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

• Published in: European journal of surgical oncology Vol. 46; no. 5; pp. 883 - 887
• Main 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
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.05.2020
• Subjects: 18F-FDG PET/CT; Locally advanced cervical cancer; Para-aortic lymph nodes; Surgical staging; 18F-FDG PET/CT; ONCO-GF; Locally advanced cervical cancer; Para-aortic lymph nodes; Surgical staging
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2019.11.496

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. 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. 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. 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.