Nodal-staging surgery for locally advanced cervical cancer in the era of PET

Gouy, Sébastien; Morice, Philippe; Narducci, Fabrice; Uzan, Catherine; Gilmore, Jennifer; Kolesnikov-Gauthier, H; Querleu, Denis; Haie-Méder, Christine; Leblanc, Éric

doi:10.1016/s1470-2045(12)70011-6

Cited by 191 publications

(124 citation statements)

References 78 publications

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“…Three comprehensive reviews by Fagotti et al [37] , Smits et al [7] , and Gouy et al [38] have concluded that laparoscopic staging in patients with locally advanced cervical cancer is feasible, does not delay further treatment, and leads to modification of planned treatment in 7-58% of patients. The overall upstaging rate in the surgical arm of the Uterus-11 study was 33%, consistent with these previous observations.…”

Section: Discussionmentioning

confidence: 99%

“…The median number of harvested pelvic and para-aortic lymph nodes in our surgical staging arm was 19 (1-70) and 17 (3-74), respectively, and the median number of pelvic and paraaortic lymph node metastases was 2.4 (0-24) and 1.3 (0-25), respectively [49] . Patients with para-aortic lymph node metastases of cervical cancer have a poorer prognosis, with a 5-year overall survival between 5 and 58% depending on nodal size, the number of involved lymph nodes, the achievement of debulking surgery, and adequate CRTx schemas [9,22,24,30,38,50,[52][53][54] . This wide range of survival data potentially reflects the detection methods used to indicate EFRT (also in the RTOG 7920 [55] and EORTC trials [39] of prophylactic para-aortic irradiation), which include CT, lymphoscintigram, PET-CT, surgical staging, and a combination of these approaches.…”

Section: Discussionmentioning

confidence: 99%

“…Complications arising from surgical staging may delay the initiation of primary chemoradiation (CRTx) [30,[38][39][40] and consequently negatively impact prognosis. Additionally, port site metastases after laparoscopic staging have occasionally been described [41,42] .…”

Section: Introductionmentioning

confidence: 99%

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Incidence of Histologically Proven Pelvic and Para-Aortic Lymph Node Metastases and Rate of Upstaging in Patients with Locally Advanced Cervical Cancer: Results of a Prospective Randomized Trial

Tsunoda

Marnitz²,

Nunes

et al. 2017

Oncology

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Background: Surgical staging is associated with a significant rate of upstaging compared to clinical/radiological staging in patients with locally advanced cervical cancer. Objective: To analyze the stage-specific percentage of pelvic and para-aortic lymph node metastases and the upstaging ratio in a prospective randomized trial (Uterus-11). Methods: FIGO stage IIB-IVA cervical cancer patients were randomized to surgical staging (arm A) or to clinical staging and primary chemoradiation (arm B). Arm B patients underwent CT-guided biopsy of suspicious para-aortic lymph nodes. Confirmed para-aortic metastasis patients received extended-field radiation therapy. Results: A total of 234 patients were enrolled, including 120 (arm A) and 114 (arm B) treated per protocol. The groups were well balanced. Pelvic and para-aortic lymph node metastases were identified after surgical staging in 51 and 24% of patients, respectively (p < 0.001). Pelvic and para-aortic lymph node metastases were confirmed in 45 and 20% of IIB patients and in 71 and 37% of IIIB patients, respectively. Upstaging occurred in 39/120 (33%) in arm A and in 9/114 (8%) in arm B (p < 0.001). Conclusion: The histological results in both groups led to a considerable rate of upstaging. Oncological data from the Uterus-11 study may reveal whether modified therapy translates into a survival benefit.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence of Histologically Proven Pelvic and Para-Aortic Lymph Node Metastases and Rate of Upstaging in Patients with Locally Advanced Cervical Cancer: Results of a Prospective Randomized Trial

Tsunoda

Marnitz²,

Nunes

et al. 2017

Oncology

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“…And last year in a large meta analysis published in Lancet Oncology by Gouy et al [7] report a 12% false negative for PET (and up to 22% in those with uptake during PET of pelvic nodes). They suggest surgical staging in PET negative patients.…”

Section: Nodal Status and Rt Treatmentmentioning

confidence: 99%

Tailored Radiotherapy Treatment in Advanced Cervical Cancer. Early Experience of Robotics in Surgical Innovation

Pulgar¹

2014

SOJS

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“…Therefore, the use of SUV max as a new biomarker that is easily measureable on PET/CT prior to the start of treatment in patients with gynecological malignancies has received considerable attention. In cervical cancer, previous studies have demonstrated the usefulness of PET/CT for the staging or assessment of lymph node metastasis (16,17). However, the correlation between the FDG uptake and clinicopathological outcome of the primary tumor has not yet been sufficiently studied and its prognostic impact remains controversial (18)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

Primary tumor SUVmax on preoperative FDG-PET/CT is a prognostic indicator in stage IA2-IIB cervical cancer patients treated with radical hysterectomy

Yagi

Yahata

Mabuchi

et al. 2016

Molecular and Clinical Oncology

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Abstract. The objective of the present study was to investigate the prognostic value of 18 F-fluoro-2-deoxy-D-glucose (FDG) uptake by primary tumors on positron emission tomography/computed tomography (PET/CT) in surgically resectable cervical cancer. A total of 59 patients with stage IA2-IIB cervical cancer who underwent preoperative FDG-PET/CT, followed by radical hysterectomy and lymphadenectomy, were included in the study. The maximum standardized uptake value (SUV max ) of the primary tumor was measured, and the association between the SUV max and clinicopathological factors or patient outcomes was analyzed. The SUV max was significantly higher in patients with an advanced stage, lymph node metastasis, lymph-vascular space involvement and large tumors. The overall survival (OS) and progression-free survival (PFS) of patients with a high SUV max were significantly lower compared with patients with a low SUV max , using an optimal cut-off value of 7.36 for OS and 5.59 for PFS obtained from receiver operating characteristic curve analysis. Similarly, OS and PFS in patients with a high SUV max were significantly lower in 39 patients with stage IB using a cut-off value of 7.90 and 6.69 for OS and PFS, respectively. Finally, multivariate analyses showed that the SUV max of the primary tumor was an independent prognostic factor for impaired PFS in all patients and those with stage IB alone. These findings demonstrated that a high SUV max on preoperative PET/CT was correlated with unfavorable clinical outcomes in patients receiving radical hysterectomy, suggesting that the SUV max of the primary tumor may be a prognostic indicator for surgically-treated, early-stage invasive cervical cancer.

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Nodal-staging surgery for locally advanced cervical cancer in the era of PET

Cited by 191 publications

References 78 publications

Incidence of Histologically Proven Pelvic and Para-Aortic Lymph Node Metastases and Rate of Upstaging in Patients with Locally Advanced Cervical Cancer: Results of a Prospective Randomized Trial

Incidence of Histologically Proven Pelvic and Para-Aortic Lymph Node Metastases and Rate of Upstaging in Patients with Locally Advanced Cervical Cancer: Results of a Prospective Randomized Trial

Tailored Radiotherapy Treatment in Advanced Cervical Cancer. Early Experience of Robotics in Surgical Innovation

Primary tumor SUVmax on preoperative FDG-PET/CT is a prognostic indicator in stage IA2-IIB cervical cancer patients treated with radical hysterectomy

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