MR Imaging-based Evaluation of Morphological Changes in the Uterus and Ovaries of Patients Following Neoadjuvant Chemotherapy for Cervical Cancer

Abstract

Objective: We used magnetic resonance (MR) imaging and hormonal levels to evaluate the influence of chemotherapy for cervical cancer on female pelvic reproductive organs.Materials and Methods: We retrospectively evaluated 16 pre-and 11 postmenopausal patients with cervical cancer who underwent neoadjuvant chemotherapy (NACT) and radical surgery. We evaluated morphological changes in the uterus and ovaries by MR imaging both quantitatively and qualitatively, measuring the volume of the uterine body and bilateral ovaries, endometrial thickness, and signal intensity of the myometrium and bilateral ovaries and assessing visibility of the junctional zone and bilateral ovarian follicles. We compared both quantitative and qualitative factors between pre-and post-NACT. Pre-and post-NACT hormonal values of estradiol, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) of 8 patients in the premenopausal group were obtained and analyzed statistically.Results: In the premenopausal group, we observed a statistically significant decrease in all quantitative parameters as well as in the visibility of the left ovarian follicle. In the postmenopausal group, only endometrial thickness changed significantly. Premenopausal patients showed a statistically significant decrease in levels of progesterone, FSH, and LH after chemotherapy.Conclusions: MR demonstrated changes in the uterus and ovaries in premenopausal subjects who underwent chemotherapy that resembled those changes classically reported in physiological postmenopausal subjects. These changes are likely due to ovarian toxicity and secondary hormonal changes. MR imaging might be a valuable tool for obtaining information regarding chemotherapy-induced infertility.

Treatment response evaluation using the mean apparent diffusion coefficient in cervical cancer patients treated with definitive chemoradiotherapy

“…Nakamura et al reported that the primary tumor ADC mean was significantly associated with FIGO stage, tumor size, stromal and parametrial infiltration, lymph node metastasis, and lymphovascular space involvement in 80 cervical cancer patients treated with radical surgery. Himoto et al found that the primary tumor ADC mean was an independent prognostic factor for event‐free survival in 123 cervical squamous cell cancer patients.…”

Uterine anatomy and function on cine magnetic resonance imaging

“…In pre-menopausal patients, both the uterine and the ovarian volumes, as well as the signal intensity of the myometrium decrease to levels similar to those seen in post-menopausal women following NACT. This is due to ovarian toxicity and secondary hormonal changes [16]. Tamoxifen citrate is an antiestrogen agent that binds to estrogen receptors.…”

Exercise and chemotherapy-induced amenorrhea

“…Aerobic exercise has systemic effects in vasculature in non-exercising tissues and may improve ovarian blood flow through antiatherogenic effects and a reduction in vascular remodeling [25][26][27]. Aerobic exercise at moderate intensity upregulates antioxidant production in humans and has been shown to decrease ovarian oxidative stress in a murine model [28][29][30][31]. The purpose of this paper is to formulate a mechanistic hypothesis on how exercise may attenuate the effects of chemotherapy on ovarian function, possibly reducing the prevalence of CIA in premenopausal women undergoing chemotherapeutic treatment for cancer.…”