The Role of 2D/3D Ultrasound to Assess the Response to Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer
- 4 September 2020
- journal article
- research article
- Published by S. Karger AG in Oncology
- Vol. 98 (11), 807-813
- https://doi.org/10.1159/000505426
Abstract
Introduction: Different imaging techniques were introduced to improve preoperative clinical staging of locally advanced cervical cancer (LACC) with transvaginal ultrasound (TV-US) or transrectal ultrasound (TR-US) representing a promising staging technique in the evaluation of the local extension of the disease for invasive tumors. The aim of this study was to evaluate the response to neoadjuvant chemotherapy (NACT) in LACC by 2D/3D ultrasound examination. Materials and Methods: We prospectively enrolled patients affected by histologically and clinically confirmed LACC. All patients were scheduled for 3 cycles of platinum-based NACT followed by radical surgery. The ultrasound examination was performed at every cycle and within 10 days before surgery. The parameters evaluated were: the volume (automatically computed by the VOCAL software) and the mass vascularization. Results: From March 2010 to March 2019, 157 women were recruited. Among these patients, 12 of them were excluded: 6 for the presence of distant metastases, 4 for rare histology, and 2 for severe comorbidities not allowing the protocol treatment. Seventeen patients after NACT were excluded because they were not amenable to radical surgery. Thus, 128 were considered for the final analysis of whom 106 (83%) were considered responders to NACT by histology. The sensibility and specificity of ultrasound with regard to the response to chemotherapy compared to histological specimen were 94 and 82%, respectively, with an accuracy of 92%. The positive predictive value and negative predictive value were 96 and 75%, respectively. Finally, we found that nonetheless there was a trend towards a continuous response to chemotherapy among patients who were considered responders to NACT at pathological examination; the major volume and vascularization index (VI) reduction were observed during the first 2 cycles (74, 71% and 47, 63%, respectively). On the contrary, non-responders showed an initial reduction of the VI (4.86 consisting of 33%, 95% CI 0.79–8.92, p = 0.013), but no significant modification in tumour volume along NACT. Conclusion: 2D/3D ultrasound is useful in assessing early response to NACT in patients with LACC.Keywords
This publication has 27 references indexed in Scilit:
- Early‐stage cervical cancer: agreement between ultrasound and histopathological findings with regard to tumor size and extent of local diseaseUltrasound in Obstetrics & Gynecology, 2011
- Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-upAnnals of Oncology, 2010
- Transvaginal ultrasonography and magnetic resonance imaging for assessment of presence, size and extent of invasive cervical cancerUltrasound in Obstetrics & Gynecology, 2009
- New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1)European Journal of Cancer, 2009
- Neoangiogenesis in early cervical cancer: Correlation between color Doppler findings and risk factors. A prospective observational studyWorld Journal of Surgical Oncology, 2008
- Transrectal ultrasound and magnetic resonance imaging in staging of early cervical cancerInternational Journal of Gynecologic Cancer, 2008
- MAGE-A and NY-ESO-1 expression in cervical cancer: Prognostic factors and effects of chemotherapyAmerican Journal of Obstetrics and Gynecology, 2008
- An update in neoadjuvant chemotherapy in cervical cancerGynecologic Oncology, 2007
- Transvaginal color Doppler sonography for predicting response to concurrent chemoradiotherapy for locally advanced cervical carcinomaJournal of Clinical Ultrasound, 2004
- Neoadjuvant chemotherapy for locally advanced cervical cancer: a systematic review and meta-analysis of individual patient data from 21 randomised trialsEuropean Journal of Cancer, 2003