MRI versus clinical assessment in staging and response evaluation in locally advanced cervix cancer patients treated with concurrent chemo-radiation in a tertiary cancer center: a prospective study

Abstract

INTRODUCTIONCervical carcinoma is currently the third most common gynaecological malignancy in the world, with data suggesting it to account about 9 % of all newly detected female cancer malignancies and is the leading cause of mortality amongst women world over. 1,2 In India, the age adjusted incidence rate of cervical carcinoma ranges from 19 to 44 per 1, 00,000 women in various cancer registries of Madras, Bangalore and Bombay. More women in India die from cervical cancer than in any other country. Cervical cancer kills around 72,000 women in India every year, more than 26% of the 275,000 deaths worldwide, says the report by the Cervical Cancer Free Coalition, The mortality rate in India is 15.2, according to a chart CCFC compiled using data from the World Health Organization, the United Nations, the World Bank and the International Agency for Research on Cancer Globocan. 3,4 Staging system recommended by International Federation of Gynecology and Obstetrics (FIGO) has been adopted worldwide for pretreatment staging purpose. The pitfall of FIGO staging however is the fact that it's based only on clinical assessment and has shown to be highly inter ABSTRACTBackground: Carcinoma cervix is staged most commonly with FIGO staging even though it has a number of pitfalls, for standardization of treatment and epidemiological purpose. The objectives of this prospective study are to evaluate the role of MRI in staging of locally advanced cervix cancer and correlate with the FIGO staging and to assess the role of MRI in evaluating treatment response. Methods: 58 biopsy proved locally advanced carcinoma cervix patients who satisfied the inclusion and exclusion criteria from January 2014 to October 2015 were recruited. After the standard pretreatment evaluation including MRI abdomen and pelvis patients were started on concurrent chemo-radiation. Pelvic External beam radiation (EBRT) to a dose of 45Gy/23 fractions for a period of 4.5 weeks with cisplatin 40mg/m2 weekly once. Followed by intracavitary brachytherapy HDR weekly once 7Gy/fraction x 3 fractions. Treatment response assessed as per RECIST criteria. As a part of follow up, three monthly clinical evaluation and 4-6 months MRI evaluation were done. Results: Agreement between MRI and clinical stage was evaluated by calculating the kappa value as the measure of agreement. The kappa value obtained was 0.18 which showed poor agreement between the two, while comparing clinical and MRI assessment with regard to treatment response, the kappa value obtained was 0.08 signifying poor agreement. Conclusions: Correlation of FIGO and MRI staging reveals significant discordance between the two and on further evaluation it is seen that MRI staging correlates well with the local recurrence of the disease.