of Obstetrics and Gynecology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Postbus 5800, 6202, Maastricht, AZ, The Netherlands
| | - R F P M Kruitwagen
- Department of Obstetrics and Gynecology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Postbus 5800, 6202, Maastricht, AZ, The Netherlands
| | - B F M Slangen
- Department of Obstetrics and Gynecology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Postbus 5800, 6202, Maastricht, AZ, The Netherlands
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Zhu L, Wang H, Zhu L, Meng J, Xu Y, Liu B, Chen W, He J, Zhou Z, Yang X. Predictive and prognostic value of intravoxel incoherent motion (IVIM) MR imaging in patients with advanced cervical cancers undergoing concurrent chemo-radiotherapy. Sci Rep 2017; 7:11635. [PMID: 28912536 PMCID: PMC5599638 DOI: 10.1038/s41598-017-11988-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/29/2017] [Indexed: 11/17/2022] Open
Abstract
By using the intravoxel incoherent motion (IVIM) model, the diffusion-related coefficient (D) and the perfusion-related parameter (f) can be obtained simultaneously. Here, we explored the application of IVIM MR imaging in predicting long-term prognosis in patients with advanced cervical cancers treated with concurrent chemo-radiotherapy (CCRT). In this study, pelvic MR examinations including an IVIM sequence were performed on 30 women with advanced cervical cancers at three time points (within 2 weeks before, as well as 2 and 4 weeks after, the initiation of CCRT). The performance of tumour size and IVIM-derived parameters in predicting long-term prognosis was evaluated. After a median follow-up of 24 months (range, 10∼34 months), 25/30 (83.33%) patients were alive, and 21/30 (70.00%) remained free of disease. A shrinkage rate of maximum diameter (time point 1 vs. 3) ≥ 58.31% was useful in predicting a good long-term prognosis. The IVIM-derived apparent diffusion coefficient (ADCIVIM) value at time point 2 and the ADCIVIM and f values at time point 3 also performed well in predicting a good prognosis, with AUC of 0.767, 0.857 and 0.820, respectively. IVIM MR imaging has great potential in predicting long-term prognosis in patients with advanced cervical cancers treated with CCRT.
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Affiliation(s)
- Li Zhu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Huanhuan Wang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Lijing Zhu
- The Comprehensive Cancer Centre of Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jie Meng
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Yan Xu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Baorui Liu
- The Comprehensive Cancer Centre of Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | | | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, 30322, USA
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Agreement Between Magnetic Resonance Imaging and Pathologic Findings in the Tumor Size Evaluation Before and After Neoadjuvant Chemotherapy Treatment: A Prospective Study. Int J Gynecol Cancer 2017. [DOI: 10.1097/igc.0000000000001038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectivesTo compare the agreement between magnetic resonance imaging (MRI) results and postsurgical pathologic findings for tumor size evaluation in cervical cancer patients before and after neoadjuvant chemotherapy (NACT) treatment.MethodsThe study analyzed the agreement between pretreatment MRI results and postsurgical pathologic findings about the tumor size in 100 cervical cancer patients without NACT and 397 cervical cancer patients with NACT, respectively.ResultsIn general, the agreement between pretreatment MRI results and postsurgical pathologic findings of tumor size was 0.855 (95% confidence interval [CI], 0.763–0.909) in cervical cancer patients without NACT, whereas the agreement between posttreatment MRI results and postsurgical pathologic findings was 0.503 (95% CI, 0.421–0.576). Only 62.72% (249/397) of patients who underwent NACT treatment have the same chemotherapy response evaluation results; the κ coefficient was 0.384(95% CI, 0.310–0.457) between posttreatment MRI and postsurgical pathologic findings. We still found International Federation of Gynecology and Obstetrics stage is associated with the chemotherapy response evaluation.ConclusionsOur data suggest that pretreatment MRI can be a surrogate indicator for postsurgical pathologic findings. However, posttreatment MRI could not be a surrogate indicator for postsurgical pathologic findings. The chemotherapy response evaluation based on only MRI is not so reliable. More indicators should be developed for chemotherapy response evaluation.
