OBJECTIVE: We evaluated the ability of pretreatment MRI and PET/CT to improve outcomes for patients with clinically staged International Federation of Gynecology and Obstetrics (FIGO) IB cervical cancer. MATERIALS AND METHODS: We developed a decision-analytic model to predict outcomes for a hypothetical patient cohort with FIGO IB cervical cancer who underwent pretreatment MRI, PET/CT, MRI and PET/CT, or no further imaging (direct pursuance of surgery). The model incorporated imaging performance, underlying parametrial extension and lymph node involvement, surgery and chemoradiation treatment options, and survival penalties from incorrect assessment of disease extent. Three outcomes were compared: 5-year overall survival, percentage of patients receiving correct primary therapy, and percentage of patients spared "trimodality therapy" (surgery followed by chemoradiation). Sensitivity analysis was performed to assess the effects of model uncertainty on outcomes. RESULTS: The preferred imaging strategy depended on the outcome studied. Five-year overall survival was comparable across strategies but was highest with the no-imaging strategy (92.37%) and with PET/CT (92.36%) and lowest with MRI (92.30%). Triage to correct primary therapy was highest with PET/CT (89.27%) and lowest with MRI (68.21%). Avoidance of trimodality therapy was highest with combined MRI and PET/CT (95.01%) and lowest with the no-imaging strategy (82.32%). Results were somewhat sensitive to imaging test performance characteristics but stable across most parameter ranges tested. CONCLUSION: Pretreatment imaging of FIGO IB cervical cancer patients can optimize triage to appropriate therapy. Although imaging does not appear to improve survival, PET/CT maximizes patient triage to correct therapy, and combined MRI and PET/CT spares the most patients unnecessary trimodality therapy.
OBJECTIVE: We evaluated the ability of pretreatment MRI and PET/CT to improve outcomes for patients with clinically staged International Federation of Gynecology and Obstetrics (FIGO) IB cervical cancer. MATERIALS AND METHODS: We developed a decision-analytic model to predict outcomes for a hypothetical patient cohort with FIGO IB cervical cancer who underwent pretreatment MRI, PET/CT, MRI and PET/CT, or no further imaging (direct pursuance of surgery). The model incorporated imaging performance, underlying parametrial extension and lymph node involvement, surgery and chemoradiation treatment options, and survival penalties from incorrect assessment of disease extent. Three outcomes were compared: 5-year overall survival, percentage of patients receiving correct primary therapy, and percentage of patients spared "trimodality therapy" (surgery followed by chemoradiation). Sensitivity analysis was performed to assess the effects of model uncertainty on outcomes. RESULTS: The preferred imaging strategy depended on the outcome studied. Five-year overall survival was comparable across strategies but was highest with the no-imaging strategy (92.37%) and with PET/CT (92.36%) and lowest with MRI (92.30%). Triage to correct primary therapy was highest with PET/CT (89.27%) and lowest with MRI (68.21%). Avoidance of trimodality therapy was highest with combined MRI and PET/CT (95.01%) and lowest with the no-imaging strategy (82.32%). Results were somewhat sensitive to imaging test performance characteristics but stable across most parameter ranges tested. CONCLUSION: Pretreatment imaging of FIGO IB cervical cancerpatients can optimize triage to appropriate therapy. Although imaging does not appear to improve survival, PET/CT maximizes patient triage to correct therapy, and combined MRI and PET/CT spares the most patients unnecessary trimodality therapy.
Authors: Corinne Balleyguier; E Sala; T Da Cunha; A Bergman; B Brkljacic; F Danza; R Forstner; B Hamm; R Kubik-Huch; C Lopez; R Manfredi; J McHugo; L Oleaga; K Togashi; K Kinkel Journal: Eur Radiol Date: 2010-11-10 Impact factor: 5.315
Authors: Evis Sala; Maura Micco; Irene A Burger; Derya Yakar; Marisa A Kollmeier; Debra A Goldman; Mithat Gonen; Kay J Park; Nadeem R Abu-Rustum; Hedvig Hricak; Hebert Alberto Vargas Journal: Int J Gynecol Cancer Date: 2015-10 Impact factor: 3.437
Authors: Jung-Yun Lee; Jina Youm; Jae Weon Kim; Kidong Kim; Hak Jae Kim; Jeong Yeon Cho; Min A Kim; Noh Hyun Park; Yong-Sang Song Journal: Cancer Res Treat Date: 2015-03-20 Impact factor: 4.679
Authors: Jonathan S Berek; Koji Matsuo; Brendan H Grubbs; David K Gaffney; Susanna I Lee; Aoife Kilcoyne; Gi Jeong Cheon; Chong Woo Yoo; Lu Li; Yifeng Shao; Tianhui Chen; Miseon Kim; Mikio Mikami Journal: J Gynecol Oncol Date: 2018-12-28 Impact factor: 4.401