Prediction of early response to concurrent chemoradiotherapy in cervical cancer: Value of multi-parameter MRI combined with clinical prognostic factors.

PURPOSE

This study aimed to investigate the prediction of early response to concurrent chemoradiotherapy (CCRT) through a combination of pretreatment multi-parametric magnetic resonance imaging (MRI) with clinical prognostic factors (CPF) in cervical cancer patients.

METHODS

Eighty-five patients with pathologically confirmed cervical cancer underwent conventional MRI, intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI), and dynamic contrast-enhanced MRI (DCE-MRI) before CCRT. The patients were divided into non- and residual tumor groups according to post-treatment MRI. Univariable and multivariable analyses were performed to pretreatment MRI parameters and CPF between the two groups, and optimal thresholds and predictive performance for post-treatment residual tumor occurrence were estimated by drawing the receiver operating characteristic (ROC) curve.

RESULTS

There were 52 patients in non- and 33 in residual group. The residual group showed a lower perfusion fraction (f) value and volume transfer constant (K) value, a higher apparent diffusion coefficient (ADC) value, diffusion coefficient (D) value and volume fraction of extravascular extracellular space (V) value, and a higher stage than the non-residual tumor group (all P < .05). D, K, V and stage were independent prognostic factors. The combination of D, K and V improved the diagnostic performance compared with individual MRI parameters. A further combination of these three MRI parameters with stage exhibited the highest predictive performance.

CONCLUSIONS

Pretreatment D, K, V and stage were independent prognostic factors for cervical cancer. The predictive capacity of multi-parametric MRI was superior to individual MRI parameters. The combination of multi-parametric MRI with CPF further improved the predictive performance.