Most of the patients were among 41-60 years (63.3 %),
with mean age of 51.63±9.63 years .
Distribution of patients according treatment type
Treatment
|
No.
of patients(n=30)
|
%
|
CCRT
|
22
|
73.3
|
Neoadjuvant chemotherapy+CCR
|
8
|
26.7
|
Total
|
30
|
100.0
|
Distribution of patients according to treatment response
Response group
|
No.
of patients(n=30)
|
%
|
Complete Response
|
2
|
6.7
|
Good Response
|
17
|
56.7
|
Partial Response
|
11
|
36.7
|
Total
|
30
|
100.0
|
Pre,
mid and post treatment comparative response evaluation of tumour size,
volume and ADC. Table 1.
A significant difference was found between pre-Tx and mid-Tx and between pre-Tx and post-Tx,
mean tumour diameter,
volumes and tumour ADC's.
Correlation of %Tumor ADC change with % tumor size and volume responses:Table 2,3&4
Comparison of tumor diameter and % size response between the response groups:
The post treatment mean tumor diameter of the complete response (CR) and good response (GR) groups were significantly lower than that of partial response (PR) group (p<0.001).
The % final size response of the complete response (CR) and good response (GR) groups were significantly greater than that of partial response (PR) group (p<0.001).
Comparison of tumor volume and % volume response between the response groups:
The pretreatment mean tumor volume of the complete response (CR) and good response(GR) groups were larger than that of partial response (PR) group,
but there was no significant difference between them(p=0.418).
The mid treatment and post treatment mean tumor volume of the complete response (CR) and good response (GR) groups were lower than that of partial response (PR) group with suggestive significance statistically (p=0.094 ;p=0.004).
Comparison of tumor ADC and % ADC change between the response groups:
The pretreatment; mid treatment and post treatment mean tumor ADC of the complete response (CR) and good response (GR) groups were statistically significant than that of partial response (PR) group (p=0.030; p=0.042; and p=0.004 respectively).
Comparison of tumor,
gluteus muscle and rectal mucosa ADC at each therapeutic time:
There was statistically significant difference between the mean ADC values of tumor to gluteus muscle and rectal mucosa at pre-Tx and mid-Tx ( both P= 0.0001 and P= 0.0004 respectively) but there was no significant difference between the ADC values at post –Tx (P = 0.76 & P = 1.5 respectively).
Disscussion:
Several studies have found that the mean ADC value of cervical tumor is significantly lower than that of normal cervical tissue.
Harry et al.
in a recent study has evaluated DW-MRI as an early response indicator in women receiving chemoradiation for advanced cervical cancer.
In their study,
DW-MRI was carried out in 20 women with advanced cervical cancer prior to chemoradiation,
and repeated 2 weeks into therapy and again at the conclusion of therapy.
The mean ADC values for each measurement were correlated with final tumour response as determined by volumetric assessment of tumour size using MR imaging and conventional clinical response(48).
It was found that the ADC values after 2 weeks of therapy correlated with eventual MR response (p = 0.048) and clinical response (p = 0.009),
as did the change in ADC values after 2 weeks of therapy (p = 0.01 for MR response; p = 0.03 for clinical response).
Hyun et al found that tumor ADCs at mid-Tx had a significant correlation with the final size response but pre-Tx ADC values were not associated with final size response(3).
Both pre and mid-Tx ADCs did not show significant correlation with the final tumour volume response.
The changes in tumor ADCs at mid –Tx had a significant correlation with the final size response ,
however mid –Tx ADC changes were not associated with the final volume response.
Hyun et al demonstrated no statistical difference in mean tumor ADCs at pre-Tx between responder and non-responder groups.
Correlations obtained in our study were consistent with that of Harry and Hyun with a significant and moderate positive linear correlation between the tumor ADCs at pre-Tx,
mid-Tx and post –Tx and the final size response( Pearson coefficient = 0.391,
0.402 ,
0.389 respectively and P value= 0.033,
0.028,
0.034 respectively).