The PRICE study: The role of conventional and diffusion-weighted magnetic resonance imaging in assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery

Eur Radiol. 2018 Jun;28(6):2425-2435. doi: 10.1007/s00330-017-5233-x. Epub 2018 Jan 9.


Objectives: To analyse the role of DW-MRI in early prediction of pathologically-assessed residual disease in locally-advanced cervical cancer (LACC) treated with neoadjuvant chemoradiotherapy followed by radical surgery.

Methods: Between October 2010-June 2014, 108 women with histologically-proven cervical cancer were screened; 88 were included in this study. Tumour volume (TV) and ADCmean were measured before (baseline-MRI) and after 2 weeks of chemoradiotherapy (early-MRI). According to histopathology, treatment response was classified as complete (CR) or partial (PR). Comparisons were made with Mann-Whitney, Wilcoxon and χ2 tests. ROC curves were generated for statistically significant parameters on univariate analysis.

Results: CR and PR were documented in 40 and 48 patients. At baseline-MRI, TV did not differ between groups. At early-MRI, TV was higher in PR than in CR (p=0.001). ΔTV reduction after treatment was lower in PR than in CR (63.6% vs. 81.1%; p=0.001). At baseline-MRI and early-MRI, ADCmean did not differ between PR and CR. ROC curve showed best cut-off for predicting pathological PR was ΔTV reduction of 73% with sensitivity, specificity, accuracy, NPV, PPV of 73%, 72.5%, 72.7%, 76%, 69%.

Conclusions: TV evaluated before and early after treatment could predict pathological response in LACC. ADCmean did not correlate with treatment outcome.

Key points: • Early-MRI tumour volume assessment could predict pathological response to nCRT in LACC. • Best cut-off for predicting pathological PR was ΔTV reduction of 73 %. • Early-MRI ADC mean measurements did not correlate with treatment outcome.

Keywords: Chemoradiotherapy · Diffusion magnetic resonance imaging; Magnetic resonance imaging; Tumour volume; Uterine cervical neoplasms.

MeSH terms

  • Adult
  • Aged
  • Chemoradiotherapy
  • Combined Modality Therapy
  • Diffusion Magnetic Resonance Imaging / methods*
  • Female
  • Humans
  • Hysterectomy*
  • Magnetic Resonance Imaging / methods
  • Middle Aged
  • Neoadjuvant Therapy
  • Neoplasm Staging*
  • Postoperative Care / methods*
  • Prospective Studies
  • ROC Curve
  • Tumor Burden*
  • Uterine Cervical Neoplasms / pathology*
  • Uterine Cervical Neoplasms / therapy