Association of Posttherapy Positron Emission Tomography With Tumor Response and Survival in Cervical Carcinoma

Schwarz, Julie K.; Siegel, Barry A.; Dehdashti, Farrokh; Grigsby, Perry W.

doi:10.1001/jama.298.19.2289

Cited by 272 publications

(169 citation statements)

References 44 publications

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“…For initial staging,85% of respondents considered pet to be a standard of care, and nearly half (45%) believed it should be a standard of care to assess treatment response. Because of access survival 3 . Other authors have evaluated pet as an aid to brachytherapy planning 4 .…”

Section: Resultsmentioning

confidence: 99%

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Positron-Emission Tomography for Locally Advanced Cervical Cancer: A Survey Assessing Canadian Practice Patterns and Access

2013

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Purpose: Imaging by fluorodeoxyglucose positron-emission tomography (PET) has emerged as a valuable tool in the management of locally advanced cervical cancer (LACC), both for assessment of lymph node status and determination of response to chemoradiotherapy. The aim of the present study was to survey Canadian radiation oncologists to determine access to PET imaging for LACC patients and to assess current patterns of practice. Methods: Radiation oncology centres across Canada were contacted to identify radiation oncologists who treat patients with LACC. The focus of the survey was patients treated with radical chemoradiotherapy with curative intent. An anonymous online tool was used to distribute a 23-item questionnaire asking about access to PET imaging, opinions on indications for PET imaging, and practice patterns relating to the use of PET in this patient population. Questionnaire responses were tabulated and analyzed. Results: The response rate was 65% (35 of 54 questionnaire recipients). Most respondents (80%) have access to PET for LACC patients, usually restricted to study protocols. Of the respondents, 48% considered that access to PET was timely. Frequency of routine orders for PET before and after treatment (to assess response) was 63% and 15% respectively. With better access, 91% of respondents would routinely order PET before treatment, and 61% would routinely order it for posttreatment assessment. For initial staging, 85% of respondents considered PET to be a standard of care, and nearly half (45%) believed it should be a standard of care to assess treatment response. Because of access limitations, nearly 70% of respondents (23 of 34) do not order pet as often as they feel it is clinically indicated, and 74% agree that better access to PET would lead to improved care for LACC patients in Canada. Conclusions: Canadian radiation oncologists support the routine use of PET imaging in the initial workup of patients with LACC. Access to PET imaging limits routine use for these patients in clinically indicated situations. There is strong support for developing guidelines for PET use in this patient population.

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Section: Resultsmentioning

confidence: 99%

“…In addition to initial stage and lymph node status, posttreatment response based on pet-ct strongly predicts for disease recurrence 3 . Schwarz et al prospectively evaluated pet-ct imaging 3 months after therapy in advanced cervical cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Positron-Emission Tomography for Locally Advanced Cervical Cancer: A Survey Assessing Canadian Practice Patterns and Access

2013

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“…Posttreatment disease response was assessed by a nuclear medicine physician reading a diagnostic FDG‐PET/CT scan performed on average 3.1 months after the conclusion of the CCRT, as previous studies have shown that the 3‐month posttreatment time point correlates with long‐term outcome 17. Treatment outcome measures were complete metabolic response (CMR), PD, or new disease (ND).…”

Section: Methodsmentioning

confidence: 99%

Pilot study of combined FDG‐PET and dynamic contrast‐enhanced CT of locally advanced cervical carcinoma before and during concurrent chemoradiotherapy suggests association between changes in tumor blood volume and treatment response

