Positron emission tomography in evaluating the feasibility of curative intent in cervical cancer patients with limited distant lymph node metastases

Objective. Clinical outcomes of cervical cancer patients with distant lymph node (LN) metastases are poor. [F-18] fluorodeoxyglucose positron emission tomography (PET) or PET/computed tomography (CT) scans could potentially benefit treatment plan. Methods. Patients with cervical cancer whose CT/magnetic resonance imaging (MRI)-based imaging showed limited metastases to para-aortic lymph node (PALN), inguinal (ILN), and/or supraclavicular (SLN) were prospectively enrolled to evaluate whether PET or PET/CT influenced management. The clinical impact of PET or PET/CT was determined on a patient basis. Results. Between November 2001 and April 2007, 47 patients were enrolled for suspected metastasis to PALN with (n=8) or without other distant nodal involvement (n=3 1), ILN (n=6), or SLN metastasis (n=2). Additional PET or PET/CT had positive clinical impact in 21 (44.7%) of the 47 study patients, 23 had no impact, and three had negative impact. Positive impact included disclosing additional curable sites (n=8), down-staging (n=6), offering metabolic biopsy (n=4) or change to palliation (n=3). The 2-year overall survival (OS) of the study patients was 56.9% with median follow-up time of 47.0 months (range: 8-71 months) in surviving patients. The 2-year OS rates for PALN (based on histology or CT/MRI-PET consensus) and histology-proven SLN metastasis were 50.6% and 24.7%, respectively. Two (40.0%) of the five patients with histology-proven ILN metastases had no evidence of disease. Conclusions. PET or PET/CT added benefit to primary treatment planning in cervical cancer with MRI-defined suspected distant nodal metastasis. (c) 2008 Elsevier Inc. All rights reserved.