The role of pretreatment FDG-PET in managing cervical cancer patients with enlarged pelvic lymph node(s) shown on MRI: a phase III randomized trial with long-term follow-up
Mené sur 129 patientes atteintes d'un cancer du col de l'utérus avec envahissement des ganglions pelviens détecté par IRM (durée de suivi : 4 ans), cet essai de phase III évalue l'intérêt de réaliser avant traitement une tomographie par émission de positrons à base de fluorodésoxyglucose (18F) pour détecter des métastases extra-pelviennes et améliorer la survie des patientes
Purpose : This report is the second analysis of a prospective randomized trial to investigate the impact of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) on cervical cancer patients with MRI-identified enlarged pelvic nodes (PvLN).
Methods and Materials : Newly diagnosed cervical cancer patients with enlarged PvLN(s) 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). Whole pelvis was the standard irradiation field for all patients except those with FDG-avid extrapelvic findings.
Results : Totally 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 PET arm and 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%. In contrast, only 1 of five 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 CCRT.
International Journal of Radiation Oncology • Biology • Physics , résumé, 2014