A prospective cohort study on cervical cancer regression using T-score and apparent diffusion coefficient value during chemoirradiation

Background: Early prediction of tumor response is critical for optimizing therapy in locally advanced cervical cancer. Aims and Objectives: This study evaluated the prognostic significance of the T-score (TS) and apparent diffusion coefficient (ADC) values during chemoradiation. Materials and Methods: In this prospective cohort study, 40 patients with biopsy-confirmed stage IB–IVA cervical carcinoma underwent pre- and post-external beam radiotherapy (EBRT) magnetic resonance imaging (MRI) with diffusion-weighted imaging. TSs and ADC values were recorded before and after EBRT. Tumor regression was assessed both clinically and radiologically. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of the ADC parameters. Results: Tumor regression was observed in 75% (n=30) of the patients. The mean pre-treatment ADC was 0.8553±0.0406 mm2/s, which significantly increased to 1.0113±0.0763 mm2/s, post-treatment. Patients with regression had significantly higher early phase ADC values (1.0297±0.0678 mm2/s) than those without (0.9560±0.0766 mm2/s, P=0.0065). The mean relative ADC was also significantly higher in the regression group (0.1977±0.0465) than in the no-regression group (0.1345±0.0696, P=0.0023). The TS significantly decreased from 9.78±4.70 to 6.38±4.29, with 72.5% of patients showing concurrent TS reduction and tumor regression (P=0.0091). ROC analysis showed that an early phase ADC >1.027 yielded 60% sensitivity and 80% specificity for predicting regression. Conclusion: Diffusion-weighted imaging MRI effectively assesses cervical cancer treatment response, with greater ADC increases and TS reduction correlating with better outcomes and aiding in the early identification of non-responders.