The Role of Pretreatment FDG-PET in Treating Cervical Cancer Patients With Enlarged Pelvic Lymph Node(s) Shown on MRI: A Phase 3 Randomized Trial With Long-Term Follow-Up.
OBJECTIVE
This report is the second analysis of a prospective randomized trial to investigate the impact of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) on cervical cancer patients with enlarged pelvic lymph nodes identified by magnetic resonance imaging.


METHODS
Patients with newly diagnosed cervical cancer with enlarged pelvic lymph nodes but free of enlarged para-aortic lymph nodes (PALN) were eligible. Patients were randomized to receive either pretreatment FDG-PET (PET arm) or not (control arm). The whole pelvis was the standard irradiation field for all patients except those with FDG-avid extrapelvic findings.


RESULTS
In all, 129 patients were enrolled. Pretreatment PET detected extrapelvic metastases in 7 patients. No new patient experienced treatment failure during the additional 4-year follow-up period. There were no significant differences between the PET arm and the control arm regarding overall survival, disease-free survival, and freedom from extrapelvic metastasis. In the control arm, 8 of 10 patients with PALN relapse had limited extrapelvic nodal failures; their 5-year disease-specific survival was 34.3%. By contrast, only 1 of 5 patients with PALN relapse in the PET arm experienced such limited failures; their 5-year survival rate was 0%.


CONCLUSIONS
Although the pretreatment detection of PALN did not translate into survival benefit, it indeed decreased the need for extended-field concurrent chemoradiation therapy.
Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.
Shinn-Yn
SY
Lin
Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taiwan; Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan.
Chien-Sheng
CS
Tsai
Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taiwan; Molecular Imaging Center and Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Yu-Chen
YC
Chang
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung, Taiwan.
Koon-Kwan
KK
Ng
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Ting-Chang
TC
Chang
Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Wei-Heng
WH
Kao
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Chyong-Huey
CH
Lai
Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taiwan; Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taiwan. Electronic address: jihong@adm.cgmh.org.tw.
Ji-Hong
JH
Hong
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010388:Pelvis; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D011446:Prospective Studies; D011837:Radiation-Protective Agents / Q000008:administration & dosage; D019275:Radiopharmaceuticals; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*
D000970:Antineoplastic Agents; D011837:Radiation-Protective Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002945:Cisplatin