Early diffusion weighted magnetic resonance imaging can predict survival in women with locally advanced cancer of the cervix treated with combined chemo-radiation

Objectives

To assess the predictive value of diffusion weighted imaging (DWI) for survival in women treated for advanced cancer of the cervix with concurrent chemo-radiotherapy.

Methods

Twenty women treated for advanced cancer of the cervix were recruited and followed up for a median of 26 (range <1 to 43) months. They each had DWI performed before treatment, 2?weeks after beginning therapy (midtreatment) and at the end of treatment. Apparent diffusion coefficient (ADC) values were calculated from regions of interest (ROI). All participants were reviewed for follow-up data. ADC values were compared with mortality status (Mann–Whitney test). Time to progression and overall survival were assessed (Kaplan–Meier survival graphs).

Results

There were 14 survivors. The median midtreatment ADC was statistically significantly higher in those alive compared to the non-survivors, 1.55 and 1.36 (×10^?3/mm²/s), respectively, P?=?0.02. The median change in ADC 14?days after treatment commencement was significantly higher in the alive group compared to non-survivors, 0.28 and 0.14 (×10^?3/mm²/s), respectively, P?=?0.02. There was no evidence of a difference between survivors and non-survivors for pretreatment baseline or post-therapy ADC values.

Conclusion

Functional DWI early in the treatment of advanced cancer of the cervix may provide useful information in predicting survival.

Key Points

? Diffusion weighted magnetic resonance imaging (DWI) is increasingly used in cervical cancer. ? Functional DWI early in treatment of cervical cancer may help predict survival. ? DWI may help clinicians to tailor or individualise treatment appropriately. ? This may limit toxicity from ineffective treatment and allow early alternative therapy.     

The Efficacy of Vaginal Laser and Other Energy-based Treatments on Genital Symptoms in Postmenopausal Women: A Systematic Review and Meta-analysis

ObjectiveThis systematic review examined energy-based treatments of the vagina for postmenopausal vaginal symptoms.Data SourcesWe performed a systematic review from April 2017 (the end date of our previous review) to April 2020, searching Medline, Embase, and Scopus.Methods of Study SelectionThe inclusion criteria were all randomized studies, prospective studies with >10 cases, and retrospective studies with >20 cases published in English or French that assessed change in postmenopausal vaginal symptoms and/or sexual function in women after energy-based vaginal treatments. Meta-analyses were performed on randomized data.Tabulation, Integration, and ResultsOf the 989 results retrieved, 3 randomized studies, 16 prospective studies, and 7 retrospective studies were included in the review, representing data from 2678 participants. Pooled data from 3 randomized controlled trials show no difference between vaginal laser and topical hormonal treatments for change in vaginal symptoms (–0.14, 95% confidence interval –1.07 to 0.80) or sexual function scores (2.22, 95% confidence interval –0.56 to 5.00). Furthermore, no difference among vaginal laser, topical hormone, and lubricant was demonstrated in sexual function (p = .577). As in our previous review, non-randomized data support energy-based treatments in improving vaginal symptoms, sexual function, and clinician-reported outcomes. No severe adverse events were reported in the included studies. Significant heterogeneity of data arising from differing measures and reported outcomes continues to be an issue, with data remaining low quality, with high risk of bias, and no double-blind or placebo-controlled randomized trials yet reported, although 1 has now completed recruitment.ConclusionThere are 3 randomized trials comparing energy-based systems with hormonal treatment, with no clinical difference in these 2 approaches. Although prospective data continue to show promising outcomes, without strong evidence from well-powered, double-blind placebo-controlled trials to determine the efficacy of treatment compared with placebo, the use of energy-based treatments should continue to be undertaken in research studies only, with high-quality studies essentially free from bias (International Prospective Register of Systematic Review registration number: 178346).