Cancer Res Treat.  2016 Jan;48(1):259-265. 10.4143/crt.2014.370.

An Alternative Triage Strategy Based on Preoperative MRI for Avoiding Trimodality Therapy in Stage IB Cervical Cancer

• Lee JY
• Youm J
• Kim JW
• Kim K
• Kim HJ
• Cho JY
• Kim MA
• Park NH
• Song YS

• KMID: 2152283
• DOI: http://doi.org/10.4143/crt.2014.370

Abstract

PURPOSE
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.
MATERIALS AND 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.
CONCLUSION
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.

Keyword

Uterine cervical neoplasms; Chemoradiotherapy; Radical hysterectomy; Trimodality therapy; Magnetic resonance imaging; Triage

MeSH Terms

Chemoradiotherapy
Cohort Studies
Humans
Hysterectomy
Lymph Nodes
Magnetic Resonance Imaging*
Neoplasm Metastasis
Retrospective Studies
Risk Factors
Seoul
Triage*
Uterine Cervical Neoplasms*

Figure

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  Fig. 1. A decision tree comparing the two strategies (primary surgery strategy and magnetic resonance imaging [MRI]–based strategy) for stage IB cervical cancer. Category 1 risk factors: positive resection margin, lymph node metastasis, parametrial involvement; category 2 risk factors: positive lymphovascular space invasion, deep stromal invasion, large tumor size.

Reference

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