An Alternative Triage Strategy Based on Preoperative MRI for Avoiding Trimodality Therapy in Stage IB Cervical Cancer

Abstract

PurposeAdjuvant chemoradiation following primary surgery is frequently indicated in patients with stage IB cervical cancer. The aim of this study is to evaluate the role of a magnetic resonance imaging (MRI)-based strategy in avoiding trimodality therapy.Materials and MethodsWe retrospectively reviewed all patients with stage IB cervical cancer treated initially with primary surgery at Seoul National University Hospital. We suggest an alternative triage strategy in which the primary treatment modality is determined based on preoperative MRI findings. Using this strategy, primary surgery is only indicated when there is no evidence of parametrial involvement (PMI) and lymph node metastasis (LNM) in the MRI results; when there is evidence of either or both of these factors, primary chemoradiation is selected. Assuming that this strategy is applied to our cohort, we evaluate how the rate of trimodality therapy is affected.ResultsOf the 254 patients in our sample, 77 (30.3%) had at least one category 1 risk factor (PMI, LNM, positive resection margin) upon pathologic examination. If the MRI-based strategy had been applied to our cohort, 168 patients would have undergone primary surgery and 86 would have undergone primary chemoradiation. Only 25 patients (9.8%) would have required trimodality therapy based on an indication of at least one category 1 pathologic risk factor following radical hysterectomy.ConclusionThe inclusion of MRI in the decision-making process for primary treatment modality could have reduced the number of patients requiring trimodality therapy based on the indication of a category 1 risk factor from 30.3% to 9.8% in our cohort.

Parametrial Involvement on Magnetic Resonance Imaging Has No Effect on the Survival of Early-Stage Cervical Cancer Patients

“…3Y5 Previous studies have pointed out that primary radical surgery followed by adjuvant CCRT (trimodality therapy) associated with higher toxicity and morbidity rates without significant benefit of survival than other treatment options. 4,6 Recently, some studies have suggested that inclusion of MRI in the decision-making process for primary treatment could reduce the number of patients requiring trimodality therapy based on risk factors such as pelvic lymph node metastasis or parametrial involvement (PMI). 6Y8 Although PMI is known to be an unfavourable prognostic factor for cervical cancer, few studies have investigated whether MRI-defined PMI has a significant impact on survival.…”

Deep-learning-based radiomics of intratumoral and peritumoral MRI images to predict the pathological features of adjuvant radiotherapy in early-stage cervical squamous cell carcinoma

“…MRI is the optimal imaging modality for assessing tumor size, involvement of vaginal and peripheral tissues [ 28 , 29 ], interstitial infiltration, and lymph node metastasis in cervical cancer [ 30 ]. Implementing a preoperative MRI-based classification strategy reduces the necessity of triple therapy for stage IB cervical cancer [ 31 ]. However, the Clinic_Sig, which consists of SCC-AG, tumor size, and positive lymph nodes on MRI, exhibited subpar performance (AUC of 0.64 in the training cohort and 0.53 in the test cohort) in accurately predicting radiotherapy options for ESCSCC.…”

Definitive Chemoradiotherapy versus Radical Hysterectomy Followed by Tailored Adjuvant Therapy in Women with Early-Stage Cervical Cancer Presenting with Pelvic Lymph Node Metastasis on Pretreatment Evaluation: A Propensity Score Matching Analysis

“…In early cervical cancer, the positive predictive value and accuracy of MRI for detecting lymph node metastasis were reportedly 51-76% and 67-76% [7,24]. Lee et al proposed a treatment decision model based on pretreatment MRI findings [25]. Applying MRI-based treatment selection strategy to their cohort, 86 out of 254 were selected for definitive CRT instead of surgery.…”