Lin Shinn-Yn, Tsai Chien-Sheng, Chang Yu-Chen, Ng Koon-Kwan, Chang Ting-Chang, Kao Wei-Heng, Lai Chyong-Huey, Hong Ji-Hong
Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.
Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taiwan; Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan.
Int J Radiat Oncol Biol Phys. 2015 Jul 1;92(3):577-85. doi: 10.1016/j.ijrobp.2015.02.027. Epub 2015 Apr 28.
This report is the second analysis of a prospective randomized trial to investigate the impact of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) on cervical cancer patients with enlarged pelvic lymph nodes identified by magnetic resonance imaging.
Patients with newly diagnosed cervical cancer with enlarged pelvic lymph nodes but free of enlarged para-aortic lymph nodes (PALN) were eligible. Patients were randomized to receive either pretreatment FDG-PET (PET arm) or not (control arm). The whole pelvis was the standard irradiation field for all patients except those with FDG-avid extrapelvic findings.
In all, 129 patients were enrolled. Pretreatment PET detected extrapelvic metastases in 7 patients. No new patient experienced treatment failure during the additional 4-year follow-up period. There were no significant differences between the PET arm and the control arm regarding overall survival, disease-free survival, and freedom from extrapelvic metastasis. In the control arm, 8 of 10 patients with PALN relapse had limited extrapelvic nodal failures; their 5-year disease-specific survival was 34.3%. By contrast, only 1 of 5 patients with PALN relapse in the PET arm experienced such limited failures; their 5-year survival rate was 0%.
Although the pretreatment detection of PALN did not translate into survival benefit, it indeed decreased the need for extended-field concurrent chemoradiation therapy.
本报告是一项前瞻性随机试验的第二次分析，旨在研究氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）对经磁共振成像发现盆腔淋巴结肿大的宫颈癌患者的影响。
符合条件的患者为新诊断的宫颈癌且盆腔淋巴结肿大但腹主动脉旁淋巴结（PALN）未肿大。患者被随机分为接受预处理FDG-PET（PET组）或不接受（对照组）。除有FDG摄取的盆腔外病变的患者外，全盆腔是所有患者的标准照射野。
共纳入129例患者。预处理PET检测出7例盆腔外转移。在额外的4年随访期内，没有新患者出现治疗失败。PET组和对照组在总生存、无病生存和盆腔外转移方面无显著差异。在对照组中，10例PALN复发患者中有8例有局限性盆腔外淋巴结失败；其5年疾病特异性生存率为34.3%。相比之下，PET组5例PALN复发患者中只有1例出现这种局限性失败；其5年生存率为0%。
虽然预处理检测PALN并未转化为生存获益，但确实减少了扩大野同步放化疗的需求。
