Role of Pelvic Ultrasound in Predicting the Response to Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer

Background/Objectives: The optimal treatment for locally advanced cervical cancer (LACC) is debated. The proposed treatments are concomitant chemoradiotherapy plus brachytherapy (cCTRT-B) or neoadjuvant chemotherapy (NACT) followed by radical surgery (RS). The prediction NACT response is crucial for identifying responder patients who may benefit from subsequent radical surgery. The aim of this study was to find ultrasound characteristics to predict the response to NACT in patients with LACC. Methods: Consecutive patients with diagnoses of LACC were prospectively enrolled. According to FIGO staging criteria, all IB2-IIIC patients underwent three cycles of platinum-based NACT followed by radical surgery. Patients were evaluated by pelvic ultrasound one week before NACT (T0) and three weeks after the last cycle of chemotherapy (T1). The parameters analysed were volume of the lesion, tumor/uterus volume ratio, parametrial infiltration, color score, resistance (RIUA) and pulsatility (PIUA) indices of uterine arteries (UA). Results: From July 2019 to April 2023, 40 patients were enrolled. A significant decrease in tumor volume (p < 0.01) and a reduced parametrial infiltration after NACT were observed (p < 0.01). The results of the unadjusted and adjusted logistic models showed that age and RIUA positively affect the estimated probability of treatment response (p < 0.01). According to the univariate and multivariate model, RIUA greater than 0.72 ensures 87% sensitivity and 70% specificity with 82.5% accuracy in predicting tumor reduction. Conclusions: Patients over 54 with a RIUA above 0.72 are more likely to respond to NACT. Pelvic ultrasound proved to be a useful tool for predicting NACT response in LACC patients.