Recurrent uterine cancer after surgery: magnetic resonance imaging patterns and their changes after concomitant chemoradiation

Abstract

Purpose: Our primary objective was to describe the magnetic resonance (MR) imaging patterns of recurrent uterine cancer after surgery and their changes following concurrent chemoradiation. The secondary objective was to identify MR imaging predictors of outcome.

Materials and methods: Twenty-two consecutive women with biopsy-proven recurrent uterine cancer after surgery (cervix 13 patients, endometrium nine patients) were enrolled in this prospective study. Inclusion criteria were MR imaging at diagnosis and during follow-up and eligibility for concurrent chemoradiation. MR images were assessed for signal intensity of the pelvic relapse on T2-weighted images, site of relapse and infiltration of adjacent organs. Pre- and posttreatment MR images were compared on the basis of the same criteria. The 3D volume of relapses after treatment was calculated, and tumour response to treatment was evaluated as complete, partial, no change or disease progression.

Results: Recurrences appeared hyperintense on T2-weighted images in 22/22 (100%) patients. Pelvic relapse site was vagina in 5/22 (23%), vaginal vault in 9/22 (41%), vaginal vault with extension to the pelvic wall in 5/22 (23%) and pelvic wall in 3/22 (13%). Infiltration of adjacent organs was detected in 9/22 (41%) patients. The mean volume of recurrences on pretreatment MR images was 38.83 cm(3). On posttreatment MR images, relapses appeared hypointense in 19/22 (86%) patients and hyperintense in 3/22 (14%). The mean volume of recurrences on posttreatment MR images was 18.01 cm(3). Complete response was seen in 11/22 (50%) patients, partial response in 8/22 (36%) and no change in 3/22 (14%).

Conclusions: MR imaging can provide an evaluation of all parameters necessary for planning treatment and assessing response to treatment.