Added value of para-aortic surgical staging compared to 18F-FDG PET/CT on the external beam radiation field for patients with locally advanced cervical cancer: An ONCO-GF study. Issue 5 (May 2020)

• Record Type: Journal Article
• Authors: De Cuypere, Marjolein; Lovinfosse, Pierre; Goffin, Frédéric; Gennigens, Christine; Rovira, Ramon; Duch, Joan; Fastrez, Maxime; Gebhart, Géraldine; Squifflet, Jean Luc; Luyckx, Mathieu; Charaf, Gabriel; Crener, Kurt; Buxant, Frédéric; Bucella, Dario; Jouret, Mathieu; Hustinx, Roland; Kridelka, Frédéric
• Is Part Of: European journal of surgical oncology. Volume 46:Issue 5(2020)
• Page Start: 883
• Page End: 887
• Publication Date: 2020-05
• Subjects: Locally advanced cervical cancer -- Para-aortic lymph nodes -- 18F-FDG PET/CT -- Surgical staging; ONCO-GF Gynecological Working Group from the GGOLFB (Groupement des Gynécologues Obstétriciens de Langue Française de Belgique); Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2019.11.496
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: 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.