title: 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.
abstract: 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
  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 FDG PET-CT in predicting viable tumor cells at EH specimen is at least debatable.
authors.affiliation: Department of Radiology Oncology, Gent University Hospital, Belgium. katrien.vandecasteele@uzgent.be
authors.forename: Katrien
authors.initials: K
authors.lastname: Vandecasteele
authors.forename: Louke
authors.initials: L
authors.lastname: Delrue
authors.forename: Bieke
authors.initials: B
authors.lastname: Lambert
authors.forename: Amin
authors.initials: A
authors.lastname: Makar
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lambein
authors.forename: Hannelore
authors.initials: H
authors.lastname: Denys
authors.forename: Philippe
authors.initials: P
authors.lastname: Tummers
authors.forename: Rudy
authors.initials: R
authors.lastname: Van den Broecke
authors.forename: Geert
authors.initials: G
authors.lastname: Villeirs
authors.forename: Gert
authors.initials: G
authors.lastname: De Meerleer
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy* / Q000601:surgery
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18