Ressonância magnética no estadiamento dos tumores de colo uterino

Abstract

Cervical cancer is the worldwide leading cause of cancer-related death of women, especially in developing countries. The International Federation of Gynecology and Obstetrics recommends staging during surgery, however, surgical-pathologic staging would not be feasible in cases of more advanced cancers. Generally, in these cases, the staging is performed by means of clinical and gynecological examination and basic imaging studies. However, such an approach fails to demonstrate the actual extent of the disease, and does not include significant prognostic factors such as tumor volume, stromal invasion and lymph node involvement. Magnetic resonance imaging has increasingly been utilized in cervical cancer staging, since at early stages of the disease its performance may be compared to intraoperative findings and, at advanced stages, it shows to be superior to the clinical evaluation. Additionally, magnetic resonance imaging presents an excellent imaging resolution for the different densities of pelvic structures, does not require ionizing radiation, is comfortable for the patient, improves de staging, allowing the early detection of recurrence and the identification of reliable prognostic factors which contribute to the therapeutic decision making process and results prediction with an excellent cost-effectiveness. The present article is aimed at reviewing the most significant aspects of magnetic resonance imaging in the cervical cancer staging.Ressonância magnética no estadiamento dos tumores de colo uterino. O câncer de colo uterino é a maior causa de morte entre mulheres em todo o mundo, notadamente nos países em desenvolvimento. A Federação Internacional de Ginecologia e Obstetrícia preconiza o estadiamento durante o ato operatório, porém nos casos mais avançados a abordagem terapêutica não é cirúrgica. Nestes casos, o estadiamento, em geral, é feito com o exame clínico ginecológico e exames básicos de imagem. Entretanto, essa forma de abordagem não expressa a real extensão da doença e não inclui importantes fatores prognósticos como volume tumoral, invasão estromal e acometimento linfonodal. A ressonância magnética está sendo cada vez mais utilizada para este fim, pois nos estádios iniciais seu desempenho pode ser comparado aos achados intra-operatórios e nos estádios avançados se mostra superior em relação à avaliação clínica. A ressonância magnética apresenta excelente resolução para diversas densidades das estruturas pélvicas, não utiliza radiação ionizante, é confortável, melhora o estadiamento, permite a detecção precoce de recidiva e a identificação de fatores prognósticos fidedignos que contribuem na decisão e predição dos resultados terapêuticos, com excelente custo-efetividade. Este artigo tem como objetivo revisar os aspectos da ressonância magnética mais importantes no estadiamento desta doença. Unitermos: Câncer de colo uterino; Estadiamento; Ressonância magnética. AbstractResumo

A Novel Positive-Contrast Magnetic Resonance Imaging Line Marker for High-Dose-Rate (HDR) MRI-Assisted Radiosurgery (MARS)

“…Accurate and precise dose delivery in HDR MARS for cervical or prostate cancer requires the use of both T1-and T2 -weighted MRI sequences [74][75][76][77][78][79]. Therefore, it is essential to be able to visualize the markers under both T1-and T2-weighted sequences.…”

A atual situação da braquiterapia de alta taxa de dose em colo do útero realizada no Brasil

“…In the literature, MRI has been described as one of the most appropriate techniques for staging patients with cervical cancer ( 12 ) . Such a method is also described as being the best tool for the acquisition of images during the routine three-dimensional planning, overcoming conventional radiography and the images obtained by means of CT ( 12 - 15 ) . On the other hand, a recent study developed by Viswanathan et al.…”

Evaluation of early nephrostomy in patients with post-renal acute renal failure with advanced Cervical Cancer

“…The ureter can become enveloped by tumors, and this leads to ureterohydronephrosis and eventually kidney failure. The pattern of pelvic dissemination of cervical carcinoma restricts the use of surgical treatment for early forms (6,7).…”

“…It is very important to select patients for curative treatment. Three significant prognostic factors have been identified that may predict a short survival time after percutaneous nephrostomy in patients with advanced-stage cancer: serum albumin, high-grade hydronephrosis, and several three or more events related to malignant dissemination, such as metastases (lung, liver, bones, retroperitoneum, lymph nodes), ascites and pleural effusion (6,8,9).…”