Evaluating The Efficacy Of Neoadjuvant Chemotherapy With Magnetic Resonance Spectroscopy In Cervical Cancer

ObjectiveTo analyze the characteristics of hydrogen proton magnetic resonance spectroscopy (1H-MRS) after neoadjuvant chemotherapy (NACT), and to discuss the value of monitoring the therapeutic effect of NACT with1H-MRS in cervical cancer.Methods15patients with locally advanced squamous carcinoma of the cervix in gynecology of the Second Xiangya Hospital of Central South University were seleced from September2012to September2013. Each patient was performed conventional Magnetic Resonance Imaging (MRI) and three-dimensional1H-MRS examination for three times (before chemotherapy,14days after the first NACT and14days after the2nd NACT). The metabolic peaks of choline (Cho)(3.2ppm), creatine (Cre)(3.0ppm),2.0ppm (2.0ppm) and lipid (Lip)(1.4ppm,1.3ppm and0.9ppm) were quantitatively analyzed on the1H-MRS maps of each patient. The tumor cell number and Ki-67expression of cervical lesions were detected by H&E staining and immunohistochemistry at three different times (before chemotherapy,14days after the first NACT and after radical surgery, respectively).The therapeutic efficacy of NACT was assessed after two courses of chemotherapy, and the longest diameter of tumor was measured on T2-weighted imaging according to the latest version of Response Evaluation Criteria in Solid Tumors.Results1. All15patients completed2times of NACT,11cases were effective chemotherapy,4cases were ineffective chemotherapy, the effective rate of chemotherapy was73.3%.15patients did the radical surgery after chemotherapy. All15patients did supplementary treatment after surgery,(8cases did chemotherapy,7cases did chemoradiotherapy).2、All15patients were successfully performed the examination of magnetic resonance spectroscopy, and the metabolic peaks of choline (Cho), creatine (Cre),2.0ppm and lipid (Lip) can be detected on the spectroscopy before and after chemotherapy. The metabolic peaks of choline of the cervical cancer lesions which was effective chemotherapy before the chemotherapy、after the first NACT and the second NACT were (138.80±63.12),(81.64±31.61) and (71.27±30.22); The metabolic peaks of choline of the cervical cancer lesions which was ineffective chemotherapy before the chemotherapy、 after the first NACT and the second NACT were (102.37±24.63),(104.44±20.01) and (108.06±35.13)。The metabolic peaks of choline which was after the second and the first time of NACT significant difference compared with that before chemotherapy (p=0.006, p=0.000); cervical cancer lesions which was ineffective chemotherapy the metabolic peaks of choline had no significant differences at three different time points. The metabolic peaks of creatine,2.0ppm and lipid all had no significant difference between different chemotherapy groups and at different time points (p>0.05).3. The areas under choline peak of the cervical cancer which were effective chemotherapy before chemotherapy, after the first NACT and the second NACT were (6.30±2.16),(3.91±0.97) and (3.03±1.38); The areas under choline peak of the cervical cancer which were ineffective chemotherapy before chemotherapy, after the first NACT and the second NACT were (5.34±2.05),(5.97±2.03) and (5.96±2.18). The areas under choline peak which was after the second and the first time of NACT significant difference compared with that before chemotherapy (p=0.002, p=0.000); cervical cancer lesions which was ineffective chemotherapy, the areas under choline peak had no significant differences at three different time points (p>0.05). Areas under the metabolic peaks of Cr,2.0ppm and Lip all had no significant difference between different chemotherapy groups and at different time points. The ratio of areas under choline peak and creatine peak (Cho/Cr) of the cervical cancer which were effective chemotherapy before chemotherapy, after the first NACT and the second NACT were (2.43±1.19),(2.13±1.01) and (1.17±1.19); Cho/Cr which was after the second and the first time of NACT significant difference compared with that before chemotherapy (p=0.034, p=0.015); in cervical cancer with ineffective chemotherapy, Cho/Cr had no significant difference at three different time points (p>0.05).2.0ppm/Cr, triglyceride-CH2/Cr and triglycerides-CH3/Cr all had no significant difference at different time points in different efficacy groups (p>0.05).4. In cervical cancer which were effective chemotherapy, after the second time of NACT, the density of tumor cells and the expression of ki-67positive cells significantly reduced than the first time of NACT (p <0.05); but in the cervical cancer which were ineffective chemotherapy, the density of tumor cells and the expression of ki-67positive cells had no significant difference before and after chemotherapy (p>0.05). In cervical cancer which were effective chemotherapy, areas under choline peak’s change and the expression of ki-67’s change showed a significant positively correlated after the first time of NACT (r=0.638, P=0.035) and after the second time of NACT (r=0.617, P=0.043), areas under choline peak’s change and the density of tumor cells’s change showed a significant positively correlated after the second time of NACT (r=0.677, P=0.022). Conclusion1. The metabolic peaks of Cho, Cr,2.0ppm and Lip can be detected on’H-MRS. Cho peak values containing peak height, areas under the peak and the ratio of Cho/Cr can reflect the metabolism changes of tumor tissues after NACT in cervical cancer.2. The cho peak on1H-MRS may be applied to evaluate the efficacy of NACT in cervical cancer.