Predictive Role of MRI and 18F FDG PET Response to Concurrent Chemoradiation in T2b Cervical Cancer on Clinical Outcome: A Retrospective Single Center Study

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.

Diagnostic Accuracy of 18F-FDG-PET/CT and MRI in Predicting the Tumor Response in Locally Advanced Cervical Carcinoma Treated by Chemoradiotherapy: A Meta-Analysis

“…e diagnostic sensitivity and specificity of PET/CT for the detection of tumor metastases in patients with locally advanced cervical carcinoma were 97% (95% CI: 94-99, I 2 : 97.3%) and 99% (95% CI: 96-100, I 2 : 00.0), and the corresponding rates for MRI were 31% (95% CI: 23-39 I 2 : 97.7%) and 98% (95% CI: 96-100 I 2 : 65.3%) based on 2 articles including 95 patients [20,29]. [18,20,22,23], and a prevalence of 11% (95% CI: 7.9-14.1, I 2 : 83.8%) for distant metastases in patients with locally advanced cervical cancer after chemo-radiotherapy based on 5 articles including 379 patients [17,18,20,22,23] (Table 3).…”

“…e mean DFI for these patients was 15 months. Each of these ratios was obtained from 2 studies involving 100, 100, and 150 patients, respectively [18][19][20][21][22][23] (Table 3).…”

Results of a Phase I-II Study on Laser Therapy for Vaginal Side Effects after Radiotherapy for Cancer of Uterine Cervix or Endometrium

“…Radiotherapy (RT) represents a cornerstone in the treatment of gynecological tumors and, in cases of advanced cervical cancers, it is the only available therapy with curative intent [1][2][3][4][5][6]. However, some side effects affecting sexual function are well known.…”

What Is the Role of Imaging in Cancers?

“…Table 1 shows a summary of the topics and the papers included for each topic [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. The majority of papers are focused on prostate cancer (PCa) and radiomics.…”

“…This latter semiquantitative parameter is predictive of overall survival in patients with recurrent ovarian cancer [ 25 ]. The same author [ 27 ] reported that PET/CT can predict more accurately than MRI the response to concurrent chemoradiation treatment in T2 cervical cancer patients. Finally, from a German experience in a small cohort of patients ( n = 16) affected by high-risk soft tissue sarcoma, the authors of [ 26 ] found that FDG kinetic analysis can be considered as a marker of response to pazopanib in soft-tissue sarcoma, and therefore it could guide anti-angiogenetic therapy.…”