Added value of para-aortic surgical staging compared to F-18-FDG PET/CT on the external beam radiation field for patients with locally advanced cervical cancer: An ONCO-GF study
Por:
De Cuypere, M, Lovinfosse, P, Goffin, F, Gennigens, C, Rovira, R, Duch, J, Fastrez, M, Gebhart, G, Squifflet, JL, Luyckx, M, Charaf, G, Crener, K, Buxant, F, Bucella, D, Jouret, M, Hustinx, R, Kridelka, F
Publicada:
1 may 2020
Resumen:
Objective: Extended field chemoradiation is recommended for patients with locally advanced cervical cancer (LACC) and para-aortic lymph node (PALN) metastases. The radiation planning may be based on PET/CT while others recommend to rely on surgical staging. We report the rate of patients for whom the radiation field defined on PET/CT was modified by the histological PALN status.
Methods: Between March 2010 and December 2016, 168 consecutive patients with LACC underwent a pre-therapeutic PET/CT and PALN dissection. The data were reviewed retrospectively. The diagnostic performance of the PET/CT for definition of PALN status was calculated. We determined the percentage of patients for whom PALN dissection altered the external beam radiotherapy (EBRT) field defined on the PET/CT basis.
Results: Of 151 patients with negative PALNs on PET/CT, 26 had histological PALN metastases. Of 17 patients with positive PALNs on PET/CT, 9 were negative on histology of which 7 were located in the common iliac region. Sensitivity, specificity, positive and negative predictive value of PET/CT were 23.5, 93.3, 47.1 and 82.8% respectively. In total, 35 out of 168 patients underwent EBRT - field adaptation (pelvic vs extended field). The rate of radiation field modification (27,7%) was particularly high in the subgroup of patients with metastatic pelvic lymph nodes (PLNs) on PET/CT.
Conclusion: Para-aortic surgical staging contributes significantly to individualize the radiation treatment of patients with LACC, particularly for those with positive PLNs at PET/CT. Indication of surgical staging deserves particular attention when the PET/CT suggests positive LNs in the common iliac region. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Filiaciones:
De Cuypere, M:
Univ Liege, Dept Obstet & Gynecol, Liege, Belgium
Lovinfosse, P:
Univ Liege, Dept Nucl Med, Liege, Belgium
Goffin, F:
Univ Liege, Dept Obstet & Gynecol, Liege, Belgium
Gennigens, C:
Univ Liege, Dept Med Oncol, Liege, Belgium
Rovira, R:
Hosp Santa Creu & St Pau Barcelona, Dept Gynecol Oncol & Laparoscopy, Barcelona, Spain
Duch, J:
Hosp Santa Creu & St Pau Barcelona, Dept Nucl Med, Barcelona, Spain
Fastrez, M:
Free Univ Brussels, St Pierre Univ Hosp, Dept Gynecol, Brussels, Belgium
Gebhart, G:
Free Univ Brussels, Inst Jules Bordet, Dept Nucl Med, Brussels, Belgium
Squifflet, JL:
Catholic Univ Louvain, St Luc Acad Hosp, Dept Gynecol, Brussels, Belgium
Luyckx, M:
Catholic Univ Louvain, St Luc Acad Hosp, Dept Gynecol, Brussels, Belgium
Charaf, G:
Univ Ambroise Pare Mons, Dept Obstet & Gynecol, Mons, Belgium
Crener, K:
Univ Ambroise Pare Mons, Dept Obstet & Gynecol, Mons, Belgium
Buxant, F:
Iris South Hosp, Dept Obstet & Gynecol, Brussels, Belgium
Bucella, D:
Iris South Hosp, Dept Nucl Med, Brussels, Belgium
Jouret, M:
CHwapi, Dept Obstet & Gynecol, Tournai, Belgium
Hustinx, R:
Univ Liege, Dept Nucl Med, Liege, Belgium
Kridelka, F:
Univ Liege, Dept Obstet & Gynecol, Liege, Belgium
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