Marjolein De Cuypere1, Pierre Lovinfosse2, Frédéric Goffin3, Christine Gennigens4, Ramon Rovira5, Joan Duch6, Maxime Fastrez7, Géraldine Gebhart8, Jean Luc Squifflet9, Mathieu Luyckx9, Gabriel Charaf10, Kurt Crener10, Frédéric Buxant11, Dario Bucella12, Mathieu Jouret13, Roland Hustinx2, Frédéric Kridelka3. 1. Department of Obstetrics and Gynecology, University of Liège, Belgium. Electronic address: mdecuypere@chuliege.be. 2. Department of Nuclear Medecine, University of Liège, Belgium. 3. Department of Obstetrics and Gynecology, University of Liège, Belgium. 4. Department of Medical Oncology, University of Liège, Belgium. 5. Department of Gynecology Oncology and Laparoscopy, Hospital de la Santa Creu i Sant Pau of Barcelona, Spain. 6. Department of Nuclear Medecine, Hospital de la Santa Creu i Sant Pau of Barcelona, Spain. 7. Department of Gynecology, St Pierre University Hospital, Free University of Brussels, Belgium. 8. Department of Nuclear Medecine, Institut Jules Bordet, Free University of Brussels, Belgium. 9. Department of Gynecology, Saint Luc Academic Hospital, Catholic University of Louvain, Brussels, Belgium. 10. Department of Obstetrics and Gynecology, University Ambroise Paré of Mons, Belgium. 11. Department of Obstetrics and Gynecology, Iris South Hospital, Brussels, Belgium. 12. Department of Nuclear Medecine, Iris South Hospital, Brussels, Belgium. 13. Department of Obstetrics and Gynecology, CHwapi, Tournai, Belgium.
Abstract
OBJECTIVE: Extended field chemoradiation is recommended for patients with locally advanced cervical cancer (LACC) and para-aortic lymph node (PALN) metastases. The radiation planning may be based on PET/CT while others recommend to rely on surgical staging. We report the rate of patients for whom the radiation field defined on PET/CT was modified by the histological PALN status. METHODS: Between March 2010 and December 2016, 168 consecutive patients with LACC underwent a pre-therapeutic PET/CT and PALN dissection. The data were reviewed retrospectively. The diagnostic performance of the PET/CT for definition of PALN status was calculated. We determined the percentage of patients for whom PALN dissection altered the external beam radiotherapy (EBRT) field defined on the PET/CT basis. RESULTS: Of 151 patients with negative PALNs on PET/CT, 26 had histological PALN metastases. Of 17 patients with positive PALNs on PET/CT, 9 were negative on histology of which 7 were located in the common iliac region. Sensitivity, specificity, positive and negative predictive value of PET/CT were 23.5, 93.3, 47.1 and 82.8% respectively. In total, 35 out of 168 patients underwent EBRT - field adaptation (pelvic vs extended field). The rate of radiation field modification (27,7%) was particularly high in the subgroup of patients with metastatic pelvic lymph nodes (PLNs) on PET/CT. CONCLUSION: Para-aortic surgical staging contributes significantly to individualize the radiation treatment of patients with LACC, particularly for those with positive PLNs at PET/CT. Indication of surgical staging deserves particular attention when the PET/CT suggests positive LNs in the common iliac region.
OBJECTIVE: Extended field chemoradiation is recommended for patients with locally advanced cervical cancer (LACC) and para-aortic lymph node (PALN) metastases. The radiation planning may be based on PET/CT while others recommend to rely on surgical staging. We report the rate of patients for whom the radiation field defined on PET/CT was modified by the histological PALN status. METHODS: Between March 2010 and December 2016, 168 consecutive patients with LACC underwent a pre-therapeutic PET/CT and PALN dissection. The data were reviewed retrospectively. The diagnostic performance of the PET/CT for definition of PALN status was calculated. We determined the percentage of patients for whom PALN dissection altered the external beam radiotherapy (EBRT) field defined on the PET/CT basis. RESULTS: Of 151 patients with negative PALNs on PET/CT, 26 had histological PALN metastases. Of 17 patients with positive PALNs on PET/CT, 9 were negative on histology of which 7 were located in the common iliac region. Sensitivity, specificity, positive and negative predictive value of PET/CT were 23.5, 93.3, 47.1 and 82.8% respectively. In total, 35 out of 168 patients underwent EBRT - field adaptation (pelvic vs extended field). The rate of radiation field modification (27,7%) was particularly high in the subgroup of patients with metastatic pelvic lymph nodes (PLNs) on PET/CT. CONCLUSION: Para-aortic surgical staging contributes significantly to individualize the radiation treatment of patients with LACC, particularly for those with positive PLNs at PET/CT. Indication of surgical staging deserves particular attention when the PET/CT suggests positive LNs in the common iliac region.
Authors: Matthias W Beckmann; Frederik A Stuebs; Dirk Vordermark; Martin Christoph Koch; Lars-Christian Horn; Tanja Fehm Journal: Dtsch Arztebl Int Date: 2021-11-26 Impact factor: 8.251