The Role of Multimodal Imaging in Pathological Response Prediction of Locally Advanced Cervical Cancer Patients Treated by Chemoradiation Therapy Followed by Radical Surgery

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2023 Jun 28

PMID 37370682

Authors

Tina Pasciuto

Francesca Moro

Angela Collarino

Maria Antonietta Gambacorta

Gian Franco Zannoni

Marco Oradei

Maria Gabriella Ferrandina

Benedetta Gui

Antonia Carla Testa

Vittoria Rufini

Affiliations

Soon will be listed here.

Abstract

Purpose: This study aimed to develop predictive models for pathological residual disease after neoadjuvant chemoradiation (CRT) in locally advanced cervical cancer (LACC) by integrating parameters derived from transvaginal ultrasound, MRI and PET/CT imaging at different time points and time intervals.

Methods: Patients with histologically proven LACC, stage IB2-IVA, were prospectively enrolled. For each patient, the three examinations were performed before, 2 and 5 weeks after treatment ("baseline", "early" and "final", respectively). Multivariable logistic regression models to predict complete vs. partial pathological response (pR) were developed and a cost analysis was performed.

Results: Between October 2010 and June 2014, 88 patients were included. Complete or partial pR was found in 45.5% and 54.5% of patients, respectively. The two most clinically useful models in pR prediction were (1) using percentage variation of SUV retrieved at PET/CT "baseline" and "final" examination, and (2) including high DWI signal intensity (SI) plus, ADC, and SUV collected at "final" evaluation (area under the curve (95% Confidence Interval): 0.80 (0.71-0.90) and 0.81 (0.72-0.90), respectively).

Conclusion: The percentage variation in SUV in the time interval before and after completing neoadjuvant CRT, as well as DWI SI plus ADC and SUV obtained after completing neoadjuvant CRT, could be used to predict residual cervical cancer in LACC patients. From a cost point of view, the use of MRI and PET/CT is preferable.

References

Eisenhauer E, Therasse P, Bogaerts J, Schwartz L, Sargent D, Ford R . New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2008; 45(2):228-47. DOI: 10.1016/j.ejca.2008.10.026. View

Maria Lima G, Matti A, Vara G, Dondi G, Naselli N, De Crescenzo E . Prognostic value of posttreatment F-FDG PET/CT and predictors of metabolic response to therapy in patients with locally advanced cervical cancer treated with concomitant chemoradiation therapy: an analysis of intensity- and volume-based PET.... Eur J Nucl Med Mol Imaging. 2018; 45(12):2139-2146. PMC: 6182406. DOI: 10.1007/s00259-018-4077-1. View

Zannoni G, Vellone V, Carbone A . Morphological effects of radiochemotherapy on cervical carcinoma: a morphological study of 50 cases of hysterectomy specimens after neoadjuvant treatment. Int J Gynecol Pathol. 2008; 27(2):274-81. DOI: 10.1097/PGP.0b013e31815b1263. View

Qin J, Cheng X, Chen X, Zhang X, Lu W, Xie X . Value of three-dimensional power Doppler to predict clinical and histological response to neoadjuvant chemotherapy in locally advanced cervical carcinoma. Ultrasound Obstet Gynecol. 2011; 39(2):226-34. DOI: 10.1002/uog.10071. View

Classe J, Rauch P, Rodier J, Morice P, Stoeckle E, Lasry S . Surgery after concurrent chemoradiotherapy and brachytherapy for the treatment of advanced cervical cancer: morbidity and outcome: results of a multicenter study of the GCCLCC (Groupe des Chirurgiens de Centre de Lutte Contre le Cancer). Gynecol Oncol. 2006; 102(3):523-9. DOI: 10.1016/j.ygyno.2006.01.022. View

Rufini V, Collarino A, Calcagni M, Meduri G, Fuoco V, Pasciuto T . The role of F-FDG-PET/CT in predicting the histopathological response in locally advanced cervical carcinoma treated by chemo-radiotherapy followed by radical surgery: a prospective study. Eur J Nucl Med Mol Imaging. 2019; 47(5):1228-1238. DOI: 10.1007/s00259-019-04436-y. View

Chen C, Cheng W, Lee C, Su Y, Hsieh C, Hsieh F . Power Doppler vascularity index for predicting the response of neoadjuvant chemotherapy in cervical carcinoma. Acta Obstet Gynecol Scand. 2004; 83(6):591-7. DOI: 10.1111/j.0001-6349.2004.00522.x. View

McNeil C . New standard of care for cervical cancer sets stage for next questions. J Natl Cancer Inst. 1999; 91(6):500-1. DOI: 10.1093/jnci/91.6.500a. View

Grigsby P, Massad L, Mutch D, Powell M, Thaker P, McCourt C . FIGO 2018 staging criteria for cervical cancer: Impact on stage migration and survival. Gynecol Oncol. 2020; 157(3):639-643. DOI: 10.1016/j.ygyno.2020.03.027. View

10.

