Functional Imaging for Assessing Tumor Response in Cancer of the Cervix

Predicting and Early Monitoring Treatment Efficiency of Cervical Cancer Under Concurrent Chemoradiotherapy by Intravoxel Incoherent Motion Magnetic Resonance Imaging

OBJECTIVE

The aim of this study was to explore the potential of intravoxel incoherent motion magnetic resonance (MR) imaging in predicting and measuring responses to concurrent chemoradiotherapy (CCRT) in advanced cervical cancers.

METHODS

Thirty-seven patients with advanced cervical cancers scheduled for CCRT underwent MR examinations including intravoxel incoherent motion sequence with 9 b values (0-800 s/mm) before CCRT, 2 and 4 weeks after the initiation of CCRT, and immediately after CCRT. Apparent diffusion coefficient, f, D, and D* values were obtained during the course. The maximum diameter of the tumor was measured to determine the treatment efficiency.

RESULTS

At the end of CCRT, 25 patients were classified as complete response and 12 as partial response. The pretreatment f of cervical cancer showed its efficiency in predicting partial response and complete response with an area under receiver operating characteristic curve of 0.768. During CCRT, the apparent diffusion coefficient, D, and D* values kept on rising, whereas f increased first and then decreased after 4 weeks of CCRT.

CONCLUSIONS

Intravoxel incoherent motion MR imaging held great potential in both predicting and early monitoring treatment efficiency of advanced cervical cancer under CCRT.

Time-window of early detection of response to concurrent chemoradiation in cervical cancer by using diffusion-weighted MR imaging: a pilot study

Background

To investigate the feasibility of DWI in evaluating early therapeutic response of uterine cervical cancer to concurrent chemoradiation (CCR) and establish optimal time window for early detection of treatment response.

Methods

This was a prospective study and informed consent was obtained from all patients. Thirty-three patients with uterine cervical cancer who received CCR underwent conventional MRI and DWI examinations prior to therapy (base-line) and at 3 days (postT1), 7 days (postT2), 14 days (postT3), 1 month (postT4) and 2 months (postT5) after the therapy initiated. Tumor response was determined by comparing the base-line and postT5 MRI by using RECIST criterion.

Results

Percentage ADC change (γADC) of complete response (CR) group at each follow up time was greater than that of partial response (PR) group, and the differences were significant at postT3 (p = 0.007), postT4 (p = 0.001), and postT5 (p = 0.019). There was positive correlation between γADC at each follow-up time and percentage size reduction at postT5. The day of 14 after the therapy initiated can be considered as the optimal time for monitoring early treatment response of uterine cervical cancer to CCR, and the representative and sensitive index was γADC. With the cut-off value of 35.4 %, the sensitivity and specificity for prediction of CR group were 100 % and 73.1 %, respectively.

Conclusions

It is feasible to use DWI to predict and monitor early treatment response in patients with uterine cervical cancer that undergoing CCR, and optimal time window for early detection of tumor response is the day of 14 after therapy initiated.