Purpose
Magnetic resonance imaging (MRI) is an accurate noninvasive modality for preoperative staging of patients with cervical cancer undergoing chemo-radiation.Purpose of this study was to assess the added value of 18FDG-PET /CT scan in planning the treatment strategy in these patients.
Methods and Materials
Study population40 patients (median age: 51, range: 29-73) with locally advanced cervical cancer (LACC).Staging included pelvic MRI, chest X-Rays and 18FDG-PET /CT scan.MRI studyMRI was performed with 1.5 T magnet and phased-array surface coil according the following study protocol:8mm axial T1- and T2-weighted FSE;3mm high-resolution FSE T2-weighted in 3 spatial orientations;8mm axial b-SSFP fatsat for paraaortic lymphnodesThe MRI diagnosticcriteria for primitive tumor were:tumoral site of origin and size;infiltration of the cervical stroma, internal os of the endocervical canal, parametria and vaginal fornices; The MRI diagnostic...
Results
According to the FIGO staging system, 10 patients were stage IB2, 25 were stage II and 5 were stage III-IVA.After 18FDG-PET/CT scan evaluation, 7/40 (17.5%) patients had a major change in treatment strategy: distant metastases (lung: 2; nodes: 4; peritoneal carcinosis: 1) were detected, leading to a change in the treatment plan from a loco-regional irradiation to a systemic approach.The remaining 33 cases received preoperative chemo-radiation.In 31/33 (94%) cases, 18FDG-PET/CT didn’t significantly modified the target volumes delineated on the basis of MRI images. Anyway the...
Conclusion
In a series of LACC patients candidate to chemoradiation on the basis of traditional staging, the use of 18FDG PET/CT scan led to a change in the treatment strategy or target definition in 23.5% of cases.
References
Showalter TN, Miller TR, Huettner P, Rader J, Grigsby PW. 18F-fluorodeoxyglucose-positron emission tomography and pathologic tumor size in early-stage invasive cervical cancer. Int J Gynecol Cancer. 2009 Nov;19(8):1412-4.Bjurberg M, Kjellén E, Ohlsson T, Bendahl PO, Brun E. Prediction of patient outcome with 2-deoxy-2-[18F]fluoro-D-glucose-positron emission tomography early during radiotherapy for locally advanced cervical cancer. Int J Gynecol Cancer. 2009 Dec;19(9):1600-5.Lai CH, Yen TC, Ng KK. Surgical and radiologic staging of cervical cancer. Curr Opin Obstet Gynecol. 2010 Feb;22(1):15-20.Brooks RA, Powell MA. Novel imaging modalities in gynecologic...
Personal Information
Dr. Gennaro Restaino, MDConsultant RadiologistImaging Department“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCatholic University of Sacred Heart86100 CampobassoITALYPhone: +39-0874-312338/6Fax: +39-0874-312522E:mail:
[email protected]
