The Role of Pretreatment FDG-PET in Treating Cervical Cancer Patients With Enlarged Pelvic Lymph Node(s) Shown on MRI: A Phase 3 Randomized Trial With Long-Term Follow-Up

Lin, Shinn‐Yn; Tsai, Chien-Sheng; Chang, Yue; Ng, Koon‐Kwan; Chang, Ting‐Chang; Kao, Wei-Chun; Lai, Chyong‐Huey; Hong, Ji-Hong

doi:10.1016/j.ijrobp.2015.02.027

Cited by 15 publications

(10 citation statements)

References 32 publications

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“…[25,26] In addition, a prospective study reported that detection of PALNs via FDG-PET had no survival benefits, although FDG-PET decreased the need for extended-field CCRT. [27,28] In that study, the PALN failure rate for patients (n = 63) receiving pelvic CCRT but not pretreatment FDG-PET was 15.9% compared with 1.3% in the present study. FDG-PET might have revealed PLNs and PALNs in some of the patients in our study, and the treatment outcomes and policies might have differed if pretreatment FDG-PET had been performed in all patients.…”

Section: Discussioncontrasting

confidence: 46%

Safety and efficacy of semiextended field intensity-modulated radiation therapy and concurrent cisplatin in locally advanced cervical cancer patients

et al. 2017

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Patients with locally advanced cervical cancer (LACC) are at risk of para-aortic lymph node (PALN) metastasis. Pelvic concurrent chemoradiotherapy, the current standard treatment for LACC, has a PALN failure rate of 9% according to the Radiation Therapy Oncology Group Trial 90–01, suggesting that it may not completely eliminate all microscopic tumors in the PALNs. To minimize the toxicities associated with conventional prophylactic extended-field radiotherapy, our institute use prophylactic semiextended field radiotherapy that includes only the PALNs below the level of the renal vessels. Use of intensity-modulated radiotherapy (IMRT) is another means of reducing the incidence of toxicity. This study evaluated the safety and efficacy of prophylactic semiextended field IMRT (SEF-IMRT) and concurrent cisplatin chemotherapy in patients with LACC.We retrospectively assessed survival and toxicity in 76 patients with stage IB2–IVA cervical cancer and negative PALNs who received prophylactic SEF-IMRT and concurrent weekly cisplatin (40 mg/m2) between 2004 and 2013. The region targeted by SEF-IMRT included the PALNs below the level of the renal vessels, and the prescribed dose was 50.4 Gy in 28 fractions. Brachytherapy was administered at a dose of 30 Gy in 6 fractions. Survival outcomes were calculated by using the Kaplan–Meier method, and acute and late toxicities were scored according to the Common Terminology Criteria for Adverse Events, version 3.0.All patients completed the planned SEF-IMRT, as well as brachytherapy. Acute grade ≥3 gastrointestinal, genitourinary, and hematologic toxicities were observed in 2, 0, and 41 patients, respectively. The median follow-up time after SEF-IMRT was 55 (range, 11–124) months. Eight patients developed out-field distant recurrences without PALN failure, and 1 patient experienced out-field PALN failure with simultaneous distant metastasis. No patients had late genitourinary toxicities, and 3 patients had late grade 3 gastrointestinal toxicities. The 5-year overall survival, disease-free survival, local failure-free survival, regional failure-free survival, PALN failure-free survival, and distant metastasis-free survival rates were 85.0%, 84.4%, 96.0%, 97.3%, 98.6%, and 88.4%, respectively.For patients with LACC, prophylactic PALN irradiation up to the level of the renal vessels reduced PALN recurrence and resulted in favorable outcomes with few severe toxicities.

