Uterine cervical carcinoma treated with chemoradiotherapy: impact of three-month MRI follow-up on clinical management and outcome

Abstract

Aim: The aim of this study was to evaluate the impact of MRI performed three months after treatment on further follow-up interventions and outcome in patients with uterine cervical carcinoma treated with definitive chemoradiotherapy.

Methods: Sixty consecutive women diagnosed with uterine cervical cancer FIGO 2009 stage IB1-IVA during 2011-2012 treated with definitive chemoradiotherapy/radiotherapy with curative intent at the Department of Gynaecological Oncology at Karolinska University Hospital were retrospectively included. A review of MRI reports and medical records with focus on follow-up interventions associated to imaging was performed.

Results: On follow-up MRI three months post treatment, 29/60 women had complete remission (mrCR), 24/60 women had partial remission (mrPR) and 7/60 had progressive disease (mrPD). In patients with mrCR, no additional procedures were performed. The group with mrPR had 27 additional MRIs, 3 PET/CT examinations and 9 biopsy procedures, none leading to diagnosis of residual tumour. Locoregional control rate was 96% after 6.5 months (median). No patient had cervical relapse only; 2/53 had cervical relapse in combination with non-regional lymph nodes and distant relapse. There was no statistically significant difference in overall survival between patients with mrCR and mrPR (HR = 2.2, P = 0.21).

Conclusion: Patients with residual changes on MRI at three months post treatment have a low risk for locoregional recurrence. If this is not recognised, follow-up MRI results in unnecessary additional procedures with low impact on treatment outcome. Further studies are needed regarding the most appropriate imaging modality and timing of post-treatment evaluation.

Keywords

Uterine cervical carcinoma / chemoradiotherapy / locoregional control / MRI / post-radiation changes / relapse / residual tumour / natural course

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