Aim: Carcinoma (Ca) cervix is staged clinically and early stages undergo radical hysterectomy but many cases need adjuvant radiotherapy (RT)-based on the high and intermediate risk factors on histopathology, thus increasing morbidity and cost. This study evaluated the role of preoperative MRI in triaging patients of early stage operable Ca cervix to identify patients likely to require adjuvant RT after surgery.
Materials and methods: In total, 28 cases of operable Ca cervix clinically staged as I B1 underwent a preoperative MRI and based on the criteria of tumor size, depth of stromal invasion (DOSI), and parametrial involvement were triaged into low and high risk for receiving adjuvant treatment. They underwent radical hysterectomy and the specimen was subjected to pathologic examination. The pathologic characteristics and need for adjuvant treatment were studied.
Results: MRI evaluation could accurately evaluate the tumor size and DOSI and parametrial metastasis in all cases of Stage B1 Ca cervix. Based on these risk criteria, the cases were triaged into low risk (13) and high risk (15) to predict the requirement of adjuvant treatment. There was a statistically significant difference in the requirement of adjuvant RT in the two risk groups (15.38 vs 66.66%).
Conclusion: MRI can effectively estimate the tumor size and DOSI and parametrial metastasis in early stage (Stage I B1) Ca cervix and can further triage them to high- and low-risk groups to effectively predict the requirement of postoperative adjuvant RT.
Clinical significance: Surgery could be avoided in patients likely to require adjuvant RT by this triage, thus reducing morbidity.
Narayan K, McKenzie A, Fisher R, et al. Estimation of tumor volume in cervical cancer by magnetic resonance imaging. Am J Clin Oncol 2003;26(5):e163–e168. DOI: 10.1097/01.coc.0000091358.78047.b5.
Hoffman MS, Cardosi RJ, Roberts WS, et al. Accuracy of pelvic examination in the assessment of patients with operable cervical cancer. Am J Obstet Gynecol 2004;190(4):986–993. DOI: 10.1016/j.ajog.2004.01.019.
Lee YK, Han SS, Kim JW, et al. Value of pelvic examination and imaging modality for the evaluation of tumor size in cervical cancer. J Gynecol Oncol 2008;19(2):108–112. DOI: 10.3802/jgo.2008.19.2.108.
Reade CJ, Eiriksson LR, Covens A. Surgery for early stage cervical cancer: how radical should it be? Gynecol Oncol 2013;131(1):222–230. DOI: 10.1016/j.ygyno.2013.07.078.
Eifel P, Morris M, Wharton J, et al. The influence of tumor size and morphology on the outcome of patients with FIGO stage IB squamous cell carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 1994;29(1):9–16. DOI: 10.1016/0360-3016(94)90220-8.
Inoue T. Prognostic significance of the depth of invasion relating to nodal metastases, parametrial extension, and cell types. A study of 628 cases with Stage IB, IIA, and IIB cervical carcinoma. Cancer 1984;54:3035–3042. https://doi.org/10.1002/1097-0142(19841215)54:12<3035::AID-CNCR2820541236>3.0.CO;2-4.
Mitchell DG, Snyder B, Coakley F, et al. Early in-vasive cervical cancer: tumor delineation by magnetic resonance imaging, computed tomography, and clinical examination, verified by pathologic results, in the ACRIN 6651/GOG 183 Intergroup Study. J Clin Oncol 2006;24(36):5687–5694. DOI: 10.1200/JCO.2006.07.4799.
Chang SJ, Bristow RE, Ryu HS. A model for prediction of parametrial involvement and feasibility of less radical resection of parametrium in patients with FIGO stage IB1 cervical cancer. Gynecol Oncol 2012;126(1):82–86. DOI: 10.1016/j.ygyno.2012.04.016.
Frumovitz M, Sun CC, Schmeler KM, et al. Parametrial involvement in radical hysterec-tomy specimens for women with early-stage cervical cancer. Obstet Gynecol 2009;114(1):93–99. DOI: 10.1097/AOG.0b013e3181ab474d.
Kodama J, Fukushima C, Kusumoto T, et al. Stage IB1 cervical cancer patients with an MRI-measured tumor size < or = 2 cm might be candidates for less-radical surgery. Eur J Gynaecol Oncol 2013;34(1):39–41. PMID: 23589998.
Gemer O, Eitan R, Gdalevich M, et al. Can parametrectomy be avoided in early cervical cancer? An algorithm for the identification of patients at low risk for parametrial involvement. Eur J Surg Oncol 2013;39(1):76–80. DOI: 10.1016/j.ejso.2012.10.013.
Bhatla N, Aoki D, Sharma DN, et al. Cancer of the cervix uteri. Int J Gynaecol Obstet 2018;143(Suppl 2):22–36. DOI: 10.1002/ijgo.12611.
Nicolet V, Carignan L, Bourdon F, et al. MR imaging of cervical carcinoma: a practical staging approach. Radiographics 2000;20(6):1539–1549. DOI: 10.1148/radiographics.20.6.g00nv111539.
Kamimori T, Sakamoto K, Fujiwara K, et al. Parametrial involvement in FIGO stage IB1 cervical carcinoma diagnostic impact of tumor diameter in preoperative magnetic resonance imaging. Int J Gynecol Cancer 2011;21(2):349–354. DOI: 10.1097/IGC.0b013e3182072eea.
Jena A, Oberoi R, Rawal S, et al. Parametrial invasion in carcinoma of cervix: role of MRI measured tumour volume. Br J Radiol 2005;78(936):1075–1077. DOI: 10.1259/bjr/36116150.
Ramirez PT, Pareja R, Rendon GJ, et al. Management of low-risk early-stage cervical cancer: should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care? Gynecol Oncol 2014;132(1):254–259. DOI: 10.1016/j.ygyno.2013.09.004.
Landoni F, Bocciolone L, Perego P, et al. Cancer of the cervix, FIGO stages IB and IIA: patterns of local growth and paracervical extension. Int J Gynecol Cancer 1995;5(5):329–334. DOI: 10.1046/j.1525-1438.1995.05050329.x.
Hricak H, Gatsonis C, Chi DS, et al. Role of imaging in pretreatment evaluation of early invasive cervical cancer: results of the intergroup study American College of Radiology Imaging Network 6651-Gynecologic Oncology Group 183. J Clin Oncol 2005;23(36):9329–9337. DOI: 10.1200/JCO.2005.02.0354.
Schmeler KM, Frumovitz M, Ramirez PT. Conservative management of early stage cervical cancer: is there a role for less radical surgery? Gynecol Oncol 2011;120(3):321–325. DOI: 10.1016/j.ygyno.2010.12.352.
Covens A. Gynecological ooncology group protocol 278. Available from: http://www.gcig.igcs.org/Spring2012/2012_june_cervix_cancer_committee.pdf.
Plante M. The SHAPE trial. Available from: http://www.gcig.igcs.org/Spring2012/2012_june_shape_trial.pdf.
Jung DC, Kim MK, Kang S, et al. Identification of a patient group at low risk for parametrial invasion in early-stage cervical cancer. Gynecol Oncol 2010;119(3):426–430. DOI: 10.1016/j.ygyno.2010.08.005.