Cervical cancer (CC) is the fourth most frequent tumor and the fourth cause of cancer death among women worldwide, accounting for about 569,847 new cases and 311,365 deaths every year. According to International guidelines, standard treatment for CC consists of surgery in early stage tumors, concomitant chemoradiotherapy or neoadjuvant chemotherapy (NAC) followed by radical surgery in locally advanced disease and chemotherapy alone for metastatic or recurrent disease.
The optimal treatment for cervical cancer depends in large part on the accuracy of clinical staging at presentation. In addition, clinical staging plays a fundamental role in cancer research, such as for the design of clinical trials and the evaluation of treatment outcomes. Previously, clinical staging of cervical cancer relied on pelvic examination and several other simple radiologic examinations, according to the International Federation of Gynecology and Obstetrics (FIGO). The accuracy of clinical staging was reported to range between 47% and 83.2% in cervical cancer. In 2018, clinical staging of cervical cancer underwent a major revision by FIGO. Radiologic examinations such as magnetic resonance imaging (MRI) are allowed to be combined with clinical staging where available. Because of the high soft tissue resolution and the increasing availability, the application of MRI in clinical staging is becoming common practice.
MRI with its standard sequences allows staging of cervical cancer, through a subjective and qualitative evaluation of images. Today some new MRI sequences (like IVIM and spectroscopy) used in research allow to obtain quantitative and repeatable tumor parameters.
The aim of our study is to determine the diagnostic performance of IVIM DWI diffusion sequences (intravoxel incoherent motion) and spectroscopy imaging parameters in predicting the response to neoadjuvant chemotherapy in patients with cervical cancer, using histogram analysis derived from whole-tumor volumes.
Standard primary treatment for locally advanced cervical cancer (LACC) is radiotherapy (RT) with concomitant platinum-based chemotherapy (CT), which leads to a 30-50 % decrease in the risk of death compared to radiotherapy alone. Over the last decades, in order to improve the prognosis of these patients, the use of neoadjuvant chemotherapy (NACT) followed by radical surgery (RS) has emerged as a valid alternative with promising results. Recently, many investigators proposed different therapeutic strategies in the attempt to improve the prognosis in patients with LACC and, in particular, in those at high risk of recurrence. For this reason, in the last decades, some Authors advocated a new strategy in the attempt to reduce both local and distant recurrences. Despite these therapeutic options, the risk of recurrence remains high.
In this scenario, it remains essential to find new elements.
The spectroscopy and IVIM have been already studied in different kinds of cancers, such us breast cancer and rectal cancer.
In these studies, new data on different signaling were found, but there was no evidence as regards the response to chemotherapy.
The aim of this study is to offer new prognostic radiologic factors of disease and a new therapy in the future in order to improve the overall survival of patients with cervical cancer.