Evaluating the Role of F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scanning in the Staging of Patients With Stage IIIB Cervical Carcinoma and the Impact on Treatment Decisions

Morkel, Marguerite; Ellmann, A; Warwick, James; Simonds, Hannah

doi:10.1097/igc.0000000000001174

Cited by 12 publications

(6 citation statements)

References 23 publications

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“…Challenges with clinical staging include the inadequate evaluation of the proximal tumour extension or side wall invasion, and inaccurate lymph node evaluation (especially deep pelvic lymph nodes). [68] With a sensitivity and specificity of lymph node evaluation of 100% and 99.6% respectively for nodes larger than 5mm, and the ability to detect metabolic changes before anatomical changes occur,[69,70] 18 F-FDG PET/CT is more effective at detecting lymph node involvement,[68] distant metastases,[71] and tumour activity. [72] LDC in our study included lymph nodes within the radiation field as visualised on 18 F-FDG PET/CT scans and we report on the loco-regional metabolic response, not the clinical response of the tumour.…”

Section: Discussionmentioning

confidence: 99%

The effect of modulated electro-hyperthermia on local disease control in HIV-positive and -negative cervical cancer women in South Africa: Early results from a phase III randomised controlled trial

et al. 2019

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Background The global burden of cervical cancer remains high with the highest morbidity and mortality rates reported in developing countries. Hyperthermia as a chemo- and radiosensitiser has shown to improve treatment outcomes. This is an analysis of the local control results at six months post-treatment of patients enrolled in an ongoing study investigating the effects of the addition of modulated electro-hyperthermia (mEHT) to chemoradiotherapy for the treatment of HIV-positive and -negative cervical cancer patients in a low-resource setting. Methods This ongoing Phase III randomised controlled trial, conducted at a state hospital in Johannesburg, South Africa, was registered with the appropriate ethics committee. After signing an informed consent, participants with FIGO stages IIB to IIIB squamous cell carcinoma of the cervix were randomised to receive chemoradiotherapy with/without mEHT using a secure online random-sampling tool (stratum: HIV status) accounting for age and stage. Reporting physicians were blind to treatment allocation. HIV-positive participants on antiretroviral treatment, or with a CD4 count >200cell/μL were included. mEHT was administered 2/weekly immediately before external beam radiation. The primary end point is local disease control (LDC) and secondary endpoints are toxicity; quality of life analysis; and two year survival. We report on six month LDC, including nodes visualised in the radiation field on 18 F-FDG PET/CT (censored for six month survival), and six month local disease free survival (LDFS) (based on intention to treat). Trial status: Recruitment closed (ClinicalTrials.gov: NCT03332069). Results 271 participants were recruited between January 2014 and November 2017, of which 210 were randomised for trial and 202 were available for analysis at six months post-treatment (mEHT: n = 101; Control: n = 101). Six month LDFS was higher in the mEHT Group (n = 39[38.6%]), than in the Control Group (n = 20[19.8%]); p = 0 . 003 ). LDC was also higher in the mEHT Group (n = 40[45.5%]) than the Control Group (n = 20[24.1%]); ( p = 0 . 003 ). Conclusion Our results show that mEHT is effective as a chemo-radiosensitiser for cervical cancer, even in high risk a patients and resource-constrained settings.

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Section: Discussionmentioning

confidence: 99%

The effect of modulated electro-hyperthermia on local disease control in HIV-positive and -negative cervical cancer women in South Africa: Early results from a phase III randomised controlled trial

et al. 2019

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“…Anatomical imaging for treatment planning has been used for a long time, but has limited sensitivity in determining the stage of cancer and low ability to determine the biology of the tumor and healthy tissue. Molecular imaging allows to assess the distribution of the molecular vector that represents the biological process, and thus better defines the area of external beam irradiation [12]. Ma et al proved that there are significant differences in tumor volume between images obtained with 18 F-FDG-PET/CT and MRI, probably resulting from the cervical and endometrial position, as well as the filling of the bladder and rectum [8].…”

