title: Role of conventional and diffusion weighted MRI in predicting treatment response after low dose radiation and chemotherapy in locally advanced carcinoma cervix.
abstract: OBJECTIVE
  To assess the diagnostic performance of conventional and diffusion weighted (DWI) magnetic resonance imaging (MRI) in predicting response in locally advanced cervical cancer.
  
  
  METHODS
  Total 24 patients with stage IIB-IIIB squamous cell carcinoma cervix were treated with initial two cycles of paclitaxel and carboplatin and concurrent low dose radiotherapy prior to standard chemoradiation. Response was assessed clinically and radiologically after 3 weeks of initial treatment. Volumetric and functional parameters derived from conventional and diffusion weighted MRI, due to treatment were measured.
  
  
  RESULTS
  Significant reduction of GTV was noted in MRI (54 cm(3) vs. 11 cm(3), p < 0.01) and DWI (44 cm(3) vs. 6 cm(3), p < 0.01, ΔADC = 0.49 × 10(-3)mm(2)/sec, p < 0.01) after treatment. Tumor volume reduction rate (TVRR) in DWI was significantly higher in pathological good responders (p = 0.03). In this group both mean post treatment apparent diffusion coefficient (ADC) value and ΔADC were significantly higher (p = 0.01 and p = 0.03). ADC was a good predictor for pathological response (area under receiver operating characteristic curve (ROC) 0.814).
  
  
  CONCLUSIONS
  TVRR (DWI) and ΔADC can be used as a predictor of early pathological response. Complete response based on DWI, could be a useful predictor of long term disease control.
authors.affiliation: Department of Radiation Oncology, Christian Medical College Vellore, India. Electronic address: saikat@cmcvellore.ac.in.
authors.forename: Saikat
authors.initials: S
authors.lastname: Das
authors.affiliation: Department of Radiology, Christian Medical College Vellore, India.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Chandramohan
authors.affiliation: Department of Radiation Oncology, Christian Medical College Vellore, India.
authors.forename: Jeba Karunya Rami
authors.initials: JK
authors.lastname: Reddy
authors.affiliation: Department of General Pathology, Christian Medical College Vellore, India.
authors.forename: Sramana
authors.initials: S
authors.lastname: Mukhopadhyay
authors.affiliation: Department of General Pathology, Christian Medical College Vellore, India.
authors.forename: Ramani Manoj
authors.initials: RM
authors.lastname: Kumar
authors.affiliation: Department of Radiation Oncology, Christian Medical College Vellore, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Isiah
authors.affiliation: Department of Radiation Oncology, Christian Medical College Vellore, India.
authors.forename: Subhashini
authors.initials: S
authors.lastname: John
authors.affiliation: Department of Nuclear Medicine, Christian Medical College Vellore, India.
authors.forename: Regi
authors.initials: R
authors.lastname: Oommen
authors.affiliation: Department of Biostatistics, Christian Medical College Vellore, India.
authors.forename: Visalakshi
authors.initials: V
authors.lastname: Jeyaseelan
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D011879:Radiotherapy Dosage; D015203:Reproducibility of Results; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*
keywords: Functional MRI; Low dose radiation; Neoadjuvant therapy; Uterine Cervix Neoplasm