Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy.
Curr Probl Cancer. 2023 Dec;47(6):101007. doi: 10.1016/j.currproblcancer.2023.101007. Epub 2023 Sep 5.
The last version of the FIGO classification recommended imaging tools to complete the clinical assessment of patients with cervical cancer. However, the preferable imaging approach is still unclear. We aimed to explore the prognostic power of Magnetic Resonance Imaging (MRI), contrast-enhanced Computed Tomography (ceCT), and [F]-Fluorodeoxyglucose Positron Emission Tomography ([F]FDG-PET)/CT in patients staged for locally advanced cervical cancer (LACC, FIGO stages IB3-IVA). Thirty-six LACC patients (mean age 55.47 ± 14.01, range 31-82) were retrospectively enrolled. All of them underwent MRI, ceCT and [F]FDG-PET/CT before receiving concurrent chemoradiotherapy. A median dose of 45 Gy (range 42-50.4; 25-28 fractions, 5 fractions per week, 1 per day) was delivered through the external-beam radiation therapy (EBRT) on the pelvic area, while a median dose of 57.5 Gy (range 16-61.1; 25-28 fractions, 5 fractions per week, 1 per day) was administered on metastatic nodes. The median doses for brachytherapy treatment were 28 Gy (range 28-30; 4-5 fractions, 1 every other day). Six cycles of cisplatin or carboplatin were administered weekly. The study endpoints were recurrence-free survival (RFS) and overall survival (OS). Metastatic pelvic lymph nodes at MRI independently predicted RFS (HR 13.271, 95% CI 1.730-101.805; P = 0.027), while metastatic paraaortic lymph nodes at [F]FDG-PET/CT independently predicted both RFS (HR 11.734, 95% CI 3.200-43.026; P = .005) and OS (HR 13.799, 95% CI 3.378-56.361; P < 0.001). MRI and [F]FDG-PET/CT findings were incorporated with clinical evidences into the FIGO classification. With respect to the combination of clinical, MRI and ceCT data, the use of next-generation imaging (NGI) determined a stage migration in 10/36 (27.7%) of patients. Different NGI-based FIGO classes showed remarkably different median RFS (stage IIB: not reached; stage IIIC1: 44 months; stage IIIC2: 3 months; P < 0.001) and OS (stage IIB: not reached; stage IIIC1: not reached; stage IIIC2: 14 months; P < 0.001). A FIGO classification based on the combination of MRI and [F]FDG-PET/CT might predict RFS and OS of LACC patients treated with concurrent chemoradiotherapy.
FIGO 分类的最新版本建议使用影像学工具完成宫颈癌患者的临床评估。然而，哪种影像学方法更好仍不清楚。我们旨在探讨磁共振成像（MRI）、增强计算机断层扫描（ceCT）和 [F]-氟脱氧葡萄糖正电子发射断层扫描（[F]FDG-PET）/CT 在局部晚期宫颈癌（LACC，FIGO 分期 IB3-IVA）患者分期中的预后能力。
我们回顾性纳入了 36 例 LACC 患者（平均年龄 55.47±14.01 岁，范围 31-82 岁）。所有患者在接受同期放化疗前均接受 MRI、ceCT 和 [F]FDG-PET/CT 检查。盆腔区外照射放疗（EBRT）给予中位剂量 45 Gy（范围 42-50.4；25-28 个分次，每周 5 次，每天 1 次），转移性淋巴结给予中位剂量 57.5 Gy（范围 16-61.1；25-28 个分次，每周 5 次，每天 1 次）。近距离放疗治疗给予中位剂量 28 Gy（范围 28-30；4-5 个分次，每隔一天 1 次）。每周给予顺铂或卡铂 6 个周期。研究终点为无复发生存率（RFS）和总生存（OS）。MRI 上的转移性盆腔淋巴结独立预测 RFS（HR 13.271，95%CI 1.730-101.805；P=0.027），而 [F]FDG-PET/CT 上的转移性主动脉旁淋巴结独立预测 RFS（HR 11.734，95%CI 3.200-43.026；P=0.005）和 OS（HR 13.799，95%CI 3.378-56.361；P<0.001）。MRI 和 [F]FDG-PET/CT 检查结果与临床证据一起纳入 FIGO 分类。考虑到临床、MRI 和 ceCT 数据的综合，下一代影像学（NGI）的使用使 36 例患者中的 10 例（27.7%）发生了分期转移。不同的 NGI 基于 FIGO 分类显示出明显不同的中位 RFS（IIIB 期：未达到；IIIC1 期：44 个月；IIIC2 期：3 个月；P<0.001）和 OS（IIIB 期：未达到；IIIC1 期：未达到；IIIC2 期：14 个月；P<0.001）。基于 MRI 和 [F]FDG-PET/CT 综合的 FIGO 分类可能预测接受同期放化疗的 LACC 患者的 RFS 和 OS。
