Multiparameter MRI and Clinical Factors for Predicting Early Response to Chemoradiotherapy in Cervical Cancer.

Abstract

HomeRadiology: Imaging CancerVol. 3, No. 1 PreviousNext Research HighlightsFree AccessMultiparameter MRI and Clinical Factors for Predicting Early Response to Chemoradiotherapy in Cervical CancerSanaz Javadi, Vikas KundraSanaz Javadi, Vikas KundraSanaz JavadiVikas KundraPublished Online:Jan 29 2021https://doi.org/10.1148/rycan.2021209038MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail Take-Away Points■ Major Focus: To assess a combination of multiparametric MRI with clinical prognostic factors for predicting treatment outcomes in patients with cervical cancer.■ Key Result: Pretreatment individual multiple MRI parameters (diffusion coefficient, volume transfer constant, and extravascular extracellular space) and stage were found to be independent prognostic factors for prediction. Combining multiple MRI parameters, multiparametric MRI biomarkers, and their combination with clinical stage can parse categories favorable, intermediate, and unfavorable for recurrence after chemoradiotherapy.■ Impact: Further assessment of this combination is warranted for improving prediction of treatment responses in patients with cervical cancer.Cervical cancer is the fourth most common cause of cancer-related mortality in women globally. Chemoradiotherapy is the treatment of choice for locally advanced cervical cancer. Early prediction of treatment response could provide a window of opportunity to modify therapy if needed. Clinical prognostic factors alone have limitations in prediction of early response. A few studies have shown functional imaging methods, including PET and diffusion-weighted MRI, can predict recurrence and response to treatment in patients with cervical cancer (1–3). Zheng et al studied this topic further by combining pre- and posttreatment MRI parameters (intravoxel incoherent motion [IVIM], dynamic contrast-enhanced [DCE] MRI, and apparent diffusion coefficient [ADC]) with clinical prognostic factors (squamous cell carcinoma antigen, tumor stage, histologic type, and lymphadenopathy) to predict response to chemoradiotherapy in patients with cervical cancer.The study included 85 patients with pathologically proven cervical cancer that was greater than 1 cm who had no prior history of chemotherapy or radiation therapy and underwent pre- and posttreatment MRI. The latter was used to assess recurrence using Response Evaluation Criteria in Solid Tumors. Treatment included a combination of external beam radiotherapy, high-dose-rate intracavitary brachytherapy, and concurrent cisplatin chemotherapy. One month after completion of chemoradiotherapy, 40% of patients had residual disease. Patients with residual disease had higher stage but no other differences in clinical prognostic factors.Higher pretreatment ADC, IVIM diffusion-related coefficient (D), and DCE volume of extravascular extracellular space per unit volume of tissue (Ve), as well as lower IVIM perfusion-related parameter (f) and DCE volume transfer constant from blood plasma to the extravascular extracellular space (Ktrans) values were seen in tumors with residual disease on univariate analysis. The authors suggest that higher pretreatment ADC and D values may identify tumor necrosis, whereas high Ve, lower f value, and lower Ktrans may reflect poorer blood supply with decreased drug delivery and hypoxia causing resistance to radiation therapy.Multivariate analysis showed sensitivity and specificity of MRI parameters for predicting posttreatment residual tumor as 82% and 65% for D, 67% and 90% for Ktrans, and 82% and 71% for Ve, respectively. Combining these MRI parameters, the sensitivity and specificity for predicting residual disease were 91% and 90%, respectively. MRI parameters and International Federation of Gynecology and Obstetrics (FIGO) stage together produced 85% sensitivity and 96% specificity. MRI parameters with and without FIGO stage segregated patients into favorable, intermediate, and unfavorable categories for residual tumor recurrence. The study suggests that the combination of multiparametric MRI and clinical stage can predict response to treatment in cervical cancer.Highlighted ArticleZheng X, Guo W, Dong J, Qian L. Prediction of early response to concurrent chemoradiotherapy in cervical cancer: Value of multi-parameter MRI combined with clinical prognostic factors. Magn Reson Imaging 2020;72:159–166. doi: https://doi.org/10.1016/j.mri.2020.06.014