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Effect of Positron Emission Tomography Imaging in Women With Locally Advanced Cervical Cancer: A Randomized Clinical Trial
IMPORTANCE: In women with locally advanced cancer of the cervix (LACC), staging defines disease extent and guides therapy. Currently, undetected disease outside the radiation field can result in undertreatment or, if disease is disseminated, overtreatment. OBJECTIVE: To determine whether adding flud...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324512/ https://www.ncbi.nlm.nih.gov/pubmed/30646153 http://dx.doi.org/10.1001/jamanetworkopen.2018.2081 |
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author | Elit, Lorraine M. Fyles, Anthony W. Gu, Chu-Shu Pond, Gregory R. D’Souza, David Samant, Rajiv Anthes, Margaret Thomas, Gillian Filion, Marc Arsenault, Julie Dayes, Ian Whelan, Timothy J. Gulenchyn, Karen Y. Metser, Ur Dhamanaskar, Kavita Levine, Mark N. |
author_facet | Elit, Lorraine M. Fyles, Anthony W. Gu, Chu-Shu Pond, Gregory R. D’Souza, David Samant, Rajiv Anthes, Margaret Thomas, Gillian Filion, Marc Arsenault, Julie Dayes, Ian Whelan, Timothy J. Gulenchyn, Karen Y. Metser, Ur Dhamanaskar, Kavita Levine, Mark N. |
author_sort | Elit, Lorraine M. |
collection | PubMed |
description | IMPORTANCE: In women with locally advanced cancer of the cervix (LACC), staging defines disease extent and guides therapy. Currently, undetected disease outside the radiation field can result in undertreatment or, if disease is disseminated, overtreatment. OBJECTIVE: To determine whether adding fludeoxyglucose F 18 positron emission tomography–computed tomography (PET-CT) to conventional staging with CT of the abdomen and pelvis affects therapy received in women with LACC. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial was conducted. Women with newly diagnosed histologically confirmed International Federation of Gynecology and Obstetrics stage IB to IVA carcinoma of the cervix who were candidates for chemotherapy and radiation therapy (CRT) were allocated 2:1 to PET-CT plus CT of the abdomen and pelvis or CT alone. Enrollment occurred between April 2010 and June 2014 at 6 regional cancer centers in Ontario, Canada. The PET-CT scanners were at 6 associated academic institutions. The median follow-up at the time of the analysis was 3 years. The analysis was conducted on March 30, 2017. INTERVENTIONS: Patients received either PET-CT plus CT of the abdomen and pelvis or CT of the abdomen and pelvis. MAIN OUTCOMES AND MEASURES: Treatment delivered, defined as standard pelvic CRT vs more extensive CRT, ie, extended field radiotherapy or therapy with palliative intent. RESULTS: One hundred seventy-one patients were allocated to PET-CT (n = 113) or CT (n = 58). The trial stopped early before the planned target of 288 was reached because of low recruitment. Mean (SD) age was 48.1 (11.2) years in the PET-CT group vs 48.9 (12.7) years in the CT group. In the 112 patients who received PET-CT, 68 (60.7%) received standard pelvic CRT, 38 (33.9%) more extensive CRT, and 6 (5.4%) palliative treatment. The corresponding data for the 56 patients who received CT alone were 42 (75.0%), 11 (19.6%), and 3 (5.4%). Overall, 44 patients (39.3%) in the PET-CT group received more extensive CRT or palliative treatment compared with 14 patients (25.0%) in the CT group (odds ratio, 2.05; 95% CI, 0.96-4.37; P = .06). Twenty-four patients in the PET-CT group (21.4%) received extended field radiotherapy to para-aortic nodes and 14 (12.5%) to common iliac nodes compared with 8 (14.3%) and 3 (5.4%), respectively, in the CT group (odds ratio, 1.64; 95% CI, 0.68-3.92; P = .27). CONCLUSIONS AND RELEVANCE: There was a trend for more extensive CRT with PET-CT, but the difference was not significant because the trial was underpowered. This trial provides information on the utility of PET-CT for staging in LACC. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00895349 |
format | Online Article Text |
