Positron emission tomography in evaluating the feasibility of curative intent in cervical cancer patients with limited distant lymph node metastases

Gynecol Oncol. 2008 Aug;110(2):172-8. doi: 10.1016/j.ygyno.2008.03.018. Epub 2008 May 22.

Abstract

Objective: Clinical outcomes of cervical cancer patients with distant lymph node (LN) metastases are poor. [(18)F] fluorodeoxyglucose positron emission tomography (PET) or PET/computed tomography (CT) scans could potentially benefit treatment plan.

Methods: Patients with cervical cancer whose CT/magnetic resonance imaging (MRI)-based imaging showed limited metastases to para-aortic lymph node (PALN), inguinal (ILN), and/or supraclavicular (SLN) were prospectively enrolled to evaluate whether PET or PET/CT influenced management. The clinical impact of PET or PET/CT was determined on a patient basis.

Results: Between November 2001 and April 2007, 47 patients were enrolled for suspected metastasis to PALN with (n=8) or without other distant nodal involvement (n=31), ILN (n=6), or SLN metastasis (n=2). Additional PET or PET/CT had positive clinical impact in 21 (44.7%) of the 47 study patients, 23 had no impact, and three had negative impact. Positive impact included disclosing additional curable sites (n=8), down-staging (n=6), offering metabolic biopsy (n=4) or change to palliation (n=3). The 2-year overall survival (OS) of the study patients was 56.9% with median follow-up time of 47.0 months (range: 8-71 months) in surviving patients. The 2-year OS rates for PALN (based on histology or CT/MRI-PET consensus) and histology-proven SLN metastasis were 50.6% and 24.7%, respectively. Two (40.0%) of the five patients with histology-proven ILN metastases had no evidence of disease.

Conclusions: PET or PET/CT added benefit to primary treatment planning in cervical cancer with MRI-defined suspected distant nodal metastasis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / diagnostic imaging*
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy*
  • Feasibility Studies
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Lymph Nodes / diagnostic imaging
  • Lymphatic Metastasis
  • Magnetic Resonance Imaging
  • Middle Aged
  • Positron-Emission Tomography
  • Prospective Studies
  • Tomography, X-Ray Computed
  • Uterine Cervical Neoplasms / diagnostic imaging*
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / therapy*

Substances

  • Fluorodeoxyglucose F18