Comparative Study Of MR Imaging Before And After Superselective Arterial Perfusion Chemotherapy In Locally Advanced Cervical Squamous Cell Carcinoma

Objective:To explore the clinical efficacy of uterine artery infusion chemotherapy(UAIC),uterine arterial chemoembolization(UACE)and intravenous chemotherapy(IVC)three neoadjuvant chemotherapy methods in the treatment of locally advanced cervical cancer(LACC)and the application value of MR imaging in evaluating the efficacy of LACC chemotherapy.Methods:The clinical and imaging data of 102 patients with LACC were retrospectively analyzed,and they were divided into uterine artery infusion chemotherapy(UAIC)group,uterine artery chemoembolization(UACE)group and intravenous chemotherapy(IVC)group according to the different chemotherapy modalities of neoadjuvant chemotherapy,with 34 cases in each group.The clinical efficiency,adverse effects,long-term efficacy,and apparent diffusion coefficient(ADC)before and after chemotherapy were compared among the three groups,and subject operating characteristic(ROC)curves were plotted to analyze the application value of ADC values to predict the efficacy of neoadjuvant chemotherapy for LACC.Results:The clinical efficiency of UAIC group,UACE group and IVC group were 64.7%,79.4% and 50.0% respectively;the clinical efficiency of UACE group was higher than that of IVC group,and the difference was statistically significant(P<0.05);the difference between the clinical efficiency of UACE group and UAIC group,UAIC group and IVC group was not statistically significant(P>0.05).The incidence of abdominal pain in the UACE group was 47.1% higher than that in the IVC group(14.7%),and the incidence of fever in the UACE group was 55.9% higher than that in the UAIC group(29.4%)and the IVC group(20.6%),with statistically significant difference(P < 0.05).The complications of nausea and vomiting and bone marrow suppression occurred in the three groups were not statistically significant(P > 0.05).The mean value of ADC of tumor before chemotherapy in the effective group was lower than that in the ineffective group,and the mean value of ADC of tumor after chemotherapy in the effective group was higher than that in the ineffective group,and the difference of ADC before and after chemotherapy in the effective group was significantly higher than that in the ineffective group,and the difference was statistically significant(P<0.05).The area under the ROC curve(AUC)of the ADC difference before and after chemotherapy to predict chemotherapy efficacy was 0.816,which was higher than the ADC value before chemotherapy and ADC value after chemotherapy,and the difference was statistically significant(P<0.05);the sensitivity and specificity of using 0.708 as the ADC difference value to predict the neoadjuvant chemotherapy efficacy of LACC were 70.8% and 77.4%,respectively.Conclusion:The clinical efficacy rate of uterine artery chemoembolization(UACE)for LACC is better than that of conventional intravenous chemotherapy(IVC),but may increase the risk of abdominal pain and fever.ADC values can be used as a reliable indicator to evaluate and predict the efficacy of neoadjuvant chemotherapy for LACC,where the predictive efficacy of the ADC difference before and after chemotherapy is more significant.