CERVICAL-CANCER RESPONSE TO NEOADJUVANT THERAPY - MR-IMAGING ASSESSMENT

PURPOSE: To determine the accuracy of magnetic resonance (MR) imaging in evaluating the invasive cervical carcinoma response to concurrent c hemotherapy and radiation therapy. MATERIALS AND METHODS: MR imaging w as performed before and after concurrent chemotherapy and radiation th erapy in 18 patients with locally invasive cervical carcinoma. Surgery followed neoadjuvant therapy in all patients. The presence of a lesio n, signal intensity, zonal anatomy integrity, vaginal and parametrial invasion, and lymph node enlargement was determined. Posttreatment MR and histopathologic findings were correlated. RESULTS: Fourteen patien ts had histopathologic confirmation of MR findings: Twelve had true-ne gative and two had true-positive findings. (Two had microscopic neopla stic foci beyond the spatial resolution of MR images; these foci do no t change Surgical treatment planning and probably do not influence pro gnosis. Therefore, these two patients were considered to have complete response.) Four patients had false-positive findings; the hyperintens e lesion on posttreatment MR images was due to a tunnel cluster patter n (focal hyperplasia of the endocervical glands with inflammation) in three patients and necrosis in one patient, without any evidence of ne oplastic tissue. Thirty-three of 36 parametrial halves and 67 of 72 va ginal fornices were correctly interpreted on posttreatment images. Inv olvement of three parametrial halves and five fornices was overestimat ed at MR, because edema or inflammation was not distinguishable from t umor. CONCLUSION: MR imaging is 78% accurate in evaluation of tumor re sponse; in 22% of patients, however, benign conditions were not distin guishable from tumor.