MRI in the synchronic chemoradiotherapy of cervical squamous cell carcinoma

Objective: This study aimed to explore the predictive value of the apparent diffusion coefficient (ADC) of diffusion weighted imaging (DWI) in evaluating the therapeutic effects of synchronic chemoradiotherapy of cervical squamous cell carcinoma by using the functional imaging of 1.5T MR. Materials and Methods: Fifty patients with cervical squamous cell carcinoma receiving synchronic chemoradiotherapy in the present hospital from October 2010 to February 2014 were enrolled in this study. MRI examination was performed on each patient before and after chemoradiotherapy. Eleven patients received an additional MRI examination when the in vitro cumulative radiation dose reached 36 Gy. The mean tumor ADC values of DWI sequence were measured before, under, and after chemoradiotherapy. At the end of the treatment, patients were divided into complete remission (CR) and partial remission (PR) groups on the basis of the residual tumors. Then the tumor ADC values and their changes before and after the treatment were analyzed using independent sample t-test. Results: At the end of the treatment, 32 patients achieved CR and 18 patients achieved PR. The tumor ADC values increased gradually with the treatment, showing significant difference between before, under, and after the treatment (p < 0.01). The mean tumor ADC values were remarkably higher in CR group than in PR group (p < 0.001). Conclusion: The ADC values of MR functional imaging DWI can reflect the hydrone diffusion movement of tumor after the treatment, so that it is able to identify CR and PR in the patients, providing a new way and method for evaluating the therapeutic effects of cervical squamous cell carcinoma.

Cervical squamous cell carcinoma; Magnetic resonance imaging; Diffusion weighted imaging; Therapeutic effect.

[1] Hu S.Y., Zheng R.S., Zhao F.H., Zhang S.W., Chen W.Q., Qiao Y.L.: “Trend analysis of cervical cancer incidence and mortality rates in Chinese women during 1989-2008”. Zhong Guo Yi Xue Ke Xue Yuan Xue Bao, 2014, 36, 119.

[2] Reig A., Membrive I., Foro P., Sanz X., Rodríguez N., Lozano J., et al.: “Long-term results and prognostic factors of patients with cervical carcinoma treated with concurrent chemoradiotherapy”. Clin. Transl. Oncol., 2011, 13, 504.

[3] Park J.H., Kim Y.S., Ahn S.D., Choi E.K., Shin S.S., Kim Y.T., et al.: “Concurrent chemoradiotherapy or radiotherapy alone for locally advanced cervical cancer in elderly women”. Tumori, 2010, 96, 959.

[4] Gaffney D.K., Jhingran A., Portelance L., Viswanathan A., Schefter T., Weidhaas J., et al.: “Radiation therapy oncology group gynecologic oncology working group: comprehensive results”. Int. J. Gynecol. Cancer, 2014, 24, 956.

[5] Keys H.M., Bundy B.N., Stehman F.B., Muderspach L.I., Chafe W.E., Suggs C.L. 3rd., et al.: “Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for Bulky Stage IB cervical carcinoma”. N. Engl. J. Med., 1999, 340, 1154.

[6] Peters W.A. 3rd., Liu P.Y., Barrett R.J. 2nd., Stock R.J., Monk B.J., Berek J.S., et al.: “Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix”. J. Clin. Oncol., 2000, 18, 1606.

[7] Jensen L.G., Hasselle M.D., Rose B.S., Nath S.K., Hasan Y., Scanderbeg D.J., et al.: “Outcomes for patients with cervical cancer treated with extended-field intensity-modulated radiation therapy and concurrent cisplatin”. Int. J. Gynecol. Cancer, 2013, 23, 119.

[8] Green J.A., Kirwan J.M., Tierney J.F., Symonds P., Fresco L., Collingwood M., et al.: “Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and metalanalysis”. Lancet, 2001, 358, 781.

[9] Barbera L., Thomas G.: “Management of early and locally advanced cervical cancer”. Semin. Oncol., 2009, 36, 155.

[10] Vincens E., Balleyguier C., Rey A., Uzan C., Zareski E., Gouy S., et al.: “Accuracy of magnetic resonance imaging in predicting residual disease in patients treated for stage IB2/II cervical carcinoma with chemoradiation therapy; correlation of radiologic findings with surgicopathologic results”. Cancer, 2008, 113, 2158.

[11] Hatano K., Sekiya Y., Araki H., Sakai M., Togawa T., Narita Y., et al.: “Evaluation of the therapeutic effect of radiotherapy on cervical cancer using magnetic resonance imaging”. Int. J. Radiat. Oncol. Biol. Phys., 1999, 45, 639.

[12] Sala E., Rockall A., Rangarajanc D., Kubik-Huch R.A.: “The role of dynamic contrast-enhanced and diffusion weighted magnetic resonance imaging in the female pelvis”. Eur. J. Radiol., 2010, 76, 367.

[13] Kim H.J., Kim W.: “Method of tumor volume evaluation using magnetic resonance imaging for outcome prediction in cervical cancertreated with concurrent chemotherapy and radiotherapy”. Radiat. Oncol. J., 2012, 30, 70.

[14] Wang J., Takashima S., Takayama F., Kawakami S., Saito A., Matsushita T., et al.: “Head and neck lesions: characterization with diffusion- weighted echo-planar MR imaging”. Radiology, 2001, 220, 621.

[15] Vargas H.A., Akin O., Zheng J., Moskowitz C., Soslow R., Abu-Rustum N., et al.: “The value of MR imaging when the site of uterine cancer origin is uncertain”. Radiology, 2011, 258, 785.

[16] Hori M., Kim T., Onishi H., Ueguchi T., Tatsumi M., Nakamoto A., et al.: “Uterine tumors: comparison of 3D versus 2D T2-Weighted turbo spin-echo MR imaging at 3.0 T-initial experience”. Radiology, 2011, 258, 154.

[17] Nakamoto Y., Eisbruch A., Achtyes E.D., Sugawara Y., Reynolds K.R., Johnston C.M., et al.: “Prognostic value of positron emission tomography Using F-l8-fluorodeoxyglucose in patients with cervical cancer undergoing radiotherapy”. Gynecol. Oncol., 2002, 84, 289.

[18] Sugita R., Ito K., Fujita N., Takahashi S.: “Diffusion-weighted MRI in abdominal oncology: clinical applications”. World J. Gastroenterol., 2010, 16, 832.

[19] Naganawa S., Sato C., Kumada H., Ishigaki T., Miura S., Takizawa O.: “Apparent diffusion coefficient in cervical cancer of the uterus: comparison with the normal uterine cervix”. Eur. Radiol., 2005, 15, 71.

[20] Kuang F., Yan Z., Wang J., Rao Z.: “The value of diffusion-weighted MRI to evaluate the response to radiochemotherapy for cervical cancer”. Magn. Reson. Imaging, 2014, 32, 342.