Abstract
In women with locally advanced cancer of the cervix (LACC), staging defines disease extent and guides therapy. Currently, undetected disease outside the radiation field can result in undertreatment or, if disease is disseminated, overtreatment. To determine whether adding fludeoxyglucose F 18 positron emission tomography-computed tomography (PET-CT) to conventional staging with CT of the abdomen and pelvis affects therapy received in women with LACC. A randomized clinical trial was conducted. Women with newly diagnosed histologically confirmed International Federation of Gynecology and Obstetrics stage IB to IVA carcinoma of the cervix who were candidates for chemotherapy and radiation therapy (CRT) were allocated 2:1 to PET-CT plus CT of the abdomen and pelvis or CT alone. Enrollment occurred between April 2010 and June 2014 at 6 regional cancer centers in Ontario, Canada. The PET-CT scanners were at 6 associated academic institutions. The median follow-up at the time of the analysis was 3 years. The analysis was conducted on March 30, 2017. Patients received either PET-CT plus CT of the abdomen and pelvis or CT of the abdomen and pelvis. Treatment delivered, defined as standard pelvic CRT vs more extensive CRT, ie, extended field radiotherapy or therapy with palliative intent. One hundred seventy-one patients were allocated to PET-CT (n = 113) or CT (n = 58). The trial stopped early before the planned target of 288 was reached because of low recruitment. Mean (SD) age was 48.1 (11.2) years in the PET-CT group vs 48.9 (12.7) years in the CT group. In the 112 patients who received PET-CT, 68 (60.7%) received standard pelvic CRT, 38 (33.9%) more extensive CRT, and 6 (5.4%) palliative treatment. The corresponding data for the 56 patients who received CT alone were 42 (75.0%), 11 (19.6%), and 3 (5.4%). Overall, 44 patients (39.3%) in the PET-CT group received more extensive CRT or palliative treatment compared with 14 patients (25.0%) in the CT group (odds ratio, 2.05; 95% CI, 0.96-4.37; P = .06). Twenty-four patients in the PET-CT group (21.4%) received extended field radiotherapy to para-aortic nodes and 14 (12.5%) to common iliac nodes compared with 8 (14.3%) and 3 (5.4%), respectively, in the CT group (odds ratio, 1.64; 95% CI, 0.68-3.92; P = .27). There was a trend for more extensive CRT with PET-CT, but the difference was not significant because the trial was underpowered. This trial provides information on the utility of PET-CT for staging in LACC. ClinicalTrials.gov Identifier: NCT00895349.
Highlights
Cervical cancer is the fourth most commonly diagnosed cancer in women, accounting for approximately 7.5% of female cancer deaths worldwide.[1]
44 patients (39.3%) in the positron emission tomography (PET)-computed tomography (CT) group received more extensive concurrent radiation therapy (CRT) or palliative treatment compared with 14 patients (25.0%) in the CT group
There was a trend for more extensive CRT with positron emission tomography–computed tomography (PET-CT), but the difference was not significant because the trial was underpowered
Summary
Cervical cancer is the fourth most commonly diagnosed cancer in women, accounting for approximately 7.5% of female cancer deaths worldwide.[1] When a patient presents with cancer of the cervix, the stage is determined to plan therapy. 40% of patients with cervical cancer present with locally advanced disease, defined as cancer that extends beyond the cervix to the vagina, parametrium, and/or lymph nodes.[2] Treatment for locally advanced cancer of the cervix (LACC) is often with curative intent consisting of cisplatin chemotherapy and concurrent radiation therapy (CRT), external beam to the pelvis, and intracavitary brachytherapy. Staging is key to patient management as undetected disease outside the radiation field can result in undertreatment, or overtreatment if the undetected disease is disseminated. Noninvasive testing using computed tomography (CT) with or without magnetic resonance imaging (MRI) was performed to determine whether cervical cancer was locally advanced
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