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

Abstract

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.

The Prognostic Impact of Radiotherapy Delays in Oropharynx Carcinoma and the Role of p16 Status

“…This may be related to limited access to diagnostic investigations which has been found to prolong the time to treatment initiation in a cohort of early-stage lung cancer patients 20. In Canada specifically, access and wait times to staging PET can be limited, as highlighted in a survey of radiation oncologists 21. Our institution has adopted strategies to mitigate TDs, such as encouraging early referrals from community practitioners, prebooking staging investigations (PET, magnetic resonance), and referring to dental oncology and medical oncology at time of triage.…”