title: Monitoring treatment response in patients undergoing chemoradiotherapy for locally advanced uterine cervical cancer by additional diffusion-weighted imaging: A systematic review.
abstract: OBJECTIVE
  To determine the role of diffusion-weighted imaging (DWI) in evaluating response to chemoradiotherapy in patients with uterine cervical cancer.
  
  
  METHODS
  A search was performed in MEDLINE and EMBASE from January 2005 to April 2014 using search terms related to uterine cervical cancer and magnetic resonance imaging. Two reviewers independently checked the studies for inclusion criteria, patient population, magnetic resonance imaging (MRI) parameters and analysis, follow-up for treatment response, apparent diffusion coefficient (ADC) values, and quality assessment.
  
  
  RESULTS
  Nine studies with 231 patients were included. International Federation of Gynecology and Obstetrics (FIGO) staging varied from Ib1 to IVb and mean age from 42 to 67 years. When baseline and after treatment pooled mean ADC values were compared, complete responders showed higher increase (0.88 × 10(-3) mm(2) /s to 1.50 × 10(-3) mm(2) /s; Δ0.62 × 10(-3) mm(2) /s) compared to partial responders (1.03 × 10(-3) mm(2) /s to 1.42 × 10(-3) mm(2) /s; Δ0.39 × 10(-3) mm(2) /s) and to nonresponders (0.87 × 10(-3) mm(2) /s to 1.18 × 10(-3) mm(2) /s; Δ0.31 × 10(-3) mm(2) /s). Individual studies also showed that an ADC of ≤0.31 was only seen in nonresponders and an increase of ADC of ≥0.62 was only seen in complete responders. The number of datasets for monitoring early response (at 2 or 4 weeks of therapy) were low and comparable increases in pooled mean ADC values between complete responders, partial responders, and nonresponders were seen. Data on quality assessment showed high risk of bias concerning patient selection, DWI evaluation, and flow and timing.
  
  
  CONCLUSIONS
  DWI can be used for monitoring treatment response after treatment, but not for the early response monitoring.
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Sanne M
authors.initials: SM
authors.lastname: Schreuder
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Rutger
authors.initials: R
authors.lastname: Lensing
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Shandra
authors.initials: S
authors.lastname: Bipat
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D002986:Clinical Trials as Topic; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009362:Neoplasm Metastasis; D012107:Research Design; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*
keywords: cervix neoplasm; diffusion weighted imaging; magnetic resonance imaging; response monitoring