[Treatment of cervical cancer]. / Arbre décisionnel et thérapeutique des cancers du col de l'utérus.

The treatment of uterine cervical cancer evolved the last past twenty years. The management of early stages cervical cancer is based on surgery +/- after an initial brachytherapy in order to increase loco-regional control. A conservative treatment preserving uterine and ovarian functions is sometimes possible for young patients < 40 years old wishing to conceive. This strategy allows pregnancies with low recurrence rate. Finally, the use of the sentinel lymph node staging should be validated within the next few years. The treatment of locally advanced stages is based on concomitant chemoradiation therapy, which allows obtaining an important complete tumour response rate (90%). Thereafter, the irradiation modalities will depend on the para-aortic lymph nodes status diagnosed by PET-computed tomography +/- staging laparoscopic para-aortic lymphadenectomy. The use of completion surgery may be indicated in case of cervical residual disease and has to be balanced with its specific morbidity. All the decisions are made during a multidisciplinary tumour board.

MRI and Ultrasound Fusion Imaging for Cervical Cancer.

BACKGROUND: Evaluating locoregional extension of cervical cancer is a key step in patient management. This study evaluated the feasibility of fusion imaging - a combination of magnetic resonance imaging (MRI) with real-time high-resolution ultrasound (US) - to diagnose cervical cancer and its extension. PATIENTS AND METHODS: This prospective bi-center study included 13 women who underwent a 1.5-T MRI protocol including at least one T2-weighted plane. The results of imaging fusion were then compared with US and MRI results alone. RESULTS: Cervical cancer was detected as a hyperechogenic hypervascularized lesion. Parametrial extension was detected by exploration of the stromal ring and the use of color Doppler mode in fusion imaging, and characterized by visualization of a vascular bridge. CONCLUSION: Fusion imaging could be used as a complementary technique for MRI to enhance diagnostic performance for cervical cancer lesions. While MRI remains the reference, real-time fusion imaging could improve its characterization and detect parametrial infiltration.