An Alternative Triage Strategy Based on Preoperative MRI for Avoiding Trimodality Therapy in Stage IB Cervical XXXX .

@entity1 @entity3 @entity5 @entity1753
Purpose: @entity1753 following primary surgery is frequently indicated in @entity1 with @entity5 . The aim of this study is to evaluate the role of an MRI-based strategy in avoiding trimodality therapy. Materials and Methods: We retrospectively reviewed all @entity1 with @entity5 treated initially with primary surgery at Seoul National University Hospital. We suggest an alternative triage strategy in which the primary treatment modality is determined based on preoperative MRI findings. Using this strategy, primary surgery is only indicated when there is no evidence of parametrial involvement (PMI) and lymph node @entity3 (LNM) in the MRI results; when there is evidence of either or both of these factors, primary chemoradiation is selected. Assuming that this strategy is applied to our cohort, we evaluate how the rate of trimodality therapy is affected. Results: Of the 254 @entity1 in our sample, 77 (30.3%) had at least one Category 1 risk factor (PMI, LNM, positive resection margin) upon pathologic examination. If the MRI-based strategy had been applied to our cohort, 168 @entity1 would have undergone primary surgery and 86 would have undergone primary chemoradiation. Only 25 @entity1 (9.8%) would have required trimodality therapy based on an indication of at least one Category 1 pathologic risk factor following radical hysterectomy. Conclusion: The inclusion of MRI in the decision-making process for primary treatment modality could have reduced the number of @entity1 requiring trimodality therapy based on the indication of a Category 1 risk factor from 30.3% to 9.8% in our cohort.