Section: Discussionmentioning

confidence: 99%

Influence of 18F-FDG-PET/CT on staging of cervical cancer

et al. 2019

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Aim Cervical cancer is one of the most common cancers of the female reproductive system. The aim of the study was to assess the usefulness of the 18F-FDG-PET/CT study in staging of cervical cancer, with focus on the primary tumor parameters. Material & Methods 105 patients (mean age 56 ± 11y) with newly diagnosed cervical cancer underwent PET/CT examination which was performed 60 min after IV injection of 18F-FDG with a mean activity of 364 ± 75MBq. 68 patients were diagnosed with stage IIIA/IIIB, 19 patients with IIB, 10 patients with IB, 8 patients with stage IVA/IVB. Wilcoxon-Mann-Whitney test and ROC curves were used for statistical analysis. Results In 35 cases 18F-FDG-PET/CT did not show active proliferative process outside the cervix. In 38 cases metastases were found in iliac lymph nodes and in 32 patients scans showed metastases above the aortic bifurcation including lymph nodes and other organs. The largest volumes of primary tumor occurred in patients with distant metastases, while the lowest in patients with disease limited only to cervix. In 63 % of the patients PET/CT result was compatible with FIGO classification, in 20 % patients PET/CT result showed less advanced disease and in 17 % of the patients PET/CT results were higher than FIGO classification. Conclusion PET/CT using 18F-FDG has an important impact on the assessment of the stage of cervical cancer. In over 30 % of patients, this study resulted in a radical change in the treatment plan.

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“…The staging of cervical cancer is based on the FIGO (International Federation of Gynecology and Obstetrics) classification, which is a clinical staging system involving a thorough clinical examination and anatomical imaging. In a resource-constrained setting, a chest x-ray, abdominal ultrasonography, and cystoscopy are routinely performed on patients with cervical cancer with further investigations considered on a case-by-case basis, and depending on resources and availability (5).…”

Section: Introductionmentioning

confidence: 99%

“…Morkel et al reported that the addition of 18 F-FDG PET/CT to the initial screening protocols for patients with FIGO stage IIIB cervical cancer revealed relevant disease information that was missed by clinical staging and other imaging techniques. The information gathered from the 18 F-FDG PET/CT resulted in a change in treatment protocols in a significant number of patients with cervical cancer (5). In a study by Kidd et al, 53% of the 234 patients with cervical cancer (FIGO stage IB1–IVA), had FDG-avid lymph nodes on 18 F-FDG PET/CT scans, with nodes visualized as high as the supraclavicular region.…”

Section: Introductionmentioning

confidence: 99%

“…Studies have shown the importance of taking the HIV status of the patient into account when interpreting the results of 18 F-FDG PET/CT images of patients with cancer. Morkel et al found a significant inverse relationship between the CD4 count of HIV-positive patients and the mean SUV of their lymph nodes (5), and another study found that HIV-positive patients with high viral load levels may have benign hypermetabolic foci visualized on 18 F-FDG PET/CT images (18). This may result in false-positive interpretations of malignancy.…”

Section: Introductionmentioning

confidence: 99%

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Defining Characteristics of Nodal Disease on PET/CT Scans in Patients With HIV-Positive and -Negative Locally Advanced Cervical Cancer in South Africa

et al. 2019

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Literature reports increased FDG nodal uptake in HIV-positive patients. Our aim is to identify differences in presentation and characteristics of FDG-avid lymph nodes between HIV-positive and HIV-negative locally advanced cervical cancer (LACC) patients in our clinical setting. We evaluated 250 pre-treatment 18F-FDG PET/CT imaging studies from women screened for a phase III randomised controlled trial investigating modulated electro-hyperthermia as a radiosensitiser (Ethics approval: M120477). The number of nodes; size; maximum standardised uptake value (SUVmax); symmetry; and relationship between nodal size and SUVmax uptake, were assessed by region and by HIV status. In total, 1314 nodes with a SUVmax ≥ 2.5 were visualised. Of 128(51%) HIV-positive participants, 82% were on antiretroviral therapy (ART) and 10 had a CD4 count <200 cells/µL. Overall pattern of presentation and nodal characteristics were similar between HIV-positive and -negative groups and the uniformity in presentation of the nodes draining the cervix strongly suggests these nodes may be attributed to malignancy rather than HIV infection. Novel findings: HIV infection is associated with: >four nodes visualised in the neck, symmetrical inguinal lymph nodes, increased rates of supraclavicular node visualisation; FDG-avid axillary nodes were more common, but not exclusive, in HIV-positive participants. 18F-FDG PET/CT is a reliable staging method for LACC in HIV-positive patients who are not in acute stages of HIV infection, have a CD4 count >200 cells/µL, and/or are on ART and there is a potential risk of underestimating metastatic spread by attributing increased nodal metabolic activity to HIV infection in these patients.

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Evaluating the Role of F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scanning in the Staging of Patients With Stage IIIB Cervical Carcinoma and the Impact on Treatment Decisions

Cited by 12 publications

References 23 publications

The effect of modulated electro-hyperthermia on local disease control in HIV-positive and -negative cervical cancer women in South Africa: Early results from a phase III randomised controlled trial

The effect of modulated electro-hyperthermia on local disease control in HIV-positive and -negative cervical cancer women in South Africa: Early results from a phase III randomised controlled trial

Influence of 18F-FDG-PET/CT on staging of cervical cancer

Defining Characteristics of Nodal Disease on PET/CT Scans in Patients With HIV-Positive and -Negative Locally Advanced Cervical Cancer in South Africa

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