id | pubmed-6324512 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-63245122019-01-22 Effect of Positron Emission Tomography Imaging in Women With Locally Advanced Cervical Cancer: A Randomized Clinical Trial Elit, Lorraine M. Fyles, Anthony W. Gu, Chu-Shu Pond, Gregory R. D’Souza, David Samant, Rajiv Anthes, Margaret Thomas, Gillian Filion, Marc Arsenault, Julie Dayes, Ian Whelan, Timothy J. Gulenchyn, Karen Y. Metser, Ur Dhamanaskar, Kavita Levine, Mark N. JAMA Netw Open Original Investigation IMPORTANCE: In women with locally advanced cancer of the cervix (LACC), staging defines disease extent and guides therapy. Currently, undetected disease outside the radiation field can result in undertreatment or, if disease is disseminated, overtreatment. OBJECTIVE: To determine whether adding fludeoxyglucose F 18 positron emission tomography–computed tomography (PET-CT) to conventional staging with CT of the abdomen and pelvis affects therapy received in women with LACC. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial was conducted. Women with newly diagnosed histologically confirmed International Federation of Gynecology and Obstetrics stage IB to IVA carcinoma of the cervix who were candidates for chemotherapy and radiation therapy (CRT) were allocated 2:1 to PET-CT plus CT of the abdomen and pelvis or CT alone. Enrollment occurred between April 2010 and June 2014 at 6 regional cancer centers in Ontario, Canada. The PET-CT scanners were at 6 associated academic institutions. The median follow-up at the time of the analysis was 3 years. The analysis was conducted on March 30, 2017. INTERVENTIONS: Patients received either PET-CT plus CT of the abdomen and pelvis or CT of the abdomen and pelvis. MAIN OUTCOMES AND MEASURES: Treatment delivered, defined as standard pelvic CRT vs more extensive CRT, ie, extended field radiotherapy or therapy with palliative intent. RESULTS: One hundred seventy-one patients were allocated to PET-CT (n = 113) or CT (n = 58). The trial stopped early before the planned target of 288 was reached because of low recruitment. Mean (SD) age was 48.1 (11.2) years in the PET-CT group vs 48.9 (12.7) years in the CT group. In the 112 patients who received PET-CT, 68 (60.7%) received standard pelvic CRT, 38 (33.9%) more extensive CRT, and 6 (5.4%) palliative treatment. The corresponding data for the 56 patients who received CT alone were 42 (75.0%), 11 (19.6%), and 3 (5.4%). Overall, 44 patients (39.3%) in the PET-CT group received more extensive CRT or palliative treatment compared with 14 patients (25.0%) in the CT group (odds ratio, 2.05; 95% CI, 0.96-4.37; P = .06). Twenty-four patients in the PET-CT group (21.4%) received extended field radiotherapy to para-aortic nodes and 14 (12.5%) to common iliac nodes compared with 8 (14.3%) and 3 (5.4%), respectively, in the CT group (odds ratio, 1.64; 95% CI, 0.68-3.92; P = .27). CONCLUSIONS AND RELEVANCE: There was a trend for more extensive CRT with PET-CT, but the difference was not significant because the trial was underpowered. This trial provides information on the utility of PET-CT for staging in LACC. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00895349 American Medical Association 2018-09-14 /pmc/articles/PMC6324512/ /pubmed/30646153 http://dx.doi.org/10.1001/jamanetworkopen.2018.2081 Text en Copyright 2018 Elit LM et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Elit, Lorraine M. Fyles, Anthony W. Gu, Chu-Shu Pond, Gregory R. D’Souza, David Samant, Rajiv Anthes, Margaret Thomas, Gillian Filion, Marc Arsenault, Julie Dayes, Ian Whelan, Timothy J. Gulenchyn, Karen Y. Metser, Ur Dhamanaskar, Kavita Levine, Mark N. Effect of Positron Emission Tomography Imaging in Women With Locally Advanced Cervical Cancer: A Randomized Clinical Trial |
title | Effect of Positron Emission Tomography Imaging in Women With Locally Advanced Cervical Cancer: A Randomized Clinical Trial |
title_full | Effect of Positron Emission Tomography Imaging in Women With Locally Advanced Cervical Cancer: A Randomized Clinical Trial |
title_fullStr | Effect of Positron Emission Tomography Imaging in Women With Locally Advanced Cervical Cancer: A Randomized Clinical Trial |
title_full_unstemmed | Effect of Positron Emission Tomography Imaging in Women With Locally Advanced Cervical Cancer: A Randomized Clinical Trial |
title_short | Effect of Positron Emission Tomography Imaging in Women With Locally Advanced Cervical Cancer: A Randomized Clinical Trial |
title_sort | effect of positron emission tomography imaging in women with locally advanced cervical cancer: a randomized clinical trial |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324512/ https://www.ncbi.nlm.nih.gov/pubmed/30646153 http://dx.doi.org/10.1001/jamanetworkopen.2018.2081 |
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