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Jalaguier-Coudray A, Villard-Mahjoub R, Delouche A, Delarbre B, Lambaudie E, Houvenaeghel G, Minsat M, Tallet A, Sabatier R, Thomassin-Naggara I. Value of Dynamic Contrast-enhanced and Diffusion-weighted MR Imaging in the Detection of Pathologic Complete Response in Cervical Cancer after Neoadjuvant Therapy: A Retrospective Observational Study. Radiology 2017; 284:432-442. [DOI: 10.1148/radiol.2017161299] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Aurélie Jalaguier-Coudray
- From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06,
| | - Rim Villard-Mahjoub
- From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06,
| | - Aurélie Delouche
- From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06,
| | - Béatrice Delarbre
- From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06,
| | - Eric Lambaudie
- From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06,
| | - Gilles Houvenaeghel
- From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06,
| | - Mathieu Minsat
- From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06,
| | - Agnès Tallet
- From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06,
| | - Renaud Sabatier
- From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06,
| | - Isabelle Thomassin-Naggara
- From the Departments of Radiology (A.J.C., B.D., R.V.M., B.D., A.D.), Gynecology (E.L., G.H.), Radiotherapy (M.M., A.T.), and Oncology (R.S.), Institut Paoli-Calmettes, 232 Boulevard Sainte-Marguerite, 13009 Marseille, France; CRCM and Université Aix-Marseille, Marseille, France (G.H.); Department of Radiology, Hôpital Tenon, APHP, Paris, France (I.T.N.); and Department of Radiology, UPMC, Université Paris 06,
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Is Routine Curettage a Useful Tool to Evaluate Persistent Tumor in Patients Who Underwent Primary Chemoradiation for Locally Advanced and/or Lymph Node Positive Cervical Cancer? Int J Gynecol Cancer 2017; 27:1216-1221. [DOI: 10.1097/igc.0000000000000331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveResponse evaluation after primary chemoradiation (RCTX) in patients with cervical cancer remains difficult. Routine hysterectomy after primary RCTX is associated with considerable surgical morbidity without impact on survival. The purpose of the present study was to evaluate value of routine curettage after RCTX to detect persistent tumor.MethodsBetween 2006 and 2012, patients (n = 217) with cervical cancer in International Federation of Gynecology and Obstetrics stages IB1 N1 (14%), IB2 (9%), IIA (5%), IIB (46%), IIIA (4%), IIIB (15%), IVA (6%), and IVB (1%), respectively, underwent primary RCTX. After RCTX, curettage was recommended to all patients to evaluate response.ResultsIn 136 (63%) of patients with cervical cancer, 1 or 2 consecutive curettages were performed at least 6 weeks after primary RCTX without any complications. In 21 (15%) patients, at least 1 curettage was positive for cervical cancer. In 7 patients, secondary hysterectomy was performed after 1 positive finding and persistent tumor was found in all of them. In the remaining 14 patients, there were 2 positive curettages in 5, 1 undetermined result followed by 1 positive in 3, and 1 positive followed by 1 negative in 6 patients, respectively. In the latter group, no tumor was detected in the uterus, whereas in all other patients with 2 curettages except one, residual carcinoma was detected. Five (24%) of 21 patients with positive histology are free of disease during follow-up. Decision for or against secondary hysterectomy was correct due to histological finding of curettage in 99%.ConclusionsRoutine curettage is a useful tool to guide decision for secondary hysterectomy with high accuracy after primary RCTX and avoids overtreatment.
