Waldenström Ann-Charlotte, Bergmark Karin, Michanek Annika, Hashimi Farida, Norrlund Rauni Rossi, Olsson Caroline E, Gjertsson Peter, Leonhardt Henrik
Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden.
Department of Oncology, Sahlgrenska University Hospital, Sweden.
Phys Imaging Radiat Oncol. 2018 Nov 27;8:33-37. doi: 10.1016/j.phro.2018.11.002. eCollection 2018 Oct.
In uterine cervical cancer tumour spread reaching the para-aortic lymph nodes is the most significant independent pre-treatment predictor of progression-free survival. When introducing [F]fluorodeoxyglucose-positron emission tomography (FDG-PET)/computed tomography (CT) in our clinic for patients with advanced cervical cancer planned for definitive radiochemotherapy, the purpose of this study was to quantify to what extent the added information lead to changes in radiotherapy planning.
We included 25 consecutive patients with cervical cancer stages IB2 - IIIB planned for definitive radiochemotherapy between November 2010 and May 2012. The patients were examined both with magnetic resonance imaging (MRI) and FDG-PET/CT before treatment and after four weeks of treatment.
In 11/24 (46%) of the patients the FDG-PET/CT before treatment provided additional diagnostic information leading to changes in treatment planning compared to information from MRI. Seven of these eleven patients (64%) were alive and without evidence of disease at four-year follow-up. The MRI detected pelvic tumour spread not seen on the FDG-PET/CT in 2/24 patients. The disease-free four-year survival was 59%.
Additional diagnostic information from FDG-PET/CT changed treatment strategy in almost half of the patients and may have increased chances of survival in this limited group of patients with locally advanced uterine cervical cancer. We recommend both modalities for nodal detection.
在子宫颈癌中，肿瘤扩散至腹主动脉旁淋巴结是无进展生存期最重要的独立治疗前预测指标。当我们的诊所为计划进行根治性放化疗的晚期宫颈癌患者引入[F]氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）/计算机断层扫描（CT）时，本研究的目的是量化额外信息在多大程度上导致放疗计划的改变。
我们纳入了2010年11月至2012年5月期间计划进行根治性放化疗的25例连续的IB2 - IIIB期宫颈癌患者。患者在治疗前和治疗四周后均接受了磁共振成像（MRI）和FDG-PET/CT检查。
与MRI提供的信息相比，11/24（46%）的患者在治疗前的FDG-PET/CT提供了额外的诊断信息，导致治疗计划发生改变。这11例患者中有7例（64%）在四年随访时存活且无疾病证据。2/24例患者的MRI检测到FDG-PET/CT未发现的盆腔肿瘤扩散。四年无病生存率为59%。
来自FDG-PET/CT的额外诊断信息在几乎一半的患者中改变了治疗策略，并且可能增加了这一局部晚期子宫颈癌有限患者群体的生存机会。我们建议两种检查方式都用于淋巴结检测。
