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Value of Magnetic Resonance and 18FDG PET-CT in Predicting Tumor Response and Resectability of Primary Locally Advanced Cervical Cancer After Treatment With Intensity-Modulated Arc Therapy: A Prospective Pathology-Matched Study
  1. Katrien Vandecasteele, MD*,
  2. Louke Delrue, MD,
  3. Bieke Lambert, MD, PhD,
  4. Amin Makar, MD, PhD§,
  5. Kathleen Lambein, MD,
  6. Hannelore Denys, MD, PhD,
  7. Philippe Tummers, MD§,
  8. Rudy Van den Broecke, MD, PhD§,
  9. Geert Villeirs, MD, PhD* and
  10. Gert De Meerleer, MD, PhD*
  1. *Departments of Radiology Oncology,
  2. Departments of Radiology,
  3. Departments of Nuclear Medicine,
  4. §Departments of Gynaecology,
  5. Departments of Pathology, and
  6. Departments of Medical Oncology, Gent University Hospital, Belgium.
  1. Address correspondence and reprint requests to Katrien Vandecasteele, MD, Department of Radiation Oncology, Gent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium. E-mail:


Objective To report on the value of magnetic resonance imaging (MRI) and 2-deoxy-2-[18] fluoro-D-glucose positron emission tomography computed tomography (18FDG PET-CT) in predicting resectability and pathological response of primary locally advanced cervical cancer after neoadjuvant intensity-modulated arc therapy (IMAT) with or without cisplatin (C).

Methods and Materials Twenty-seven patients with International Federation of Gynecology and Obstetrics stages IB2 to IVA cervical cancer were treated with IMAT-C followed by extrafascial hysterectomy (EH). All patients received MRI and 18FDG PET-CT after IMAT-C. The end points of this study were to:

  1. Assess the ability of MRI to predict negative surgical margins (R0).

  2. Assess the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI in predicting the following situation at the EH specimen: “no residual disease or minimal microscopically visible residual tumor.”

  3. Assess the sensitivity, specificity, PPV, and NPV value of 18FDG PET-CT in predicting “no residual viable tumor cells” at the EH specimen.

Results An R0 resection was obtained in all patients. None of the EH specimens contained macroscopically visible tumor. In 13 patients, no viable tumor cells were found and only 14 had residual microscopic disease. Twenty-four of 27 MRIs were able to correctly predict R0 resection. A negative MRI was 100% predictive for the end point “R0 resection.” The specificity and NPV of MRI (end point 2) were 74% and 100%, respectively. No sensitivity or PPV could be calculated. The sensitivity, specificity, PPV, and NPV of 18FDG PET-CT were 29%, 62%, 44%, and 44%, respectively (end point 3).

Conclusions A negative MRI after IMAT-C predicts 100% correctly for R0 resection. The role of 18FDG PET-CT in predicting viable tumor cells at EH specimen is at least debatable.

  • Locally advanced cervical cancer
  • MRI
  • 18FDG PET-CT
  • Prediction
  • Tumor response

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  • Note: The first 2 authors contributed equally to this manuscript.

  • The authors have no conflict of interest.