Monitoring Treatment Response In Patients Undergoing Concurrent Chemoradiotherapy for Locally Advanced Uterine Cervical Carcinoma Using Intravoxel Incoherent Motion Imaging: A Systematic Review And Meta-Analysis

Abstract Background: To the best of our knowledge, there are no systematic reviews or meta-analyses on the use of IVIM to assess treatment response of cervical cancer patients undergoing CCRT. Therefore, this study aimed to determine the role and optimal parameters of intravoxel incoherent motion imaging (IVIM) for evaluating treatment response in patients undergoing concurrent chemoradiotherapy (CCRT) for uterine cervical cancer.Methods: We searched the PubMed, PMC, EMBASE, Cochrane Library, and Ovid databases. Two reviewers independently performed data extraction, checked patient inclusion criteria, conducted the imaging protocols and follow-up for treatment response, recorded IVIM parameters, and performed quality assessment.Results: Six studies with 237 patients were included in our meta-analysis. The mean patient age ranged between 47 and 69 years. The International Federation of Gynecology and Obstetrics (FIGO) staging varied from Ib1 to IVb. The pooled mean values of apparent diffusion coefficient (ADC), tissue diffusion (D), and perfusion fraction (f) were 0.51, 0.18, and 6.24, respectively, in the complete response (CR) group, while the values were 0.38, 0.16, and 5.84, respectively, in the non-complete response (non-CR) group. In the subgroup meta-analysis, the ADC and D values in the CR group were higher compared to the non-CR group. Similarly, the incremental increase in f values in the CR group was higher compared to the non-CR groups (3.26, 5.84). All studies had a higher risk of bias in quality assessment due to study confounding and attrition.Conclusions: IVIM could be used to monitor the pre- and post-treatment response of cervical cancer patients undergoing CCRT. Early response assessment could begin 1 week after CCRT. However, we were unable to determine the optimal IVIM parameter from our analysis.