et al. 2018

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Modern PET/CT radiotherapy simulators offer FDG‐PET and dynamic contrast‐enhanced (DCE) CT imaging for combined volumetric assessment of tumor metabolism and perfusion. However, the clinical utility of such assessment has not been clearly defined. Thus, in a prospective longitudinal study of primary cervical tumors treated with concurrent chemoradiotherapy (CCRT) we evaluated: (1) whether PET and perfusion parameters correlate or provide complementary information; (2) what imaging changes occur during CCRT; and (3) whether any parameters are predictive of treatment response as assessed by PET/CT 3 months posttherapy. FDG‐PET/CT and DCE‐CT scans were performed on 21 patients prior to and during CCRT. Coregistered volumetric parametric maps of standardized uptake value (SUV) measures and perfusion parameters blood flow (BF), blood volume (BV), and permeability were generated. Summary statistics for these parameters and their changes were calculated within the metabolic tumor volume (MTV). Correlations between SUV and BF/BV/permeability on local and global bases were assessed with Pearson's coefficient r. MTV, maximum SUV, and mean SUV decreased significantly between the pre‐ and during‐treatment time points, while mean BV and permeability increased significantly. Global correlations between mean BF/BV/permeability and mean SUV values (−.15 < r < .29) were at most moderate. An increase in mean tumor BV during treatment was significantly correlated with complete metabolic response on 3‐month posttreatment PET/CT. Weak correlations of SUV and perfusion parameters suggest a complementary role of FDG‐PET and DCE‐CT for tumor characterization. The association between relative change in mean BV and outcome suggests a potential role for DCE‐CT in early evaluation of cervical tumor response to chemoradiotherapy.

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“…According to Grigsby et al [9], PET is valuable to evaluate the response to treatment and for the surveillance of patients after initial therapy. Schwartz et al [10], in their prospective study on 92 patients after chemoradiation, showed that the 3-year progression-free survival rates, according to the metabolic response, were 78 % for a complete response, 33 % for partial response, and 0 % for progressive disease. The major advantage of 18F-FDG-PET in cervical cancer is the diagnosis of relapse.…”

Section: Cervical Cancermentioning

confidence: 99%

Role of PET–CT Scan in Gynaeconcology

Pawar

Patil

Patel

et al. 2015

J Obstet Gynecol India

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The purpose of this study This study was undertaken to evaluate the role of positron emission tomography-CT (PET-CT) in diagnosis and management of gynecological malignancies in primary and recurrent settings and also to investigate its role in inappropriately treated patients, for pretreatment evaluation (staging) to help in proper therapeutic management. Method This is a retrospective study of 56 patients of gynecological malignancy registered in Gujarat Cancer Research Institute from June 2011 to December 2013. Results Out of 56 cases where PET was done, the results were as follows: carcinoma cervix-23, carcinoma ovary-20, carcinoma endometrium-9, carcinoma vulva-1, carcinoma vagina-2, and GTN-1. PET scan was negative in 37 % of patients where CT scan was suspicious, which changed the therapeutic modality and prevented further unnecessary interventions. In cases where clinical suspicion of recurrence was high based on rising tumor marker and CT scan was negative, subsequent PET-CT was able to pick up malignancy in 75 % cases. Eleven patients (25 %) with suspected recurrence with inconclusive CT scan and negative PET-CT scan were kept on follow-up, thus reducing further morbidity and cost. Conclusion Addition of PET-CT, a noninvasive method to the oncologist's imaging armamentarium may ultimately improve both outcomes and costs by altering management strategies in primary and recurrent settings. The potential use of PET-CT appears promising in several decisionmaking steps in the management of patients with gynecological malignancy. It defines the extent of metastatic disease which enables the clinician to decide regarding salvageable surgical intervention or palliative measures.

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Association of Posttherapy Positron Emission Tomography With Tumor Response and Survival in Cervical Carcinoma

Cited by 272 publications

References 44 publications

Positron-Emission Tomography for Locally Advanced Cervical Cancer: A Survey Assessing Canadian Practice Patterns and Access

Positron-Emission Tomography for Locally Advanced Cervical Cancer: A Survey Assessing Canadian Practice Patterns and Access

Pilot study of combined FDG‐PET and dynamic contrast‐enhanced CT of locally advanced cervical carcinoma before and during concurrent chemoradiotherapy suggests association between changes in tumor blood volume and treatment response

Role of PET–CT Scan in Gynaeconcology

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