Added value of para-aortic surgical staging compared to F-FDG PET/CT on the external beam radiation field for patients with locally advanced cervical cancer: An ONCO-GF study.

De Cuypere, Marjolein;Lovinfosse, Pierre;Goffin, Frédéric;Gennigens, Christine;Kridelka, Frédéric;et.al.
(2019) European journal of surgical oncology the journal of the European Society of Surgical Oncology — (2019)

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Authors
  • De Cuypere, Marjolein
    Author
  • Lovinfosse, Pierre
    Author
  • Goffin, Frédéric
    Author
  • Gennigens, Christine
    Author
  • Squifflet, Jean LucUCLouvain
    Author
  • Luyckx, MathieuUCLouvain
    Author
  • Kridelka, Frédéric
    Author
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Abstract
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.
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De Cuypere, M., Lovinfosse, P., Goffin, F., Gennigens, C., Rovira, R., Duch, J., Fastrez, M., Gebhart, G., Squifflet, J. L., Luyckx, M., Charaf, G., Crener, K., Buxant, F., Bucella, D., Jouret, M., Hustinx, R., & Kridelka, F. (2019). Added value of para-aortic surgical staging compared to F-FDG PET/CT on the external beam radiation field for patients with locally advanced cervical cancer: An ONCO-GF study. European journal of surgical oncology the journal of the European Society of Surgical Oncology. Submitted. https://doi.org/10.1016/j.ejso.2019.11.496 (Original work published 2019)