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Section: Discussioncontrasting

confidence: 46%

Safety and efficacy of semiextended field intensity-modulated radiation therapy and concurrent cisplatin in locally advanced cervical cancer patients

et al. 2017

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“…MRI is useful to delineate disease extent and to guide decisions regarding fertility-sparing versus non-fertility-sparing treatment approaches, [15][16][17][18][19][20][21] whereas PET/CT may be useful to detect and/or rule out metastasis. [22][23][24][25][26]…”

Section: Clinical Stagingmentioning

confidence: 99%

Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

Koh¹,

Abu‐Rustum²,

Bean³

et al. 2019

J Natl Compr Canc Netw

737

595

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Cervical cancer is a malignant epithelial tumor that forms in the uterine cervix. Most cases of cervical cancer are preventable through human papilloma virus (HPV) vaccination, routine screening, and treatment of precancerous lesions. However, due to inadequate screening protocols in many regions of the world, cervical cancer remains the fourth-most common cancer in women globally. The complete NCCN Guidelines for Cervical Cancer provide recommendations for the diagnosis, evaluation, and treatment of cervical cancer. This manuscript discusses guiding principles for the workup, staging, and treatment of early stage and locally advanced cervical cancer, as well as evidence for these recommendations. For recommendations regarding treatment of recurrent or metastatic disease, please see the full guidelines on NCCN.org.

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“…A total of 1309 articles were screened, resulting in 6 randomized studies with para-aortic RT: EORTC (4), RTOG 7920 (5–6), Osaka University (18), Chang Gung University (12,19), RTOG 9001 (7–8), and a Chinese trial (20). The study by Du et al .…”

Section: Resultsmentioning

confidence: 99%

Does para-aortic irradiation reduce the risk of distant metastasis in advanced cervical cancer? A systematic review and meta-analysis of randomized clinical trials

Sapienza

Gomes

Calsavara

et al. 2017

Gynecologic Oncology

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Purpose To evaluate the impact of the extension of the radiotherapy field cranially toward para-aortic lymph nodes (EF-RT) in advanced cervical cancer. Materials and Methods A systematic search of databases (PubMed, CENTRAL, Clinical Trials) was performed and included studies that were published between 1960 and November 2015 without language restrictions. All randomized clinical trials (RCTs) were analyzed further. All patients must have undergone pelvic radiotherapy and the same systemic therapy in both arms. The primary endpoints were locoregional failure, incidence of distant metastasis, para-aortic failure, and cancer related death. The Mantel-Haenszel method was used in the meta-analysis. The risk of bias analysis was determined using the 7-domain method per the Cochrane Handbook for Systematic Reviews of Interventions V5.1.0. A review of the treatment technique and toxicity was also performed. Results A total of 1309 studies were evaluated, 4 RCTs of which met the inclusion criteria; 506 patients were allocated to standard pelvic irradiation, and 494 underwent EF-RT. The risk of bias was considered to be low in nearly 80% of the domains. EF-RT significantly reduced the rate of para-aortic failure (HR 0.35, 95% CI 0.19–0.64; p<0.01) and the incidence of other distant metastases (HR 0.69, 95% CI 0.50–0.96; p=0.03). Locoregional failure and cancer-related death were not significantly altered (OR 1.06 [0.80–1.42]; p=0.67, and 0.68 [0.45–1.01]; p=0.06, respectively). The radiotherapy technique was conventional in 3 studies and conformational in 1 study. In total, 10 treatment-related deaths occurred—4 in pelvic radiation and 6 in EF-RT (OR 2.12 [0.71–6.27]; p=0.18). Conclusions EF-RT that targets the para-aortic lymphatic chain reduces distant metastatic events, but its impact on survival is unknown. Future studies should examine the value of EF-RT using modern radiation techniques.

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The Role of Pretreatment FDG-PET in Treating Cervical Cancer Patients With Enlarged Pelvic Lymph Node(s) Shown on MRI: A Phase 3 Randomized Trial With Long-Term Follow-Up

Cited by 15 publications

References 32 publications

Safety and efficacy of semiextended field intensity-modulated radiation therapy and concurrent cisplatin in locally advanced cervical cancer patients

Safety and efficacy of semiextended field intensity-modulated radiation therapy and concurrent cisplatin in locally advanced cervical cancer patients

Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

Does para-aortic irradiation reduce the risk of distant metastasis in advanced cervical cancer? A systematic review and meta-analysis of randomized clinical trials

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