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Simple Summary: In patients with locally advanced cervical cancer, there is still a high reported locoregional recurrence rate after chemoradiation therapy. Therefore, timely detection of locoregional residual disease is important for patients to be treated with salvage surgery. Furthermore, it is important to select only the patients who would benefit from salvage surgery and not to expose patients unnecessarily to the risks of surgery. Therefore, the aim of this study is to assess two different imaging techniques, MRI and 18F[FDG]-PET/CT, for their ability to determine the presence of locoregional residual disease after chemoradiotherapy in patients with locally advanced cervical cancer. MRI and 18F[FDG]-PET/CT were compared with pathology-proven locoregional residual disease or locoregional recurrence identified from biopsy and/or salvage surgery. The findings from this research provide insights into the ability of MRI and 18F[FDG]-PET/CT to detect locoregional residual disease. Objectives: There is no consensus on the most reliable procedure to determine remission of cervical cancer after chemoradiotherapy (CRT). Therefore, this study aims to assess the diagnostic performance of two different imaging techniques, MRI and 18F[FDG]-PET/CT, in determining the presence of locoregional residual disease after CRT in patients with locally advanced cervical cancer. Methods: Patients diagnosed with locally advanced cervical cancer (FIGO 2009) treated with CRT were retrospectively identified from a regional cohort. The accuracy of MRI and 18F[FDG]-PET/CT in detecting locoregional residual disease was assessed with histology as the reference standard. Results: The negative predictive value (NPV) and positive predictive value (PPV) for locoregional residual disease detection of MRI and 18F[FDG]-PET/CT combined were 84.2% (95% CI 73.2–92.1), and 70.4% (95% CI 51.8–85.2), respectively. The NPV and PPV of MRI alone were 80.2% (95% CI 71.2–87.5) and 47.7% (95% CI 35.8–59.7), respectively, and values of 81.1% (95% CI 72.2–88.3) and 55.8 (95% CI 42.2–68.7), respectively, were obtained for 18F[FDG]-PET/CT alone. Conclusion: In this study, the reliability of MRI and 18F[FDG]-PET/CT in detecting locoregional residual disease was limited. Combining MRI and 18F[FDG]-PET/CT did not improve predictive values. Routine use of both MRI and 18F[FDG]-PET/CT in the follow-up after CRT should be avoided. MRI during follow-up is the advised imaging technique. Pathology confirmation of the presence of locoregional residual disease before performing salvage surgery is warranted. [ABSTRACT FROM AUTHOR]

Simple Summary: The treatment for patients with locally advanced cervical cancer generally consists of platinum-based chemotherapy during external beam radiotherapy, followed by brachytherapy. Some medical centers perform adjuvant hysterectomy after chemoradiation therapy, even though the international guideline advises otherwise. Performing adjuvant hysterectomy after chemoradiation therapy is associated with a high complication rate and the percentage residual disease in adjuvant hysterectomy specimen is unknown. Therefore, the aim of our systematic review was to determine the percentage of residual disease in the adjuvant hysterectomy specimen. Furthermore, we want to determine if there is an association between the time of adjuvant hysterectomy and the percentage residual disease in adjuvant hysterectomy specimens. Findings from this research provide insight into potential complications, survival benefits, and an overtreatment rate. Patients need to be well informed before considering an adjuvant hysterectomy. Objective: To determine the incidence of pathology-proven residual disease in adjuvant hysterectomy specimens in patients with cervical cancer, treated with chemoradiation therapy. Secondly, to assess a possible association for pathology-proven residual disease regarding the time between chemoradiation therapy and adjuvant hysterectomy. Additionally, the survival rate and complication rate were assessed. Methods: PubMed, EMBASE, and the Cochrane database were searched from inception up to 8 March 2021. Results: Of the 4601 screened articles, eleven studies were included. A total of 1205 patients were treated with chemoradiation therapy and adjuvant hysterectomy, ranging from three to twelve weeks after chemoradiation therapy. A total of 411 out of 1205 patients (34%) had pathology-proven residual disease in the adjuvant hysterectomy specimen. There was no association found in the time between chemoradiation therapy and adjuvant hysterectomy. Follow-up ranged from 2.4 to 245 months, during which 270 patients (22%) relapsed, and 298 patients (27%) were deceased. A total of 202 (35%) complications were registered in 578 patients. Conclusion: there is no association found in the time between chemoradiation therapy and residual disease on adjuvant hysterectomy specimens. The survival rates after chemoradiation therapy and adjuvant hysterectomy are suboptimal, while the risk of complications after adjuvant hysterectomy is high. [ABSTRACT FROM AUTHOR]