Therapy Response Imaging in Gynecologic Malignancies

The three most common malignancies in gynecological oncology are cervical cancer, endometrial cancer, and ovarian cancer. Studies related to treatment response and prognosis of these cancers have mainly examined magnetic resonance (MR) imaging factors, which include tumor size, diffusion-weighted image (DWI), and perfusion image, followed by positron emission tomography/computed tomography (PET/CT) and CT images. To study cervical cancer, imaging modalities and factors have been combined variously with clinical factors, and DWI and derived apparent diffusion coefficient (ADC) values playing important roles. Because endometrial cancer diagnosed at an early stage exhibits favorable overall survival, many studies have specifically examined relations with clinical factors such as stage, histology, depth of myometrial invasion, lymphovascular invasion, and lymph node (LN) metastasis. Ovarian cancer is diagnosed at a high stage with tumor spread in the abdomen and thoracic cavity. Then PET/CT is more emphasized than MRI for the evaluation of treatment response. The latest analytic methods using radiogenomics and texture analysis are also applied to evaluate cervical cancer and ovarian cancer.