Imaging in cervical cancer

Abstract

Cervical cancer traditionally has been staged clinically. Advances in imaging could improve the staging of cervical cancer by facilitating the detection of lymph node metastases and micrometastases in distant organs. Such progress could lead to improvements in treatment selection and therefore increase overall survival rates.

Whole-body 18FDG PET plus pelvic MRI in the pre-treatment assessment of cervical cancers: an alternative to the FIGO clinical staging

“…In the assessment of primary cervical cancers, the value of MRI is well documented [4,5,16,17]. More recently, increasing amounts of data also have shown that 18 FDG PET may detect an intense metabolic signal at the level of the primary site with a high sensitivity (81-100%) [10,11,12,13,14,18,19,20]. When the performances of both imaging modalities were compared in a prospective series including 22 patients with histologically proven cervical cancers, a similar sensitivity of 91% was found.…”

“…This includes the detection of the initial tumour site and its precise delineation in a three-dimensional space. Also critical is the assessment of prognostic variables such as the depth and width of stromal invasion, local extension into the vagina or the parametrium, as well as the spread of the tumour into the pelvic wall and beyond into the bladder and/or the rectum [1,2,13,15]. In the assessment of primary cervical cancers, the value of MRI is well documented [4,5,16,17].…”

“…Although lung, liver and bone metastases are the most frequent sites of secondary localisations arising from cervical cancers, results from large surgical series and autopsy studies showed that a large spectrum of organs may be affected with a variable frequency [35]. Also, 18 FDG PET appears particularly appropriate for the detection of distant tumour sites through the entire body [13,14,32,36]. Interestingly, cervical cancers exhibit high rates of GLUT-1 (type-1 glucose transporter) and glycolytic enzymes (type-2 hexokinase, phosphofructokinase and pyruvate kinase), which makes the imaging by means of the glucose analogue theoretically and practically valid for such gynaecological malignancies [37,38,39,40,41].…”

“…In recent years, many reports demonstrated the clinical usefulness provided by whole-body 18 F-fluorodeoxyglucose positron emission tomography (wb- 18 FDG PET) as well as by pelvic magnetic resonance imaging (pMRI), respectively, in the initial assessment of uterine cancers [4,5,10,11,12,13,14]. The purpose of this paper was to assess the appropriateness of wb 18 FDG PET plus pMRI in the pre-treatment staging of primary cervical cancers on the basis of the TNM classification.…”

A novel dynamic field-matching technique for treatment of patients with para-aortic node-positive cervical cancer: Clinical experience

“…[1][2][3][4][5] Intensity modulated radiation therapy (IMRT) enables definitive treatment of para-aortic target volumes with escalated doses of radiation while simultaneously sparing the adjacent organs at risk including the small bowel, spinal cord, and kidneys. [6][7][8][9] Though IMRT for postoperative pelvic radiation treatment for cervical cancer is well established, conventional 3-D conformal fourfield pelvic RT remains a standard of care and is often preferred for intact cervical cancer.…”