Integration of diagnostic imaging in the clinical management of cervical cancer.
Diagnostic imaging plays multiple roles during the initial assessment, treatment, and surveillance follow-up of patients with cervical cancer. Clarification of pretreatment disease extent aids in understanding prognosis, may influence selection of treatment modalities, and permits outcome comparison between different therapeutic interventions employed in similar groups of patients. Recently, use of historically important imaging assessments has declined precipitously, coincident with the increased use of contemporary imaging modalities not yet acknowledged by the International Federation of Gynecology and Obstetrics staging. In the United States, approximately 50% of the patients with invasive cancer will receive all, or a portion, of their initial treatment with radiation therapy. Clarification of the target volumes for radiotherapy, including both teletherapy and brachytherapy components, enables delivery of radiation therapy, with maximal confidence that all identifiable cancer is within the treatment field and normal tissues are excluded to the greatest extent possible. Imaging assessments can help select patients most likely to benefit from aggressive salvage therapies. Identification of sites of recurrence provides guidance for refinements in existing therapies and is an important element in the prospective evaluation of new treatments. As postmortem examination of patients who have died of cancer becomes a rare event, antemortem imaging can serve as an alternative to the traditional autopsy in determining cause of death and ultimate patterns of failure. Future challenges for diagnostic imaging include addressing the need for disciplined, prospective evaluation of emerging imaging technologies and, when sensible, rational integration of widely available, standardized imaging modalities into algorithms for initial staging and subsequent monitoring of patients treated for invasive cervical cancer.
Russell
A H
AH
Department of Obstetrics and Gynecology, School of Medicine, University of California at Davis, USA.
D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006801:Humans; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000628:therapy*