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Xu Y, Zhu L, Liu B, Ru T, Wang H, He J, Liu S, Yang X, Zhou Z, Liu T. Strain elastography imaging for early detection and prediction of tumor response to concurrent chemo-radiotherapy in locally advanced cervical cancer: feasibility study. BMC Cancer 2017. [PMID: 28629386 PMCID: PMC5477276 DOI: 10.1186/s12885-017-3411-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background To investigate the feasibility of strain elastography imaging in early detecting and predicting treatment response in patients receiving concurrent chemo-radiotherapy (CCRT) for locally advanced cervical cancer. Methods Between January 2015 and June 2016, 47 patients with locally advanced cervical cancer were enrolled in a feasibility study approved by the institutional review board. All patients underwent CCRT and received strain elastography examinations at 4 time points: pre-therapy (baseline), 1 week and 2 weeks during, as well as immediately post CCRT. Treatment response was evaluated by MRI at the time of diagnosis and immediately after CCRT. Based on the MRI findings, the treatment outcome was characterized as complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Strain ratio of the normal parametrial tissue vs. cervical tumor was calculated and compared with the clinical outcome. Results Out of the 47 patients, 36 patients who completed all 4 examinations were included in the analyses: 25 were classified as CR, 11 as PR, and 0 in the SD/PD groups. Strain ratios were significantly different among the time points in both the CR group (F = 87.004, p < 0.001) and PR group (F = 38.317, p < 0.001). Strain ratios were significantly difference between the CR and PR groups (F = 7.203 p = 0.011). Strain ratios between the CR group and PR group were significantly different at 1 week after treatment initiation (p < 0.05). Compared to the baseline, a significant decrease in the CR group was observed at week 1, week 2 and post treatment (all p < 0.001), while a significant decrease in the PR group was shown in week 2 and post treatment (both p < 0.05), but not at week 1 during CCRT (p = 0.084). Conclusions We have conducted a prospective longitudinal study to evaluate tumor response in women receiving CCRT for cervical cancers. This study has demonstrated the potential of strain elastography imaging in monitoring and early predicting tumor response induced by CCRT. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3411-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yan Xu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.,Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Lijing Zhu
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Baorui Liu
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Tong Ru
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Huanhuan Wang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Song Liu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA.
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Mezzetta L, Rubini A, Bourillon C, Carrabin N. Pathologies utérines : pas si élémentaire… Certitudes, doutes et pièges diagnostiques. IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Disease courses in patients with residual tumor following concurrent chemoradiotherapy for locally advanced cervical cancer. Gynecol Oncol 2017; 144:34-39. [DOI: 10.1016/j.ygyno.2016.10.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 11/22/2022]
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Lucas R, Lopes Dias J, Cunha TM. Added value of diffusion-weighted MRI in detection of cervical cancer recurrence: comparison with morphologic and dynamic contrast-enhanced MRI sequences. Diagn Interv Radiol 2016. [PMID: 26200480 DOI: 10.5152/dir.2015.14427] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE We aimed to evaluate the added value of diffusion-weighted imaging (DWI) to standard magnetic resonance imaging (MRI) for detecting post-treatment cervical cancer recurrence. The detection accuracy of T2-weighted (T2W) images was compared with that of T2W MRI combined with either dynamic contrast-enhanced (DCE) MRI or DWI. METHODS Thirty-eight women with clinically suspected uterine cervical cancer recurrence more than six months after treatment completion were examined with 1.5 Tesla MRI including T2W, DCE, and DWI sequences. Disease was confirmed histologically and correlated with MRI findings. The diagnostic performance of T2W imaging and its combination with either DCE or DWI were analyzed. Sensitivity, positive predictive value, and accuracy were calculated. RESULTS Thirty-six women had histologically proven recurrence. The accuracy for recurrence detection was 80% with T2W/DCE MRI and 92.1% with T2W/DWI. The addition of DCE sequences did not significantly improve the diagnostic ability of T2W imaging, and this sequence combination misclassified two patients as falsely positive and seven as falsely negative. The T2W/DWI combination revealed a positive predictive value of 100% and only three false negatives. CONCLUSION The addition of DWI to T2W sequences considerably improved the diagnostic ability of MRI. Our results support the inclusion of DWI in the initial MRI protocol for the detection of cervical cancer recurrence, leaving DCE sequences as an option for uncertain cases.
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Affiliation(s)
- Rita Lucas
- Department of Radiology, Hospital de Santo António dos Capuchos, CHLC, Lisboa, Portugal.
