Post treatment imaging in patients with local advanced cervical carcinoma

Ciulla, Sandra; Celli, Veronica; Aiello, A. A.; Gigli, Silvia; Ninkova, R.; Miceli, V.; Ercolani, Giada; Dolciami, Miriam; Ricci, Paolo; Palaia, Innocenza; Catalano, Carlo; Manganaro, Lucia

doi:10.3389/fonc.2022.1003930

Cited by 6 publications

(5 citation statements)

References 104 publications

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“…There is growing evidence for the utilization of functional MRI in gynaecological malignancies [30]. Early tissue changes, visualized by MRI scans during the chemoradiotherapy course, have the potential to predict tumor responses and late toxicity, and thus may be used to determine the optimal individual irradiation dose [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Daily AI-Based Treatment Adaptation under Weekly Offline MR Guidance in Chemoradiotherapy for Cervical Cancer 1: The AIM-C1 Trial

Weykamp,

Meixner,

Arians

et al. 2024

JCM

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(1) Background: External beam radiotherapy (EBRT) and concurrent chemotherapy, followed by brachytherapy (BT), offer a standard of care for patients with locally advanced cervical carcinoma. Conventionally, large safety margins are required to compensate for organ movement, potentially increasing toxicity. Lately, daily high-quality cone beam CT (CBCT)-guided adaptive radiotherapy, aided by artificial intelligence (AI), became clinically available. Thus, online treatment plans can be adapted to the current position of the tumor and the adjacent organs at risk (OAR), while the patient is lying on the treatment couch. We sought to evaluate the potential of this new technology, including a weekly shuttle-based 3T-MRI scan in various treatment positions for tumor evaluation and for decreasing treatment-related side effects. (2) Methods: This is a prospective one-armed phase-II trial consisting of 40 patients with cervical carcinoma (FIGO IB-IIIC1) with an age ≥ 18 years and a Karnofsky performance score ≥ 70%. EBRT (45–50.4 Gy in 25–28 fractions with 55.0–58.8 Gy simultaneous integrated boosts to lymph node metastases) will be accompanied by weekly shuttle-based MRIs. Concurrent platinum-based chemotherapy will be given, followed by 28 Gy of BT (four fractions). The primary endpoint will be the occurrence of overall early bowel and bladder toxicity CTCAE grade 2 or higher (CTCAE v5.0). Secondary outcomes include clinical feasibility, quality of life, and imaging-based response assessment.

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Section: Discussionmentioning

confidence: 99%

Daily AI-Based Treatment Adaptation under Weekly Offline MR Guidance in Chemoradiotherapy for Cervical Cancer 1: The AIM-C1 Trial

Weykamp,

Meixner,

Arians

et al. 2024

JCM

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“…In the future, these promising results may contribute to detection of locoregional residual disease. However, PET/MRI is not used in all hospitals due to limited availability and high costs [ 26 ]. In addition to radiological imaging, our study indirectly evaluates the performance of the multidisciplinary team.…”

Section: Discussionmentioning

confidence: 99%

Comparing Methods to Determine Complete Response to Chemoradiation in Patients with Locally Advanced Cervical Cancer

van Kol,

Ebisch,

Beugeling

et al. 2023

Cancers

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Objectives: There is no consensus on the most reliable procedure to determine remission of cervical cancer after chemoradiotherapy (CRT). Therefore, this study aims to assess the diagnostic performance of two different imaging techniques, MRI and 18F[FDG]-PET/CT, in determining the presence of locoregional residual disease after CRT in patients with locally advanced cervical cancer. Methods: Patients diagnosed with locally advanced cervical cancer (FIGO 2009) treated with CRT were retrospectively identified from a regional cohort. The accuracy of MRI and 18F[FDG]-PET/CT in detecting locoregional residual disease was assessed with histology as the reference standard. Results: The negative predictive value (NPV) and positive predictive value (PPV) for locoregional residual disease detection of MRI and 18F[FDG]-PET/CT combined were 84.2% (95% CI 73.2–92.1), and 70.4% (95% CI 51.8–85.2), respectively. The NPV and PPV of MRI alone were 80.2% (95% CI 71.2–87.5) and 47.7% (95% CI 35.8–59.7), respectively, and values of 81.1% (95% CI 72.2–88.3) and 55.8 (95% CI 42.2–68.7), respectively, were obtained for 18F[FDG]-PET/CT alone. Conclusion: In this study, the reliability of MRI and 18F[FDG]-PET/CT in detecting locoregional residual disease was limited. Combining MRI and 18F[FDG]-PET/CT did not improve predictive values. Routine use of both MRI and 18F[FDG]-PET/CT in the follow-up after CRT should be avoided. MRI during follow-up is the advised imaging technique. Pathology confirmation of the presence of locoregional residual disease before performing salvage surgery is warranted.

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“…Post-treatment changes can persist for up to 9 months post-chemoradiotherapy; therefore, distinguishing residual tumours from post-treatment oedema can be challenging as both will appear as intermediate signal intensities on T2W1. The use of DWI can help differentiate the two, as only tumours should demonstrate restricted diffusion [50]. More recently, the application of MRI-guided brachytherapy has been shown to deliver more accurate dosing, which can be individually tailored to the tumour volume, thereby improving overall morbidity [51][52][53].…”

Section: Impact Of Mri Findings On Treatment Selectionmentioning

confidence: 99%

“…After fertility-sparing surgery, patients are imaged with MRI at six months and then annually for 2-3 years. After chemoradiotherapy, patients are reimaged with FDG-PET/CT and MRI at 3-6 months [50]. The protocol is similar to that used in initial staging; however, the axial oblique planes are adjusted to the vaginal vault in the setting of prior hysterectomy.…”

Section: Recurrent Cervical Cancermentioning

confidence: 99%

An Update on the Role of MRI in Treatment Stratification of Patients with Cervical Cancer

Shakur,

Lee,

Freeman

2023

Cancers

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Cervical cancer is the fourth most common cancer in women worldwide and the most common gynaecological malignancy. The FIGO staging system is the most commonly utilised classification system for cervical cancer worldwide. Prior to the most recent update in the FIGO staging in 2018, the staging was dependent upon clinical assessment alone. Concordance between the surgical and clinical FIGO staging decreases rapidly as the tumour becomes more advanced. MRI now plays a central role in patients diagnosed with cervical cancer and enables accurate staging, which is essential to determining the most appropriate treatment. MRI is the best imaging option for the assessment of tumour size, location, and parametrial and sidewall invasion. Notably, the presence of parametrial invasion precludes surgical options, and the patient will be triaged to chemoradiotherapy. As imaging is intrinsic to the new 2018 FIGO staging system, nodal metastases have been included within the classification as stage IIIC disease. The presence of lymph node metastases within the pelvis or abdomen is associated with a poorer prognosis, which previously could not be included in the staging classification as these could not be reliably detected on clinical examination. MRI findings corresponding to the 2018 revised FIGO staging of cervical cancers and their impact on treatment selection will be described.

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Post treatment imaging in patients with local advanced cervical carcinoma

Cited by 6 publications

References 104 publications

Daily AI-Based Treatment Adaptation under Weekly Offline MR Guidance in Chemoradiotherapy for Cervical Cancer 1: The AIM-C1 Trial

Daily AI-Based Treatment Adaptation under Weekly Offline MR Guidance in Chemoradiotherapy for Cervical Cancer 1: The AIM-C1 Trial

Comparing Methods to Determine Complete Response to Chemoradiation in Patients with Locally Advanced Cervical Cancer

An Update on the Role of MRI in Treatment Stratification of Patients with Cervical Cancer

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