(P006) The Role of Sequential Imaging in Cervical Cancer Management

Publication
Article
OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Despite uncertainty regarding the anatomic resolution of PET, sequential use of contrast-enhanced CT, PET-CT, and/or MRI had no impact on treatment planning that was not accomplished by the use of PET alone. Future work should focus on determining the optimal pretreatment imaging for women with cervical cancer and developing guidelines to optimize outcomes while minimizing cost and radiation exposure.

A. MacDonald, C. Tung, M. Bonnen, M.Y. Williams-Brown, C.R. Diaz-Arrastia, M. Ludwig, M.L. Anderson; UT Health Science Center at Houston; Baylor College of Medicine

OBJECTIVES: In the absence of International Federation of Gynecology and Obstetrics (FIGO) guidelines, optimal imaging of women diagnosed with cervical cancer in settings where multiple modalities are available for treatment planning remains unclear. The purpose of this study was to determine whether sequential imaging by contrast-enhanced computed tomography (CT), 18-fluoro-deoxyglucose positron emission tomography (FDG-PET)-CT, and/or magnetic resonance imaging (MRI) enhances radiation treatment planning for women with cervical cancer.

METHODS: After obtaining institutional review board (IRB) approval, all women diagnosed with cervical cancer who were eligible for definitive chemoradiation (FIGO stages IB1–IVA) in a regional safety-net health system between July 2012 and August 2014 were identified. Clinical demographics and treatment plans were reviewed and abstracted so that the impact of imaging modalities could be compared.

RESULTS: A total of 93 women (mean age: 51.0 ± 13.2 yr) with IB1 (n = 3, 3.2%), IB2 (n = 16, 17.2%), IIA (n = 11, 11.8%), IIB (n = 33; 35.4%), IIIA (n = 5, 5.3%), IIIB (n = 22;23.7%), and IVA (n = 3; 3.2%) disease were identified. Histologies included squamous cell (n = 78, 83.8%), adenosquamous (n = 2, 2.1%), poorly differentiated (n = 3, 3.2%), small cell (n = 1, 1.1%), and adenocarcinomas (n = 9, 9.6%). Pretreatment, 48 women underwent contrast-enhanced CT (abdomen/pelvis and/or chest) alone, 28 received CT followed by PET, 6 received PET and MRI, 4 received CT and MRI, 1 received PET only, and 6 underwent all three tests. For the 34 women who had CT followed by PET, no anatomic findings were identified by CT that were not also detected by PET. In contrast, PET identified lesions that were not seen in anatomic fields evaluated by CT in eight women. PET resulted in radiation treatment modifications for 22 (65%) of these women. Of the 12 patients who received PET and MRI, treatment was modified in response to PET but not MRI for 8 (67%). Treatment modifications due to PET included nodal boost (n = 20, 67%), extension of irradiated field (n = 8, 26%), or both (n = 2, 7%).

CONCLUSIONS: Despite uncertainty regarding the anatomic resolution of PET, sequential use of contrast-enhanced CT, PET-CT, and/or MRI had no impact on treatment planning that was not accomplished by the use of PET alone. Future work should focus on determining the optimal pretreatment imaging for women with cervical cancer and developing guidelines to optimize outcomes while minimizing cost and radiation exposure.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
Recent Videos
The development of RAS-directed vaccines may help decrease the likelihood of disease recurrence in patients undergoing treatment for pancreatic cancer.
Medical use of AI increases every day, and in the future, will be exponentially greater and many forms of treatment will be improved, according to Russell C. Langan, MD, FACS, FSSO.
Shubham Pant, MD, MBBS, highlights an “exciting time” in the treatment of patients with RAS-mutated pancreatic cancer.
Greater direct access to academic oncologists may help address challenges associated with a lack of CAR T education in the community setting.
A computational linguistics model designed to locate pancreatic cysts that started to locate pancreatic cancer has the potential to lead to more efficient treatment.
Brett L. Ecker, MD, discusses the importance of multidisciplinary collaboration in improving patient outcomes in neuroendocrine tumors.
Related Content