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Scarsbrook A, Vaidyanathan S, Chowdhury F, Swift S, Cooper R, Patel C. Efficacy of qualitative response assessment interpretation criteria at 18F-FDG PET-CT for predicting outcome in locally advanced cervical carcinoma treated with chemoradiotherapy. Eur J Nucl Med Mol Imaging 2016; 44:581-588. [PMID: 27738729 PMCID: PMC5323466 DOI: 10.1007/s00259-016-3537-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/26/2016] [Indexed: 12/03/2022]
Abstract
Objectives To evaluate the utility of a standardized qualitative scoring system for treatment response assessment at 18F-FDG PET-CT in patients undergoing chemoradiotherapy for locally advanced cervical carcinoma and correlate this with subsequent patient outcome. Methods Ninety-six consecutive patients with locally advanced cervical carcinoma treated with radical chemoradiotherapy (CRT) in a single centre between 2011 and 2014 underwent 18F-FDG PET-CT approximately 3 months post-treatment. Tumour metabolic response was assessed qualitatively using a 5-point scale ranging from background level activity only through to progressive metabolic disease. Clinical and radiological (MRI pelvis) follow-up was performed in all patients. Progression-free (PFS) and overall survival (OS) was calculated using the Kaplan-Meier method (Mantel-Cox log-rank) and correlated with qualitative score using Chi-squared test. Results Forty patients (41.7 %) demonstrated complete metabolic response (CMR) on post-treatment PET-CT (Score 1/2) with 38 patients (95.0 %) remaining disease free after a minimum follow-up period of 18 months. Twenty-four patients (25.0 %) had indeterminate residual uptake (ID, Score 3) at primary or nodal sites after treatment, of these eight patients (33.3 %) relapsed on follow-up, including all patients with residual nodal uptake (n = 4Eleven11 of 17 patients (64.7 %) with significant residual uptake (partial metabolic response, PMR, Score 4) subsequently relapsed. In 15 patients (15.6 %) PET-CT demonstrated progressive disease (PD, Score 5) following treatment. Kaplan-Meier analysis showed a highly statistically significant difference in PFS and OS between patients with CMR, indeterminate uptake, PMR and PD (Log-rank, P < 0.0001). Chi-squared test demonstrated a highly statistically significant association between increasing qualitative score and risk of recurrence or death (P < 0.001). Conclusion Use of a 5-point qualitative scoring system to assess metabolic response to CRT in locally advanced cervical carcinoma predicts survival outcome and this prognostic information may help guide further patient management.
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Affiliation(s)
- Andrew Scarsbrook
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. .,Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Level 1, Bexley Wing, St James's University Hospital, Becket Street, Leeds, LS9 7TF, UK. .,Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK.
| | - Sriram Vaidyanathan
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Level 1, Bexley Wing, St James's University Hospital, Becket Street, Leeds, LS9 7TF, UK
| | - Fahmid Chowdhury
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Level 1, Bexley Wing, St James's University Hospital, Becket Street, Leeds, LS9 7TF, UK
| | - Sarah Swift
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rachel Cooper
- Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chirag Patel
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Level 1, Bexley Wing, St James's University Hospital, Becket Street, Leeds, LS9 7TF, UK
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Mazeron R, Gouy S, Chargari C, Rivin del Campo E, Dumas I, Mervoyer A, Genestie C, Bentivegna E, Balleyguier C, Pautier P, Morice P, Haie-Meder C. Post radiation hysterectomy in locally advanced cervical cancer: Outcomes and dosimetric impact. Radiother Oncol 2016; 120:460-466. [DOI: 10.1016/j.radonc.2016.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/08/2016] [Accepted: 07/15/2016] [Indexed: 02/06/2023]
