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Gynecol Oncol. 2017 Nov;147(2):334-339. doi: 10.1016/j.ygyno.2017.08.029. Epub 2017 Sep 19.

Magnetic resonance imaging during definitive chemoradiotherapy can predict tumor recurrence and patient survival in locally advanced cervical cancer: A multi-institutional retrospective analysis of KROG 16-01.

Author information

1
Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea; Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Suwon, Republic of Korea.
2
Department of Radiation Oncology, Gachon University of Medical and Science, Incheon, Republic of Korea.
3
Department of Radiation Oncology, Cheil General Hospital, Dankook University College of Medicine, Seoul, Republic of Korea.
4
Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea.
5
Department of Radiation Oncology, Hwasun Chonnam National University Hospital, Hwasun, Republic of Korea.
6
Department of Radiation Oncology, Ewha Woman's University School of Medicine, Seoul, Republic of Korea.
7
Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.
8
Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
9
Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
10
Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
11
Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Suwon, Republic of Korea.
12
Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Suwon, Republic of Korea.
13
Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Suwon, Republic of Korea. Electronic address: koppul@catholic.ac.kr.

Abstract

OBJECTIVE:

Definitive chemoradiotherapy (CRT) followed by brachytherapy is a standard treatment for locally advanced cervical cancer. During CRT, marked reduction of cervical tumor is often observed in magnetic resonance imaging (MRI). The primary aim of this study was to assess the association between tumor response in MRI using FIGO classification and clinical outcomes.

METHODS:

Multi-institutional data were retrospectively reviewed to identify the significance of MR tumor response on tumor recurrence and patient survival. 225 patients with histologically confirmed squamous cell carcinoma of the cervix, staged as FIGO Ib2-IVa on initial pelvic MRI, were included. Post-CRT MRI was performed median 35days after the beginning of CRT and before brachytherapy. A median 54Gy of external radiation was given with weekly cisplatin during CRT.

RESULTS:

112 (49.7%) of the 225 patients showed a positive response in post-CRT MRI and were named the responsive arm. After a median follow-up time of 36.2months, the responsive arm had significantly lower para-aortic recurrence (7.5% vs. 12.4%; p=0.04) and distant metastasis (13.2% vs. 27.6%; p=0.03) rates than did the non-responsive arm. The responsive arm had significantly higher 3-year cause-specific survival rate (94.6% vs. 81.1%, p<0.01) than did the non-responsive arm. In the multivariate analysis, tumor size (hazard ratio, 1.91 and 95% confidence interval, 1.07-3.43; p=0.028) and positive MR response (hazard ratio, 1.75 and 95% confidence interval, 1.06-2.27; p=0.045) were significant factors for recurrence-free survival CONCLUSION: Early tumor response evaluation with MRI using FIGO classification effectively predicted distant tumor metastasis and disease-specific survival in locally advanced cervical cancer.

KEYWORDS:

Cervical cancer; Chemoradiotherapy; Early response; MRI

PMID:
28935271
DOI:
10.1016/j.ygyno.2017.08.029
[Indexed for MEDLINE]

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