Added value of para-aortic surgical staging compared to 18F-FDG PET/CT on the external beam radiation field for patients with locally advanced cervical cancer: An ONCO-GF study

Cuypere, Marjolein De; Lovinfosse, Pierre; Goffin, Frédéric; Gennigens, Christine; Rovira, Ramón; Duch, Joan; Fastrez, Maxime; Gebhart, Geraldine; Squifflet, Jean Luc; Luyckx, Mathieu; Charaf, G; Crener, K.; Buxant, Frédéric; Bucella, Dario; Jouret, Mathieu; Hustinx, Roland; Kridelka, Frédéric

doi:10.1016/j.ejso.2019.11.496

Cited by 21 publications

(36 citation statements)

References 24 publications

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“…In imaging and surgical staging group, EFI was performed in 19.4 and 44.2% of patients ( 14 ). In the study of De Cuypere et al ( 5 ) 15 (18.1%) of 83 patients with positive pelvic LNs changed the target volume from the pelvis to the pelvis and PALN region after surgical staging. Ramirez reported that 18.3% of patients had a treatment modification based on surgical findings ( 21 ).…”

Section: Surgical Staging Of Paln Regionmentioning

confidence: 95%

“…For PET/CT, it was reported that the false negative rate of PALN metastasis was 8.4–13.6% in patients with LACC ( 19 , 20 ), which is comparatively low. However, in patients with positive pelvic LNs on PET/CT, the false negative rate was 24–27.7% ( 19 , 20 ), and the negative predictive value of PET/CT in diagnosing PALN metastasis was only 77.6% ( 5 ). Ramirez et al ( 21 ) reported that 22% patients with positive pelvic but negative para-aortic LNs on PET/CT had positive histologically confirmed positive PALN.…”

Section: Pet/ct In Detecting Paln Metastasismentioning

confidence: 98%

“…De Cuypere et al ( 5 ) reported that in patients with LACC, 20.2% had histologic positive PALNs, 10.1% had positive PALNs on PET/CT and 4.8% had positive PALNs both on PET/CT and surgical staging. In patients with positive pelvic LNs on PET/CT, 27.7% had histologic positive PALNs, 19.3% had positive PALNs on PET/CT and 9.6% had positive PALNs both on PET/CT and surgical staging.…”

Section: Pet/ct In Detecting Paln Metastasismentioning

confidence: 99%

“…In Uterus-11, surgical staging led to upstaging in 33% of patients ( 72 ). De Cuypere et al ( 5 ) reviewed 168 patients with LACC underwent pretreatment PET/CT and PALN dissection. Of them, 35 patients (20.8%) underwent radiotherapy field adaption after PALN dissection.…”

Section: Surgical Staging Of Paln Regionmentioning

confidence: 99%

“…Para-aortic lymph node (PALN) metastasis plays an important role in the metastasis of cervical cancer. It was reported that 13.5–20.2% of patients with locally advanced cervical cancer (LACC) had positive PALNs ( 2 – 5 ). For patients with FIGO stage IB, IIB and III disease, the incidences of PALN metastasis are 5%, 16% and 25% ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

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Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

et al. 2020

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Currently, the standard radiation field for locally advanced cervical cancer patients without evidence of para-aortic lymph node (PALN) metastasis is the pelvis. Due to the low accuracy of imaging in the diagnosis of PALN metastasis and the high incidence of PALN failure after pelvic radiotherapy, prophylactic pelvic and para-aortic irradiation, also called extended-field irradiation (EFI), is performed for patients with cervical cancer. In the era of concurrent chemoradiotherapy, randomized controlled trials are limited, and whether patients with cervical cancer can benefit from prophylactic EFI is still controversial. With conformal or intensity-modulated radiation therapy, patients tolerate prophylactic EFI very well. The severe toxicities of prophylactic EFI are not significantly higher than those of pelvic radiotherapy. We recommend delivering prophylactic EFI to cervical cancer patients with common iliac lymph nodes metastasis. Clinical trials are needed to investigate whether patients with ≥3 positive pelvic lymph nodes and FIGO stage IIIB disease can benefit from prophylactic EFI. According to the distribution of PALNs, it is reasonable to use the renal vein as the upper border of the radiation therapy field for patients treated with prophylactic EFI. The clinical target volume expansion of the node from the vessel should be smaller in the right para-caval region than in the left lateral para-aortic region. The right para-caval region above L2 or L3 may be omitted from the PALN target volume to reduce the dose to the duodenum. More clinical trials on prophylactic EFI in cervical cancer are needed.

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Section: Surgical Staging Of Paln Regionmentioning

confidence: 95%

Section: Pet/ct In Detecting Paln Metastasismentioning

confidence: 98%

Section: Pet/ct In Detecting Paln Metastasismentioning

confidence: 99%

Section: Surgical Staging Of Paln Regionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

et al. 2020

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Multicentric development and evaluation of 18F-FDG PET/CT and MRI radiomics models to predict para-aortic lymph node involvement in locally advanced cervical cancer

Lucia

Bourbonne

Pleyers³

et al. 2023

Eur J Nucl Med Mol Imaging

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Purpose To develop machine learning models to predict para-aortic lymph node (PALN) involvement in patients with locally advanced cervical cancer (LACC) before chemoradiotherapy (CRT) using 18 F-FDG PET/CT and MRI radiomics combined with clinical parameters. Methods We retrospectively collected 178 patients (60% for training and 40% for testing) in 2 centers and 61 patients corresponding to 2 further external testing cohorts with LACC between 2010 to 2022 and who had undergone pretreatment analog or digital 18 F-FDG PET/CT, pelvic MRI and surgical PALN staging. Only primary tumor volumes were delineated. Radiomics features were extracted using the Radiomics toolbox®. The ComBat harmonization method was applied to reduce the batch effect between centers. Different prediction models were trained using a neural network approach with either clinical, radiomics or combined models. They were then evaluated on the testing and external validation sets and compared. Results In the training set (n = 102), the clinical model achieved a good prediction of the risk of PALN involvement with a C-statistic of 0.80 (95% CI 0.71, 0.87). However, it performed in the testing (n = 76) and external testing sets (n = 30 and n = 31) with C-statistics of only 0.57 to 0.67 (95% CI 0.36, 0.83). The ComBat-radiomic (GLDZM_HISDE_PET_FBN64 and Shape_maxDiameter2D3_PET_FBW0.25) and ComBat-combined (FIGO 2018 and same radiomics features) models achieved very high predictive ability in the training set and both models kept the same performance in the testing sets, with C-statistics from 0.88 to 0.96 (95% CI 0.76, 1.00) and 0.85 to 0.92 (95% CI 0.75, 0.99), respectively. Conclusions Radiomic features extracted from pre-CRT analog and digital 18 F-FDG PET/CT outperform clinical parameters in the decision to perform a para-aortic node staging or an extended field irradiation to PALN. Prospective validation of our models should now be carried out.

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Update S3-Leitlinie Zervixkarzinom

Stübs

Beckmann

Fehm

2022

best practice onkologie

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Added value of para-aortic surgical staging compared to 18F-FDG PET/CT on the external beam radiation field for patients with locally advanced cervical cancer: An ONCO-GF study

Cited by 21 publications

References 24 publications

Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

Prophylactic Extended-Field Irradiation in Patients With Cervical Cancer: A Literature Review

Multicentric development and evaluation of 18F-FDG PET/CT and MRI radiomics models to predict para-aortic lymph node involvement in locally advanced cervical cancer

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