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Gui B, Valentini AL, Miccò M, D'Agostino GR, Tagliaferri L, Zannoni GF, Fanfani F, Manfredi R, Bonomo L. Cervical cancer response to neoadjuvant chemoradiotherapy: MRI assessment compared with surgery. Acta Radiol 2016; 57:1123-31. [PMID: 26622060 DOI: 10.1177/0284185115617346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/19/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Imaging findings of residual cervical tumor after chemoradiotherapy can closely resemble those of post-irradiation inflammation. PURPOSE To determine the diagnostic performance of magnetic resonance imaging (MRI) in evaluating residual disease after chemoradiotherapy in patients with locally advanced cervical carcinoma (LACC). MATERIAL AND METHODS Retrospective analysis of prospectively collected data from 41 patients with histopathologically proven LACC (International Federation of Gynecology and Obstetrics stage ≥IB2) who underwent MRI before and after chemoradiotherapy. At each examination, a qualitative and semi-quantitative analysis of primary tumor, including tumor volume and signal intensity were assessed on T2-weighted (T2W) images. All patients had surgery after post-chemoradiotherapy MRI. MRI and histopathologic results were compared. RESULTS All patients showed significant difference in tumor volume and signal intensity between pre- and post-chemoradiotherapy MRI (P < 0.0001). According to pathology, 27/41 (66%) patients had true negative and 2/41 (5%) had true positive post-chemoradiotherapy MRI. Eleven out of 41 (27%) patients showed inflammation with false positive post-chemoradiotherapy MRI and 1/41 (2%) had a false negative post-chemoradiotherapy MRI. Sensitivity, specificity, accuracy, positive predictive values, and negative predictive values of post-chemoradiotherapy MRI in predicting residual disease were 69%, 71%, 71%, 15%, and 96%, respectively. CONCLUSION The differentiation of residual tumor from post-irradiation inflammation with early post- chemoradiotherapy MRI (within 28-60 days) is difficult with a high risk of false positive results. Combination of qualitative and semi-quantitative analysis does not improve the accuracy. Conversely, post-chemoradiotherapy MRI has a high negative predictive value with a low risk of false negative results. The role of conventional MRI combined with functional techniques should be evaluated.
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Affiliation(s)
- Benedetta Gui
- Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Anna Lia Valentini
- Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Maura Miccò
- Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Giuseppe Roberto D'Agostino
- Department of Radiation Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Luca Tagliaferri
- Department of Radiation Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Gian Franco Zannoni
- Department of Pathology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Francesco Fanfani
- Department of Gynecologic Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
| | - Riccardo Manfredi
- Department of Radiology, University of Verona, Policlinico G.B. Rossi, Italy
| | - Lorenzo Bonomo
- Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy
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Predictive criteria for MRI-based evaluation of response both during and after radiotherapy for cervical cancer. J Contemp Brachytherapy 2016; 8:181-8. [PMID: 27504126 PMCID: PMC4965503 DOI: 10.5114/jcb.2016.61065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/24/2016] [Indexed: 11/17/2022] Open
Abstract
PURPOSE For cervical carcinoma, the presence of persistent disease after radiotherapy (RT) is a significant predictor for survival. To date, no standard protocol is available to evaluate a response. This study was performed to assess magnetic resonance imaging (MRI) to evaluate presence of local residual disease during and after RT for Federation of Gynecology and Obstetrics (FIGO) stage Ib1-IVa cervical cancer. MATERIAL AND METHODS Forty-two patients were included. Patients underwent MRI before external beam RT, at final intracavitary brachytherapy (BCT) and 2-3 months after completion of RT. Two blinded radiologists (observer 1: experienced, observer 2: less experienced) scored the likelihood of residual tumor. Magnetic resonance imaging was evaluated by means of (a) 'subjective' visual evaluation of T2 weighted MRI images, and (b) 'objective' visual evaluation of T2 weighted MRI images according to predefined imaging criteria. RESULTS Seven patients had residual disease. Area under the receiver operating characteristics curve (AUC) for 'subjective' visual assessment was 0.79/0.75 (observer 1/observer 2) after RT and 0.75/0.43 at final BCT. The combined 'objective' MRI criteria (isointense, nodular, and irregular) resulted in improved prediction of residual tumor (AUCs of 0.91/0.85 after RT). For the less experienced observer, the MRI criteria set significantly improved prediction of residual tumor compared to 'subjective' visual assessment. Observer dependency decreased, kappa of 0.41 compared to 0.84 for the MRI criteria set after RT. CONCLUSION Compared to 'subjective' visual assessment, predefined 'objective' MRI criteria increase diagnostic performance and decrease observer dependency for assessing residual tumor after RT in cervical cancer.
