Prognostic impact of tumor size reduction assessed by magnetic resonance imaging after radiochemotherapy in patients with locally advanced cervical cancer

Abstract

ObjectivePelvic magnetic resonance imaging (MRI) is a key exam used for the initial assessment of loco-regional involvement of cervical cancer. In patients with locally advanced cervical cancer, MRI is used to evaluate the early response to radiochemotherapy before image-guided brachytherapy, the prognostic impact of which we aimed to study.MethodsPatients with locally advanced cervical cancer treated using concomitant radiochemotherapy followed by closure treatment between January 2010 and December 2015 were included in this study. Clinical, anatomopathological, radiological, therapeutic, and follow-up data were evaluated.ResultsAfter applying the inclusion and exclusion criteria to the initially chosen 310 patients, 232 were included for evaluation (median follow-up period, 5.3 years). The median age was 50 years (range, 25–83 years), and the median tumor size was 47.5 mm (range, 0–105 mm). Based on the International Federation of Gynaecology and Obstetrics classification system, 9 patients were in stage IB2; 20, IB3; 2, IIA; 63, IIB; 4, IIIA; 7, IIIB; and 127, IIIC1 or higher. The re-evaluation MRI was performed at the median dose of 55.5 Gy, and median reduction in tumor size was 55.2% (range, −20–100%). There was a difference between the disease-free and overall survival rates of the patients with a tumor response greater or lesser than 50%. The risk of recurrence or death reduced by 39% in patients with a tumor size reduction >50%. The overall 5-year survival rate of patients with a response greater and lesser than 50% were 77.7% and 61.5%, respectively. The 5-year disease-free survival rate for these two groups of patients were 68.8% and 51.5%, respectively.ConclusionOur study confirms the prognostic impact of tumor size reduction using MRI data obtained after radiochemotherapy in patients with locally advanced cervical cancer.

The prognostic effect of tumor volume, reduction ratio, and cumulative doses on external beam radiotherapy with central-shielding method and image-guided adaptive brachytherapy for cervical cancer

“…Several studies have shown that tumor reduction determined on MRI during EBRT was a significant prognostic factor ( 6 , 7 , 16 , 17 ). Most of these studies used treatment without CS and reported a cutoff value of 80–90% tumor volume reduction during EBRT of 45–50 Gy.…”

“…Recently, tumor reduction during EBRT has been reported to be a prognostic factor (5)(6)(7). Tumor volume at diagnosis and its reduction during EBRT could be crucial factors in appropriate dose delivery in IGABT.…”

Observation of hemostatic effectiveness and safety of ultrasound-CT guided 3D intracavitary and interstitial brachytherapy in the treatment of larger cervical cancer with bleeding: A retrospective study

“…This adaptive target volume concept was developed to reflect tumor shrinkage at the end of initial chemoradiation and serves for an image-guided boost delivered through BT. [31,32] According to the analysis by Liu et al, [33] in domestic and foreign published literature related to ISBRT research, about 36% of the units use image-guided 3D-IGBT, CT is still the main guidance method, accounting for about 58%, MRI image guidance has made rapid progress, accounting for about 27% of image guidance, and the rest use X-ray or ultrasound guidance. Traditional CT-guided IGBT treatment requires multiple CT scans, increasing patient radiation dose.…”

“…This adaptive target volume concept was developed to reflect tumor shrinkage at the end of initial chemoradiation and serves for an image-guided boost delivered through BT. [ 31 , 32 ]…”