Prediction of disease progression following concurrent chemoradiotherapy for uterine cervical cancer: value of post-treatment diffusion-weighted imaging

Objective: To investigate the value of post-treatment diffusion-weighted imaging (DWI) for predicting disease progression following concurrent chemoradiotherapy (CCRT) for cervical cancer. Methods: This retrospective study included 100 consecutive patients with locally advanced cervical cancer who underwent T2-weighted imaging (T2WI) and DWI 1 month after completing CCRT. The presence of residual tumour was independently determined on T2WI and T2WI plus DWI. The imaging findings were compared regarding prediction of disease progression. Results: Disease progressed in 24 patients during follow-up. Forty-one and 22 patients were determined as having residual tumour on T2WI and T2WI plus DWI, respectively. Regarding prediction of disease progression, positive predictive values of imaging findings on T2WI and T2WI plus DWI were 32.7 % and 54.4 %, respectively, 1 year after treatment (P = 0.004), 37.2 % and 73.0 %, respectively, 2 years after treatment (P < 0.001), and 39.3 % and 72.7 %, respectively, 3 years after treatment (P = 0.001). Multivariate Cox regression analysis revealed that the presence of residual tumour on T2WI plus DWI was the independent predictor of disease progression (hazard ratio = 6.34, P < 0.001). Conclusion: Post-treatment DWI offers an incremental value to T2WI in predicting disease progression after CCRT of cervical cancer. Key Points: • T2WI alone has limited prognostic value after CCRT of cervical cancer. • Adding DWI to T2WI improves prediction of disease progression after CCRT. • Residual tumour on post-treatment T2WI plus DWI is associated with disease progression.