A L Valentini1, M Miccò1, B Gui2, M Giuliani1, E Rodolfino1, A M Telesca1, T Pasciuto3, A Testa3, M A Gambacorta4, G Zannoni5, V Rufini6, A Giordano6, V Valentini4, G Scambia3, R Manfredi1. 1. Department of Radiology, Università Cattolica del Sacro Cuore, Fondazione Agostino Gemelli, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy. 2. Department of Radiology, Università Cattolica del Sacro Cuore, Fondazione Agostino Gemelli, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy. benedetta.gui@policlinicogemelli.it. 3. Department of Gynecology and Obstetrics, Università Cattolica del Sacro Cuore, Fondazione Agostino Gemelli, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy. 4. Department of Radiotherapy, Università Cattolica del Sacro Cuore, Fondazione Agostino Gemelli, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy. 5. Department of Histopathology, Università Cattolica del Sacro Cuore, Fondazione Agostino Gemelli, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy. 6. Department of Nuclear Medicine, Università Cattolica del Sacro Cuore, Fondazione Agostino Gemelli, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy.
Abstract
OBJECTIVES: To analyse the role of DW-MRI in early prediction of pathologically-assessed residual disease in locally-advanced cervical cancer (LACC) treated with neoadjuvant chemoradiotherapy followed by radical surgery. METHODS: Between October 2010-June 2014, 108 women with histologically-proven cervical cancer were screened; 88 were included in this study. Tumour volume (TV) and ADCmean were measured before (baseline-MRI) and after 2 weeks of chemoradiotherapy (early-MRI). According to histopathology, treatment response was classified as complete (CR) or partial (PR). Comparisons were made with Mann-Whitney, Wilcoxon and χ2 tests. ROC curves were generated for statistically significant parameters on univariate analysis. RESULTS: CR and PR were documented in 40 and 48 patients. At baseline-MRI, TV did not differ between groups. At early-MRI, TV was higher in PR than in CR (p=0.001). ΔTV reduction after treatment was lower in PR than in CR (63.6% vs. 81.1%; p=0.001). At baseline-MRI and early-MRI, ADCmean did not differ between PR and CR. ROC curve showed best cut-off for predicting pathological PR was ΔTV reduction of 73% with sensitivity, specificity, accuracy, NPV, PPV of 73%, 72.5%, 72.7%, 76%, 69%. CONCLUSIONS: TV evaluated before and early after treatment could predict pathological response in LACC. ADCmean did not correlate with treatment outcome. KEY POINTS: • Early-MRI tumour volume assessment could predict pathological response to nCRT in LACC. • Best cut-off for predicting pathological PR was ΔTV reduction of 73 %. • Early-MRI ADC mean measurements did not correlate with treatment outcome.
OBJECTIVES: To analyse the role of DW-MRI in early prediction of pathologically-assessed residual disease in locally-advanced cervical cancer (LACC) treated with neoadjuvant chemoradiotherapy followed by radical surgery. METHODS: Between October 2010-June 2014, 108 women with histologically-proven cervical cancer were screened; 88 were included in this study. Tumour volume (TV) and ADCmean were measured before (baseline-MRI) and after 2 weeks of chemoradiotherapy (early-MRI). According to histopathology, treatment response was classified as complete (CR) or partial (PR). Comparisons were made with Mann-Whitney, Wilcoxon and χ2 tests. ROC curves were generated for statistically significant parameters on univariate analysis. RESULTS:CR and PR were documented in 40 and 48 patients. At baseline-MRI, TV did not differ between groups. At early-MRI, TV was higher in PR than in CR (p=0.001). ΔTV reduction after treatment was lower in PR than in CR (63.6% vs. 81.1%; p=0.001). At baseline-MRI and early-MRI, ADCmean did not differ between PR and CR. ROC curve showed best cut-off for predicting pathological PR was ΔTV reduction of 73% with sensitivity, specificity, accuracy, NPV, PPV of 73%, 72.5%, 72.7%, 76%, 69%. CONCLUSIONS: TV evaluated before and early after treatment could predict pathological response in LACC. ADCmean did not correlate with treatment outcome. KEY POINTS: • Early-MRI tumour volume assessment could predict pathological response to nCRT in LACC. • Best cut-off for predicting pathological PR was ΔTV reduction of 73 %. • Early-MRI ADC mean measurements did not correlate with treatment outcome.
Entities:
Keywords:
Chemoradiotherapy · Diffusion magnetic resonance imaging; Magnetic resonance imaging; Tumour volume; Uterine cervical neoplasms
Authors: J L Benedet; F Odicino; P Maisonneuve; U Beller; W T Creasman; A P Heintz; H Y Ngan; M Sideri; S Pecorelli Journal: J Epidemiol Biostat Date: 2001