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

• DOI: 10.1007/s00330-017-5233-x
• Publication Date: 2018-01-09T13:50:32Z
• Authors: 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; V. Valentini; G. Scambia; R. Manfredi
• Keywords: Adult; Postoperative Care; Chemoradiotherapy; Diffusionmagneticresonance imaging; Magnetic resonance imaging; Tumour volume; Uterine cervical neoplasms; Adult; Aged; Chemoradiotherapy; Combined Modality Therapy; Diffusion Magnetic Resonance Imaging; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Neoadjuvant Therapy; Postoperative Care; Prospective Studies; ROC Curve; Uterine Cervical Neoplasms; Hysterectomy; Neoplasm Staging; Tumor Burden; Uterine Cervical Neoplasms; Chemoradiotherapy; Middle Aged; Hysterectomy; 16. Peace & justice; Combined Modality Therapy; Magnetic Resonance Imaging; Neoadjuvant Therapy; Tumor Burden; 3. Good health; 03 medical and health sciences; Diffusion Magnetic Resonance Imaging; 0302 clinical medicine; ROC Curve; MRI; Cervical cancer; Humans; Female; Prospective Studies; Aged; Neoplasm Staging

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.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.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%.TV evaluated before and early after treatment could predict pathological response in LACC. ADCmean did not correlate with treatment outcome.• 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 ADC mean measurements did not correlate with treatment outcome.