Pre-treatment Apparent Diffusion Coefficient Does Not Predict Therapy Response to Radiochemotherapy in Cervical Cancer: A Systematic Review and Meta-analysis

Background/aim Magnetic resonance imaging is used for staging purposes in cervical cancer (CC). Diffusion-weighted imaging and the apparent diffusion coefficient (ADC) are associated with tumor microstructure. The present analysis sought to compare pre-treatment ADC values to predict treatment outcome of radiochemotherapy for CC based upon a large patient sample. Materials and methods MEDLINE library and SCOPUS databases were assessed for suitable articles up to May 2020. The primary endpoint was the mean ADC value of CC according to the treatment response to radiochemotherapy. In total, 16 studies were included in the analysis. Results For the response group, 416 patients were included in the analysis (72.5%) and for the no-response group 158 patients were included (27.5%). The mean ADC value of patients with CC with treatment response was 0.87×10-3 mm2/s (95% confidence interval=0.81-0.94×10-3 mm2/s), and for the patients with no response was 0.92×10-3 mm2/s (95% confidence interval=0.85-0.98×10-3 mm2/s). Conclusion Pre-treatment ADC values alone cannot be used to reliably predict treatment response to radiochemotherapy in CC.