title: An Alternative Triage Strategy Based on Preoperative MRI for Avoiding Trimodality Therapy in Stage IB Cervical Cancer.
abstract: OBJECTIVE
  Adjuvant chemoradiation following primary surgery is frequently indicated in patients with stage IB cervical cancer. The aim of this study is to evaluate the role of a magnetic resonance imaging (MRI)-based strategy in avoiding trimodality therapy.
  
  
  METHODS
  We retrospectively reviewed all patients with stage IB cervical cancer treated initially with primary surgery at Seoul National University Hospital. We suggest an alternative triage strategy in which the primary treatment modality is determined based on preoperative MRI findings. Using this strategy, primary surgery is only indicated when there is no evidence of parametrial involvement (PMI) and lymph node metastasis (LNM) in the MRI results; when there is evidence of either or both of these factors, primary chemoradiation is selected. Assuming that this strategy is applied to our cohort, we evaluate how the rate of trimodality therapy is affected.
  
  
  RESULTS
  Of the 254 patients in our sample, 77 (30.3%) had at least one category 1 risk factor (PMI, LNM, positive resection margin) upon pathologic examination. If the MRI-based strategy had been applied to our cohort, 168 patients would have undergone primary surgery and 86 would have undergone primary chemoradiation. Only 25 patients (9.8%) would have required trimodality therapy based on an indication of at least one category 1 pathologic risk factor following radical hysterectomy.
  
  
  CONCLUSIONS
  The inclusion of MRI in the decision-making process for primary treatment modality could have reduced the number of patients requiring trimodality therapy based on the indication of a category 1 risk factor from 30.3% to 9.8% in our cohort.
authors: Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
authors: Jung-Yun
authors: JY
authors: Lee
authors: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors: Jina
authors: J
authors: Youm
authors: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors: Jae Weon
authors: JW
authors: Kim
authors: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors: Kidong
authors: K
authors: Kim
authors: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
authors: Hak Jae
authors: HJ
authors: Kim
authors: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
authors: Jeong Yeon
authors: JY
authors: Cho
authors: Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.
authors: Min A
authors: MA
authors: Kim
authors: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors: Noh Hyun
authors: NH
authors: Park
authors: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors: Yong-Sang
authors: YS
authors: Song
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D000066491:Clinical Decision-Making / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D066106:Seoul; D014218:Triage / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*
keywords: Chemoradiotherapy; Magnetic resonance imaging; Radical hysterectomy; Triage; Trimodality therapy; Uterine cervical neoplasms