Abstract
BackgroundAdvanced stage cervical cancer is primarily treated by radiotherapy. Local tumor control is a prerequisite for cure. Imaging after treatment is controversial. Positron emission tomography (PET) combined with computer tomography (PET-CT) shows great promise for detecting metastases. On the other hand, magnetic resonance imaging (MRI) is superior in depicting anatomical details. The combination of PET-MRI could result in more accurate evaluation of cervical cancer treatment outcome. The aim of this pilot study is to share our initial experience with PET-MRI in the evaluation of treatment response in cervical cancer after radiation treatment.MethodsTen patients with cervical carcinoma (FIGO ≥IB2) were prospectively evaluated. Eleven weeks (median; range 8–15 weeks) after radiation therapy, treatment response was evaluated by PET-MRI. The PET, MRI, and combined PET-MRI images were evaluated for the presence of local residual tumor and metastasis. Diagnostic performance was assessed by area under the receiver operator characteristic (ROC) curve for evaluation of local residual tumor. The readers were blinded for outcome data. Local residual disease, metastasis, diagnostic confidence, and change of opinion were scored on a 5-point Likert scale. The reference standard consisted of pathology and/or follow-up according to the clinical guidelines.ResultsThree out of ten patients had local residual abnormalities suggestive for tumor residue after radiation treatment. The availability of both PET and MRI resulted in an increase in diagnostic confidence in 80–90% of all patients. Change of opinion was observed in 70% and change of policy in 50%, especially in the group with residual tumor. The diagnostic accuracy increased significantly for the radiologist if PET-MRI was combined (AUC .54 versus .83).ConclusionsPET-MRI shows promise for evaluation of treatment response after radiation for cervical cancer, especially increasing diagnostic confidence, while potentially increasing diagnostic performance.
Highlights
Advanced stage cervical cancer is primarily treated by radiotherapy
The aim of our study was to share our initial experience with the Positron emission tomography (PET)-magnetic resonance imaging (MRI) in the evaluation of radiotherapy treatment to discriminate between patients with a complete local response and patients with local residual tumor
We evaluate the potential value of combined PET-MRI in comparison to the MRI and PET component
Summary
Advanced stage cervical cancer is primarily treated by radiotherapy. The combination of PET-MRI could result in more accurate evaluation of cervical cancer treatment outcome. The aim of this pilot study is to share our initial experience with PET-MRI in the evaluation of treatment response in cervical cancer after radiation treatment. Radiation treatment for cervical cancer is recommended for advanced disease (International Federation of Gynecology and Obstetrics (FIGO) stages ≥IB2). Local persistent tumor is responsible for one fourth of treatment failure; lymph node metastasis and distant metastasis are responsible for the remaining part [2]. Assessment could lead to an overestimation of residual tumor; on the contrary, late assessment could miss the opportunity to treat asymptomatic persistent disease [4]
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