Magnetic resonance imaging in carcinoma cervix- does it have a prognostic relevance

PURPOSE: To evaluate the prognostic relevance of tumor size as determined on Magnetic Resonance Imaging (MRI) in cervical cancer. METHODS AND MATERIALS: A total of 70 consecutive patients were included in the study. 15 patients underwent surgery alone (Group A), 27 patients underwent surgery followed by adjuvant radiation (Group B), 14 patients underwent concomitant chemo radiation (Group C), and 14 patients underwent radical radiation alone (Group D). External radiation was delivered followed by intra cavitary brachytherapy. Serial MRI scans were performed in all patients before and after completion of treatment on a 1.0 Tesla MRI scanner. Patients were divided into three groups based upon MR volumes < 40 cc, 40-99 cc and > 100 cc. A correlation between MR volume, FIGO stage, disease free survival (DFS) and overall survival (OS) was done. Disease free and overall survivals were calculated using Kaplan Meier survival curves according to stage, MR volume and treatment protocol. RESULTS: In group I (MR volume < 40 cc), 44% of patients had stage I disease, 47% of patients with stage II and 9% patients had stage III disease. In group II (MR volume 40-99 cc), 35% patients had stage I, 45% had stage II disease and 10% had stage III and IV disease each. In group III (MR volume > 100 cc), 57% patients had stage II, 14% had stage III and 29% patients had stage IV disease. The DFS and OS did not achieve a level of statistical significance when evaluated as per protocol [DFS at p = 0.0685 and OS p = 0.3242], however a statistical significance was seen when DFS and OS were evaluated according to MR volumes [DFS, p = 0.0015 and OS, p = 0.0001]. CONCLUSION: In cervical cancer, the volume of disease as assessed on MRI may be a better prognostic indicator than FIGO staging and needs further evaluation