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CSUTAK CSABA, ORDEANU CLAUDIA, NAGY VIORICAMAGDALENA, POP DIANACRISTINA, BOLBOACA SORANADANIELA, BADEA RADU, CHIOREAN LILIANA, DUDEA SORINMARIAN. A prospective study of the value of pre- and post-treatment magnetic resonance imaging examinations for advanced cervical cancer. CLUJUL MEDICAL (1957) 2016; 89:410-8. [PMID: 27547062 PMCID: PMC4990438 DOI: 10.15386/cjmed-558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/19/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM Cervical cancer has high incidence and mortality in developing countries. It is the only gynecological malignancy that is clinically staged. Staging at the time of diagnosis is crucial for treatment planning. After radiation therapy, clinical examination is limited because of radiation changes. An imaging method relatively unaffected by radiation changes would be useful for the assessment of therapy results and for management. We sought to demonstrate the value of magnetic resonance imaging (MRI) in the pre- and post-treatment assessment of cervical cancer. METHODS This was a prospective study, carried out between November 2012 and October 2014 on 18 subjects with advanced-stage cervical cancer diagnosed by colposcopy. The disease stage was determined clinically according to the International Federation of Gynecology and Obstetrics (FIGO) criteria. Only patients with disease stage ≥ IIB or IIA with one of the tumor dimensions > 4 cm were enrolled in the study. All patients underwent abdominal-pelvic contrast-enhanced MRI as part of the workup. Tumor size, local invasion, involved pelvic lymph nodes, and staging according to MRI criteria were evaluated. Clinical and MRI examinations were also performed after chemoradiotherapy. After chemoradiotherapy, 94% of the patients (17 of 18) were treated surgically. RESULTS Eighteen patients aged 32-67 met the inclusion criteria and were enrolled: 10 stage IIB, 6 stage IIIA, 1 stage IIA and 1 stage IIIB, according to clinical staging. Using histopathological findings as a reference, MRI staging accuracy was 83.3%. The concordance of the clinical stage with MRI stage at the first examination was 56%. Parametrial involvement was assessed on pretreatment and post-treatment MRI, with post-treatment MRI compared with histology. There was no statistically significant difference between the pre- and post-therapy gynecological examinations (GYN) and the corresponding MRI assessments as to tumor size measurements (p>0.05). The post-therapy restoration of the cervical stroma ruled out tumor recurrence. CONCLUSIONS For a detailed characterization of loco-regional extension, the calculation of tumor volume, and the evaluation of distant metastatic changes, clinical examination is insufficient. Magnetic resonance imaging is helpful aftertherapy.
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Affiliation(s)
- CSABA CSUTAK
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - CLAUDIA ORDEANU
- Institute of Oncology Prof. Dr. Ion Chiricuta, Cluj-Napoca, Romania
| | | | | | - SORANA DANIELA BOLBOACA
- Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - RADU BADEA
- Department of Medical Imaging, Iuliu Haţieganu University of Medicine and Pharmacy, Institute of Octavian Fodor Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - LILIANA CHIOREAN
- Department of Medical Imaging, Iuliu Haţieganu University of Medicine and Pharmacy, Institute of Octavian Fodor Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - SORIN MARIAN DUDEA
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Lakhman Y, Nougaret S, Miccò M, Scelzo C, Vargas HA, Sosa RE, Sutton EJ, Chi DS, Hricak H, Sala E. Role of MR Imaging and FDG PET/CT in Selection and Follow-up of Patients Treated with Pelvic Exenteration for Gynecologic Malignancies. Radiographics 2016; 35:1295-313. [PMID: 26172364 DOI: 10.1148/rg.2015140313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pelvic exenteration (PE) is a radical surgical procedure used for the past 6 decades to treat locally advanced malignant diseases confined to the pelvis, particularly persistent or recurrent gynecologic cancers in the irradiated pelvis. The traditional surgical technique known as total PE consists of resection of all pelvic viscera followed by reconstruction. Depending on the tumor extent, the procedure can be tailored to remove only anterior or posterior structures, including the bladder (anterior exenteration) or rectum (posterior exenteration). Conversely, more extended pelvic resection can be performed if the pelvic sidewall is invaded by cancer. Preoperative imaging evaluation with magnetic resonance (MR) imaging and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is central to establishing tumor resectability and therefore patient eligibility for the procedure. These imaging modalities complement each other in diagnosis of tumor recurrence and differentiation of persistent disease from posttreatment changes. MR imaging can accurately demonstrate local tumor extent and show adjacent organ invasion. FDG PET/CT is useful in excluding nodal and distant metastases. In addition, FDG PET/CT metrics may serve as predictive biomarkers for overall and disease-free survival. This pictorial review describes different types of exenterative surgical procedures and illustrates the central role of imaging in accurate patient selection, treatment planning, and postsurgical surveillance.
