Abstract
IntroductionMRI is very accurate in selecting young women with cervical cancer for fertility-sparing surgery (FSS), in particular radical hysterectomy (RH). In order to improve obstetrical outcomes, neoadjuvant chemotherapy (NACT) followed by cold knife conization (CKC) has been proposed as alternative technique.ObjectiveTo investigate the role of MRI in evaluation of response to treatment after neoadjuvant chemotherapy (NACT), followed by CKC, in patients with cervical cancer FIGO stage IB2-IIA1 with tumor size 2 – 4 cm, desiring to preserve their fertility.Methods13 young women (23–36 years old) with cervical cancer stage IB2-IIA1 desiring to preserve their fertility were included. Tumor diameter at baseline and after treatment was detected on 1.5 T MRI. Treatment response was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST 1.1) and then compared to histopathology result.ResultsMRI correctly assessed 11 out of 13 cases, according to RECIST 1.1, compared to histopathology. Among these 7 patients with partial response (PR), 2 cases of CR, 1 SD and 1 PD with persistence or enlargement of primary tumor.ConclusionOur pilot study supports the usefulness of MRI in assessment of treatment response after NACT, followed by CKC.Trial registration numberClinicalTrials.gov: NCT02323841
Highlights
magnetic resonance imaging (MRI) is very accurate in selecting young women with cervical cancer for fertility-sparing surgery (FSS), in particular radical hysterectomy (RH)
The purpose of this study was to investigate the role of MRI, including diffusion-weighted imaging (DWI), in the evaluation of response to treatment after neoadjuvant chemotherapy (NACT), followed by cold knife conization (CKC), in patients with early stage cervical cancer (ECC) (FIGO 2018 stage IB2-IIA1) with tumor size 2–4 cm, desiring to preserve their fertility
The results from our series confirm the usefulness of MRI, including DWI, in tumor response evaluation after NACT in patients with ECC (FIGO 2018 stage IB2-IIA1)
Summary
MRI is very accurate in selecting young women with cervical cancer for fertility-sparing surgery (FSS), in particular radical hysterectomy (RH). Objective To investigate the role of MRI in evaluation of response to treatment after neoadjuvant chemotherapy (NACT), followed by CKC, in patients with cervical cancer FIGO stage IB2-IIA1 with tumor size 2 – 4 cm, desiring to preserve their fertility. Methods 13 young women (23–36 years old) with cervical cancer stage IB2-IIA1 desiring to preserve their fertility were included. Results MRI correctly assessed 11 out of 13 cases, according to RECIST 1.1, compared to histopathology Among these 7 patients with partial response (PR), 2 cases of CR, 1 SD and 1 PD with persistence or enlargement of primary tumor. In women with early stage cervical cancer (ECC), fertility-sparing surgery techniques include laparoscopic, abdominal or vaginal radical trachelectomy (RT) and cold knife conization (CKC) with or without pelvic lymph nodes dissection. RT is proposed as fertilitysparing surgery (FSS), alternative to radical hysterectomy, in patients with ECC staged IA1-IB1, as by the 2018 International Federation of Gynecology and Obstetrics (FIGO) classification [4]
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