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Prediction of disease progression following concurrent chemoradiotherapy for uterine cervical cancer: value of post-treatment diffusion-weighted imaging

European Radiology volume 26, pages 3272–3279 (2016)Cite this article

Abstract

Objective

To investigate the value of post-treatment diffusion-weighted imaging (DWI) for predicting disease progression following concurrent chemoradiotherapy (CCRT) for cervical cancer.

Methods

This retrospective study included 100 consecutive patients with locally advanced cervical cancer who underwent T2-weighted imaging (T2WI) and DWI 1 month after completing CCRT. The presence of residual tumour was independently determined on T2WI and T2WI plus DWI. The imaging findings were compared regarding prediction of disease progression.

Results

Disease progressed in 24 patients during follow-up. Forty-one and 22 patients were determined as having residual tumour on T2WI and T2WI plus DWI, respectively. Regarding prediction of disease progression, positive predictive values of imaging findings on T2WI and T2WI plus DWI were 32.7 % and 54.4 %, respectively, 1 year after treatment (P = 0.004), 37.2 % and 73.0 %, respectively, 2 years after treatment (P < 0.001), and 39.3 % and 72.7 %, respectively, 3 years after treatment (P = 0.001). Multivariate Cox regression analysis revealed that the presence of residual tumour on T2WI plus DWI was the independent predictor of disease progression (hazard ratio = 6.34, P < 0.001).

Conclusion

Post-treatment DWI offers an incremental value to T2WI in predicting disease progression after CCRT of cervical cancer.

Key Points

• T2WI alone has limited prognostic value after CCRT of cervical cancer.

• Adding DWI to T2WI improves prediction of disease progression after CCRT.

• Residual tumour on post-treatment T2WI plus DWI is associated with disease progression.

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Abbreviations

ADC:

Apparent diffusion coefficient

CCRT:

Concurrent chemoradiotherapy

DWI:

Diffusion-weighted imaging

EBRT:

External beam radiotherapy

FIGO:

International Federation of Gynecology and Obstetrics

FOV:

Field of view

HR:

Hazard ratio

ICR:

Intracavitary brachytherapy

LN:

Lymph node

NPV:

Negative predictive value

MRI:

Magnetic resonance imaging

PPV:

Positive predictive value

SCC:

Squamous cell carcinoma

SI:

Signal intensity

T2WI:

T2-weighted imaging

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Acknowledgments

The scientific guarantor of this publication is Dr. Won Jae Lee. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. This retrospective study was approved by our institutional review board, with a waiver of the requirement for informed consent.

No study subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Jung Jae Park, Chan Kyo Kim & Byung Kwan Park

  2. Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea

    Chan Kyo Kim

Authors
  1. Jung Jae Park
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  2. Chan Kyo Kim
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Correspondence to Chan Kyo Kim.

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Park, J.J., Kim, C.K. & Park, B.K. Prediction of disease progression following concurrent chemoradiotherapy for uterine cervical cancer: value of post-treatment diffusion-weighted imaging. Eur Radiol 26, 3272–3279 (2016). https://doi.org/10.1007/s00330-015-4156-7

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  • DOI: https://doi.org/10.1007/s00330-015-4156-7

Keywords

  • Magnetic resonance imaging
  • Diffusion-weighted imaging
  • Cervical cancer
  • Concurrent chemoradiotherapy
  • Disease progression