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Affiliation(s)
- Yulia Lakhman
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Stephanie Nougaret
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Maura Miccò
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Chiara Scelzo
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Hebert A Vargas
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Ramon E Sosa
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Elizabeth J Sutton
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Dennis S Chi
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Hedvig Hricak
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Evis Sala
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
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Papadopoulou I, Stewart V, Barwick TD, Park WHE, Soneji N, Rockall AG, Bharwani N. Post–Radiation Therapy Imaging Appearances in Cervical Carcinoma. Radiographics 2016; 36:538-53. [DOI: 10.1148/rg.2016150117] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Laparoscopic hysterectomy after concurrent radiochemotherapy in locally advanced cervical cancer compared to laparotomy: A multi institutional prospective pilot study of cost, surgical outcome and quality of life. Eur J Surg Oncol 2016; 42:391-9. [DOI: 10.1016/j.ejso.2015.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/20/2015] [Accepted: 09/08/2015] [Indexed: 12/27/2022] Open
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Tanaka YO, Okada S, Satoh T, Matsumoto K, Saida T, Minami M, Yoshikawa H. Uterine cervical cancer volumetry using T2- and diffusion-weighted MR images in patients treated by primary surgery and neoadjuvant chemotherapy. Acta Radiol 2016; 57:378-83. [PMID: 25838450 DOI: 10.1177/0284185115579077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 02/22/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tumor volumetry with magnetic resonance imaging (MRI) is very common; however, the accuracy of such measures remains unclear, especially after treatment. PURPOSE To determine the accuracy of preoperative volume measurements of uterine cervical carcinomas resected with and without neoadjuvant chemotherapy (NAC) on T2-weighted (T2W) and diffusion-weighted (DWI) MRI. MATERIAL AND METHODS Twenty-nine consecutive patients with surgically confirmed uterine cervical carcinoma were included in this study. MRI scans were performed before preoperative treatment in 17 patients and after two courses of NAC in 12 patients. In all patients, T2W images and DWI were obtained to measure the tumor diameters. The maximum diameter of the surgical specimens was macroscopically measured. The correlation coefficients between the measured tumor size using T2W imaging and DWI and the size measured on the surgical specimens were calculated for all specimens. RESULTS The correlation coefficient of the three-dimensional (3D) tumor volume measurement using T2W imaging and DWI was 0.97 in the primary surgery group and was 0.96 in the NAC group. The 3D tumor volume measurement using MRI and the measurement of the actual surgical specimen was 0.55 for T2WI and 0.48 for DWI in the primary surgery group and 0.88 for T2WI and 0.95 for DWI in the NAC group. CONCLUSION T2WI and DWI can provide accurate 3D tumor volume measurements of uterine cervical carcinomas in patients with and without preoperative chemotherapy, suggesting that tumor volumetry using 3 T MRI after uterus-preserving treatment is feasible.
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Affiliation(s)
- Yumiko Oishi Tanaka
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoshi Okada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Koji Matsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tsukasa Saida
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Manabu Minami
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Yoshikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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