Prognostic impact of tumor size reduction assessed by magnetic resonance imaging after radiochemotherapy in patients with locally advanced cervical cancer

Abel Cordoba; Benedicte Durand; Alexandre Escande; Sophie Taieb; Mariem Ben Haj Amor; Marie Cecile Le Deley; Andree Michel; Florence Le Tinier; Delphine Hudry; Carlos Martinez; Eric Leblanc; Stephanie Becourt; Cyril Abdedaim; Lucie Bresson; Eric Lartigau; Xavier Mirabel; Fabrice Narducci

doi:10.3389/fonc.2022.1046087

Prognostic impact of tumor size reduction assessed by magnetic resonance imaging after radiochemotherapy in patients with locally advanced cervical cancer

Front Oncol. 2022 Dec 2:12:1046087. doi: 10.3389/fonc.2022.1046087. eCollection 2022.

Authors

Abel Cordoba¹, Benedicte Durand¹, Alexandre Escande¹, Sophie Taieb², Mariem Ben Haj Amor², Marie Cecile Le Deley³, Andree Michel³, Florence Le Tinier¹, Delphine Hudry⁴, Carlos Martinez⁴, Eric Leblanc⁴, Stephanie Becourt⁵, Cyril Abdedaim⁵, Lucie Bresson⁶, Eric Lartigau¹, Xavier Mirabel¹, Fabrice Narducci⁴

Affiliations

¹ Academic Radiotherapy Department, Oscar Lambret Center, Lille, France.
² Radiology Department, Oscar Lambret Center, Lille, France.
³ Biostatistics Department, Oscar Lambret Center, Lille, France.
⁴ Medical Oncology Department, Oscar Lambret Center, Lille, France.
⁵ Surgical Oncology Department, Oscar Lambret Center, Lille, France.
⁶ Department of Surgical Oncology, Polyclinique Henin Beaumont, Henin, France.

Abstract

Objective: Pelvic magnetic resonance imaging (MRI) is a key exam used for the initial assessment of loco-regional involvement of cervical cancer. In patients with locally advanced cervical cancer, MRI is used to evaluate the early response to radiochemotherapy before image-guided brachytherapy, the prognostic impact of which we aimed to study.

Methods: Patients with locally advanced cervical cancer treated using concomitant radiochemotherapy followed by closure treatment between January 2010 and December 2015 were included in this study. Clinical, anatomopathological, radiological, therapeutic, and follow-up data were evaluated.

Results: After applying the inclusion and exclusion criteria to the initially chosen 310 patients, 232 were included for evaluation (median follow-up period, 5.3 years). The median age was 50 years (range, 25-83 years), and the median tumor size was 47.5 mm (range, 0-105 mm). Based on the International Federation of Gynaecology and Obstetrics classification system, 9 patients were in stage IB2; 20, IB3; 2, IIA; 63, IIB; 4, IIIA; 7, IIIB; and 127, IIIC1 or higher. The re-evaluation MRI was performed at the median dose of 55.5 Gy, and median reduction in tumor size was 55.2% (range, -20-100%). There was a difference between the disease-free and overall survival rates of the patients with a tumor response greater or lesser than 50%. The risk of recurrence or death reduced by 39% in patients with a tumor size reduction >50%. The overall 5-year survival rate of patients with a response greater and lesser than 50% were 77.7% and 61.5%, respectively. The 5-year disease-free survival rate for these two groups of patients were 68.8% and 51.5%, respectively.

Conclusion: Our study confirms the prognostic impact of tumor size reduction using MRI data obtained after radiochemotherapy in patients with locally advanced cervical cancer.

Keywords: MRI; brachytherapy; locally advanced cervical cancer; radiochemotherapy; tumor shrinkage.