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Magnetic resonance imaging after external beam radiotherapy and concurrent chemotherapy for locally advanced cervical cancer helps to identify patients at risk of recurrence
  1. Martina Aida Angeles1,
  2. Pauline Baissas1,
  3. Eric Leblanc2,
  4. Amélie Lusque3,
  5. Gwénaël Ferron1,4,
  6. Anne Ducassou5,
  7. Carlos Martínez-Gómez1,6,
  8. Denis Querleu7 and
  9. Alejandra Martinez1,6
  1. 1 Department of Surgical Oncology, Institut Claudius Regaud - Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
  2. 2 Department of Gynecologic Oncology, Oscar Lambret Cancer Center, Toulouse, France
  3. 3 Biostatistics Unit, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse, Toulouse, France
  4. 4 INSERM CRCT 19, Toulouse, France
  5. 5 Department of Radiotherapy, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
  6. 6 INSERM CRCT 1, Toulouse, France
  7. 7 Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
  1. Correspondence to Dr Alejandra Martinez, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse 31300, France; martinez.alejandra{at}


Objective Tumor volume and regression after external beam radiotherapy have been shown to be accurate parameters to assess treatment response via magnetic resonance imaging (MRI). The aim of the study was to evaluate the prognostic value of tumor size reduction rate after external beam radiotherapy and chemotherapy prior to brachytherapy.

Methods Patients with locally advanced cervical cancer treated at two French comprehensive cancer centers between 1998 and 2010 were included. Treatment was pelvic external beam radiotherapy with platinum based chemotherapy followed by brachytherapy. Records were reviewed for demographic, clinical, imaging, treatment, and follow-up data. Anonymized linked data were used to ascertain the association between pre-external and post-external beam radiotherapy MRI results, and survival data.

Results 185 patients were included in the study. Median age at diagnosis was 45 years (range 26–72). 77 patients (41.6%) were International Federation of Gynecology and Obstetrics stage IB2-IIA disease and 108 patients (58.4%) were stage IIB-IVA. Median tumor size after external beam radiotherapy and chemotherapy was 2.0 cm (range 0.0–8.0) and median tumor size reduction rate was 62.4% (range 0.0–100.0%). Tumor size and tumor reduction rate at 45 Gy external beam radiotherapy MRI were significantly associated with local recurrence free survival (P<0.001), disease free survival, and overall survival (P<0.05). Tumor reduction rate ≥60% was significantly associated with a decreased risk of relapse and death (HR (95% CI) 0.21 (0.09 to 0.50), P=0.001 for local recurrence free survival; 0.48 (0.30 to 0.77) P=0.002 for disease free survival; and 0.51 (0.29 to 0.88), P=0.014 for overall survival).

Conclusions Tumor size reduction rate >60% between pre-therapeutic and post-therapeutic 45 Gy external beam radiotherapy with concurrent chemotherapy was associated with improved survival. Future studies may help to identify patients who may ultimately benefit from completion surgery, adjuvant chemotherapy, and closer follow-up.

  • imaging tool
  • uterine cervix cancer
  • concomitant chemoradiotherapy
  • treatment response assessment
  • risk of recurrence

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  • Contributors Conceptualization: MAA, PB, EL, GF, AD, CM-G, DQ, and AM. Methodology: MAA, PB, EL, AL, GF, AD, CM-G, DQ, and AM. Software, validation, and formal analysis: AL. Investigation: MAA, PB, EL, AL, GF, AD, CM-G, DQ, and AM. Resources: AL, DQ, and AM. Data curation: MAA, PB, and AL. Writing - original draft: MAA and PB. Writing - review and editing: EL, GF, AD, CM-G, DQ, and AM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Institutional review board approval was obtained from both participating centers.

  • Provenance and peer review Not commissioned; externally peer reviewed.