PO-0806: Cervical cancer stem cells and response to chemo-radiation in locally advanced cervical cancer

Purpose or ObjectiveThe aim of this study was to determine if radiomics features from 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) images could contribute to prognosis in cervical cancer. Material and MethodsOne hundred and two patients (69 for training and 33 for testing) with locally advanced cervical cancer (LACC) receiving chemoradiotherapy (CRT) from 08/2010 to 12/2016 were enrolled in this study. 18F-FDG PET/CT and MRI examination (T1, T2, T1C, Diffusion-weighted imaging (DWI)) was performed for each patient before CRT.Primary tumor volumes were delineated with the fuzzy locally adaptive Bayesian algorithm in the PET images and with 3D Slicer TM in the MRI images.Radiomics features (intensity, shape and textural) were extracted and their prognostic value was compared with clinical parameters for recurrence-free and locoregional control. ResultsIn the training cohort median follow-up was 3.0 years (0.43-6.56 range) and relapse occurred in 36% of patients.In univariate analysis, FIGO stage (I-II vs. III-IV) and metabolic response (complete vs. non complete) were probably associated with outcome without reaching statistical significance, contrary to several radiomics features from both PET and MRI sequences.Multivariate analysis in training test identified Grey Level Non UniformityGLRLM in PET and EntropyGLCM in ADC maps from DWI MRI as independent prognostic factors.These had significantly higher prognostic power than clinical parameters, as evaluated in the testing cohort with accuracy of 94% for predicting recurrence and 100% for predicting lack of loco-regional control (versus ~50-60% for clinical parameters). ConclusionIn LACC treated with CRT, radiomics features such as EntropyGLCM and GLNUGLRLM from functional imaging DWI-MRI and PET respectively, are independent predictors of recurrence and loco-regional control with significantly higher prognostic power than usual clinical parameters.Further research is warranted for their validation which may justify more aggressive treatment in patients identified with high probability of recurrence.