Evaluation of a new prognostic tumor score in locally advanced cervical cancer integrating clinical examination and magnetic resonance imaging.

Forfattere Lindegaard JC, Petric P, Lindegaard AM, Tanderup K, Fokdal LU.
Kilde nt J Radiat Oncol Biol Phys. 2020 Mar 15;106(4):754-763 Publiceringsdato 30 nov 2019


The integral results of clinical examination and magnetic resonance imaging (MRI) of patients with locally advanced cervical cancer (LACC) may provide prognostic information that cannot readily be placed in current staging systems such as proximal versus distal parametrial invasion, unilateral versus bilateral involvement or organ infiltration on MRI. The aim was to develop and investigate the performance of a simple but comprehensive tumor score for reporting and prognostication.


400 consecutive patients with LACC treated 2005-2018 with chemoradiation and image guided adaptive brachytherapy (IGABT) were analyzed. The diagnostic work-up included clinical examination, PET-CT and MRI. International Federation of Gynecology and Obstetrics (FIGO) 2009 stage distribution was IB-IIA 9%, IIB 61% and III-IV 30%. Involvement of 8 anatomical locations (cervix, left parametrium, right parametrium, vagina, bladder, ureter, rectum and uterine corpus) was scored according to a ranked ordinal scale with 0-3 points. The total sum of points constituted the T-score.


The median T-score was 6 (range 0-20). Based on the frequency distribution of the T-score, 4 equally sized groups were formed: 0-4, 5-6, 7-9 and >9 points. The T-score grouping was highly significant in both univariate and multivariable analysis and outperformed FIGO stage for both survival and local control enabling also intra-stage prognostication. Used as a linear variable, the T-score was correlated with IGABT target volume (CTVHR), use of interstitial needles, dose (D90 of CTVHR) and Total Reference Air Kerma (TRAK).


The T-score is a simple instrument for combining clinical findings and imaging into a powerful prognostic factor for survival and local control with capabilities surpassing traditional staging. In addition, the T-score may already at diagnosis predict essential IGABT parameters and may be used for audit and comparison of results in multicenter settings.