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Research Article: Oxygen-enhanced MRI in patients with uterine cervical carcinoma: feasibility and treatment-associated changes in tumour oxygen-enhanced response

Date Published: 2026-07-24

Abstract:
Tumour hypoxia causes resistance against radiotherapy and chemotherapy in locally advanced cervical cancer (LACC). Non-invasive magnetic resonance imaging (MRI) biomarkers have the potential to guide hypoxia-targeted therapy but require technical development and validation. This study evaluated the feasibility and early treatment response monitoring capabilities of oxygen-enhanced MRI (OE-MRI) in healthy female volunteers and patients with LACC. Healthy volunteers underwent OE-MRI to demonstrate the feasibility of the technique and to compare the onset, magnitude, and duration of change in longitudinal relaxation rate (? R 1 ) for breathing either 100% oxygen or carbogen. Uterine cervix and body tissues were examined. Next, patients with biopsy-proven LACC underwent OE-MRI pre-treatment, and then, at 3 and 5 weeks into chemotherapy, it was combined with external beam radiotherapy. Feasibility was demonstrated in 97% (31/32) of uterine tissue regions of interest, measured in 18 volunteers. ? R 1 values in the uterine cervix and body were similar across gas types with a cohort ? R 1 of between 0.026 and 0.033 s ?1 . In patients with LACC, significant increases in tumour ? R 1 were observed during treatment by week 3 (mean increase, 0.0143 s ?1 ; 95% CI 0.0014 to 0.0273; p = 0.035). At week 5, six of eight evaluable patients showed a >50% treatment-associated increase in tumour ? R 1 . Changes persisted in most patients to the end of treatment. This first dedicated OE-MRI study in cervical cancer shows technique feasibility in healthy volunteers and patients with LACC. Treatment-associated increases in tumour ? R 1 were demonstrated during chemoradiotherapy and likely reflect hypoxia modification. These findings support further evaluation of OE-MRI alongside independent hypoxia biomarkers in larger cervical cancer cohorts.

Introduction:
Uterine cervical cancer is a major global health problem. It is the fourth most frequent cancer in women worldwide, with an estimated 660,000 new cases in 2022 and approximately 350,000 deaths ( 1 ). Oxygen deficiency, termed hypoxia, is a hallmark of solid tumours that promotes tumour angiogenesis, genetic instability, and metastasis ( 2 ). The majority of patients present with locally advanced cervical cancer (LACC) that covers FIGO (International Federation of Gynecology and Obstetrics) stages IB 2 to IVA.…

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