Timmerman D, Valentin L, Bourne T, COLLINS W, Verrelst H, Vergote I . Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2001; 16(5):500-5. DOI: 10.1046/j.1469-0705.2000.00287.x. View

11.

Micco M, Vargas H, Burger I, Kollmeier M, Goldman D, Park K . Combined pre-treatment MRI and 18F-FDG PET/CT parameters as prognostic biomarkers in patients with cervical cancer. Eur J Radiol. 2014; 83(7):1169-1176. DOI: 10.1016/j.ejrad.2014.03.024. View

12.

Touboul C, Uzan C, Mauguen A, Gouy S, Rey A, Pautier P . Prognostic factors and morbidities after completion surgery in patients undergoing initial chemoradiation therapy for locally advanced cervical cancer. Oncologist. 2010; 15(4):405-15. PMC: 3227965. DOI: 10.1634/theoncologist.2009-0295. View

13.

Houvenaeghel G, Lelievre L, Gonzague-Casabianca L, Buttarelli M, Moutardier V, Goncalves A . Long-term survival after concomitant chemoradiotherapy prior to surgery in advanced cervical carcinoma. Gynecol Oncol. 2005; 100(2):338-43. DOI: 10.1016/j.ygyno.2005.08.047. View

14.

Kido A, Nakamoto Y . Implications of the new FIGO staging and the role of imaging in cervical cancer. Br J Radiol. 2021; 94(1125):20201342. PMC: 9327757. DOI: 10.1259/bjr.20201342. View

15.

Salib M, Russell J, Stewart V, Sudderuddin S, Barwick T, Rockall A . 2018 FIGO Staging Classification for Cervical Cancer: Added Benefits of Imaging. Radiographics. 2020; 40(6):1807-1822. DOI: 10.1148/rg.2020200013. View

16.

Cetina L, Gonzalez-Enciso A, Cantu D, Coronel J, Perez-Montiel D, Hinojosa J . Brachytherapy versus radical hysterectomy after external beam chemoradiation with gemcitabine plus cisplatin: a randomized, phase III study in IB2-IIB cervical cancer patients. Ann Oncol. 2013; 24(8):2043-7. DOI: 10.1093/annonc/mdt142. View

17.

Ueno Y, Lisbona R, Tamada T, Alaref A, Sugimura K, Reinhold C . Comparison of FDG PET metabolic tumour volume versus ADC histogram: prognostic value of tumour treatment response and survival in patients with locally advanced uterine cervical cancer. Br J Radiol. 2017; 90(1075):20170035. PMC: 5594985. DOI: 10.1259/bjr.20170035. View

18.

Valentini A, Micco M, Gui B, Giuliani M, Rodolfino E, Telesca A . 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. Eur Radiol. 2018; 28(6):2425-2435. DOI: 10.1007/s00330-017-5233-x. View

19.

Jalaguier-Coudray A, Villard-Mahjoub R, Delouche A, Delarbre B, Lambaudie E, Houvenaeghel G . Value of Dynamic Contrast-enhanced and Diffusion-weighted MR Imaging in the Detection of Pathologic Complete Response in Cervical Cancer after Neoadjuvant Therapy: A Retrospective Observational Study. Radiology. 2017; 284(2):432-442. DOI: 10.1148/radiol.2017161299. View

20.

Ferrandina G, Gambacorta A, Gallotta V, Smaniotto D, Fagotti A, Tagliaferri L . Chemoradiation with concomitant boosts followed by radical surgery in locally advanced cervical cancer: long-term results of the ROMA-2 prospective phase 2 study. Int J Radiat Oncol Biol Phys. 2015; 90(4):778-85. DOI: 10.1016/j.ijrobp.2014.07.033. View