Development of a Predictive Model for Therapy Response in Advanced-Stage Cervical Cancer Using Apparent Diffusion Coefficient (ADC) Value and Quantitative T2 Tumor on MRI: Correlation with Survivin Expression

The aims of this study are to optimize Magnetic Resonance Imaging (MRI) as a predictive modality for therapy response in advanced-stage cervical cancer and to identify predictors of this response in relation to survivin expression. This case-control study was conducted from January 2023 to May 2024, with total 35 subjects. The target population comprised patients with stages IIB to IIIC2 (FIGO 2018) cervical cancer. MR examination was performed three times: pre therapy, in the mid cycle of external radiation (20-30Gy), and 2 months after complete therapy. The study analyzed relations between age, tumor size, nodal metastasis, ADC and T2 parameters on MR, and survivin levels, with final therapeutic response. The predictive model for final therapy response was developed using four variables: patient age, tumor size, nodal metastasis, and the T2 tumor-to-muscle ratio on MRI #2. The scoring system showed the minimum total score was 0 and the maximum total score was 6. The cut-off score on this predictive model is score 3 to differentiate between the prediction of good or poor response with the sensitivity of 92,86% and a specificity of 85,71%. This study found that T2 tumor-to-muscle ratio (T2 t/m ratio) on MR in the mid-cycle external radiation is a potential predictive factor of final therapy response on advanced-stage cervical cancer. A predictive model for assessing the final response could effectively incorporate clinical and MR parameters, including patient age, tumor size, nodal metastasis findings on MR, and Ratio T2 t/m on MR in the mid-cycle external radiation.