The PRICE study: The role of conventional and diffusion-weighted magnetic resonance imaging in assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery

A. L. Valentini, M. Miccò, B. Gui, M. Giuliani, E. Rodolfino, A. M. Telesca, T. Pasciuto, A. Testa, M. A. Gambacorta, G. Zannoni, V. Rufini, A. Giordano, Vincenzo Valentini, G. Scambia, R. Manfredi

Research output: Contribution to journalArticle

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 ADCmeanmeasurements did not correlate with treatment outcome.

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalEuropean Radiology
DOIs
Publication statusAccepted/In press - Jan 9 2018

Keywords

  • Chemoradiotherapy · Diffusion magnetic resonance imaging
  • Magnetic resonance imaging
  • Tumour volume
  • Uterine cervical neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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