A Prospective Randomized Trial to Study the Impact of Pretreatment FDG-PET for Cervical Cancer Patients With MRI-Detected Positive Pelvic but Negative Para-Aortic Lymphadenopathy

Presented at the 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Philadelphia, PA, USA, Nov 5–9, 2006.

Received 4 July 2008; received in revised form 17 December 2008; accepted 9 February 2009. published online 22 May 2009.

Purpose

This prospective randomized study was undertaken to determine the possible impact of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) on extrapelvic metastasis detection, radiation field design, and survival outcome for cervical cancer patients with enlarged pelvic nodes on MRI image.

Methods and Materials

Inclusion criteria were patients with newly diagnosed Stage I–IVA cervical cancer and with positive pelvic but negative para-aortic lymph nodes (PALN) as detected by magnetic resonance image and good performance status for concurrent chemoradiotherapy. Eligible patients were randomized to receive either pretreatment FDG-PET (study group) or not (control group). Whole pelvis was the standard irradiation field for the control group and those with no extrapelvic findings on PET. The radiation fields for the rest of the study group were extended to include the PALN region or were modified according to the extrapelvic PET finding.

Results

From January 2002 to April 2006, 129 patients were included, and 66 of them were randomized to receive FDG-PET. PET detected seven extrapelvic metastases (11%, 6 PALN and 1 omental node), and four of them remained disease-free after treatment modification. For patients who underwent PET compared with those who did not, there were no differences in the 4-year rates of overall survival (79% vs. 85%, p = 0.65), disease-free survival (75 % vs. 77%, p = 0.64), and distant metastasis-free survival (82% vs. 78%, p = 0.83).

Conclusions

Pretreatment FDG-PET in conjunction with magnetic resonance imaging can improve the detection of extrapelvic metastasis, mainly PALN, and help select patients for extended-field radiotherapy. However, the addition of FDG-PET may not translate into survival benefit, even though PALN relapses are reduced.

Cervical cancer, Positive pelvic node, 18F-fluorodeoxyglucose positron emission tomography, Extended-field radiotherapy, Extrapelvic metastasis

∗ Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

† Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

‡ Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

§ Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

¶ Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

‖ Department of Medical Imaging and Radiological Science, Chang Gung University, School of Medicine, Taoyuan, Taiwan

∗∗ Department of Radiation Oncology, University of California, Los Angeles, CA

Reprint requests to: Ji-Hong Hong, M.D. Ph.D., Department of Radiation Oncology, Chung Gung Memorial Hospital, #5, Fu-Shin St., KweiShan, Taoyuan, Taiwan, R.O.C. Tel: (886) 3-3282177; Fax: (886) 3-3280797

Note—An online CME test for this article can be taken at http://asro.astro.org under Continuing Education.

Supported by Grants CMRPG32024 from Chang Gung Memorial Hospital and NSC93-2314-B-182A-127 from National Science Council, Taiwan.

Conflict of interest: none.

PII: S0360-3016(09)00259-4

doi:10.1016/j.ijrobp.2009.02.020

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