Assessing the Early Response of Advanced Cervical Cancer to Neoadjuvant Chemotherapy Using Intravoxel Incoherent Motion Diffusion-weighted Magnetic Resonance Imaging

Abstract

Background:Diffusion-weighted imaging (DWI) with the intravoxel incoherent motion (IVIM) model has shown promising results for providing both diffusion and perfusion information in cervical cancer; however, its use to predict and monitor the efficacy of neoadjuvant chemotherapy (NACT) in cervical cancer is relatively rare. The study aimed to evaluate the use of DWI with IVIM and monoexponential models to predict and monitor the efficacy of NACT in cervical cancer.Methods:Forty-two patients with primary cervical cancer underwent magnetic resonance exams at 3 time points (pre-NACT, 3 weeks after the first NACT cycle, and 3 weeks after the second NACT cycle). The response to treatment was determined according to the response evaluation criteria in solid tumors 3 weeks after the second NACT treatment, and the subjects were classified as two groups: responders and nonresponders groups. The apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion-related pseudo-diffusion coefficient (D*), and perfusion fraction (f) values were determined. The differences in IVIM-derived variables and ADC between the different groups at the different time points were calculated using an independent samples t-test.Results:The D and ADC values were all significantly higher for the responders than for the nonresponders at all 3 time points, but no significant differences were observed in the D* and f values. An analysis of the receiver operating characteristic (ROC) curves indicated that a D value threshold <0.93 × 10−3 mm2/s and an ADC threshold <1.11 × 10−3 mm2/s could differentiate responders from nonresponders at pre-NACT time point, yielding area under the curve (AUC) of which were 0.771 and 0.806, respectively. The ROC indicated that the AUCs of D and ADC at the 3 weeks after the first NACT cycle and 3 weeks after the second NACT cycle were 0.823, 0.763, and 0.787, 0.794, respectively. The AUC values of D and ADC at these 3 time points were not significantly different (P = 0.641, 0.512, and 0.547, respectively).Conclusions:D and ADC values may be useful for predicting and monitoring the efficacy of NACT in cervical cancer. An IVIM model may be equal to monoexponential model in predicting and monitoring the efficacy of NACT in cervical cancer.

ADCtotal ratio and D ratio derived from intravoxel incoherent motion early after TACE are independent predictors for survival in hepatocellular carcinoma

“…The unfavorable results may be related to the small number of cases or due to other factors. Previous studies put forward that pretreatment D and ADC values may be useful for predicting the efficacy of chemotherapy in cervical cancer or in locally advanced hypopharyngeal carcinoma . However, their quantitative results regarding their responders' responses to therapy were controversial.…”

“…Previous studies put forward that pretreatment D and ADC values may be useful for predicting the efficacy of chemotherapy in cervical cancer or in locally advanced hypopharyngeal carcinoma. 15,27 However, their quantitative results regarding their responders' responses to therapy were controversial. Furthermore, in terms of predicting or assessing treatment efficacy, survival remains the key endpoint in clinical studies, while radiological responses were used as surrogate endpoints in their research.…”

Can the low and high b-value distribution influence the pseudodiffusion parameter derived from IVIM DWI in normal brain?

“…Perfusion has been proven an important surrogate marker of many physiologic or pathologic processes as well as a predictor of recovery with reperfusion in patients of acute ischemic stroke [12]. Also, perfusion measurement has demonstrated improved sensitivity and predictive value for tumor grading and prognosis [13][14][15][16][17][18][19].…”

Endostar Rebuilding Vascular Homeostasis and Enhancing Chemotherapy Efficacy in Cervical Cancer Treatment

“…Uterine cervical cancer is the second most common cancer and one of the leading causes of cancer death for women,only less than breast cancer.Radiation therapy is regarded as a standard treatment just like surgery,but radiation can induce radiation colitis,loss of ovarian function and sexual capacity, these shortcomings make it only as an alternate option.Neoadjuvant chemotherapy (NACT) is used to treat locally advanced cervical cancer in Italy, Japan and Korea.Application of NACT before surgery or before radiotherapy can reduce tumor load, tumor cell micrometastasis and lymph nodes invasion.But NACT is not more than 87.5% effective against cervical cancer. Ineffective NACT can lead to tumor progression, increase the di culty of surgery, and affect treatment outcome of patients [1,2].…”