Skip to main content
SpringerLink
Log in

Positron emission tomography for staging locally advanced cervical cancer and assessing intensity modulated radiotherapy approach

  • ONCOLOGY IMAGING
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Aims

To evaluate toxicity and outcome of concomitant chemotherapy and intensity modulated radiotherapy (IMRT) with 18-fluorodeoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT) based simultaneous integrated boost (SIB) of locally advanced cervical cancer (LACC).

Methods

Patients with LACC underwent chemo-radiation with IMRT and SIB. Staging and follow-up were performed with clinical evaluation and CT, MRI, 18FDG-PET/CT. SIB was done on positive nodes with 18FDG-PET/CT based planning. CT-based planning high-dose-rate brachytherapy (HDR-BT) was delivered as subsequent boost to the primary tumor. Cisplatin concomitant chemotherapy was administered during IMRT.

Results

Fourteen patients with cervical cancer were prospectively recruited between August 2014 and June 2017, 13 (93%) had a LACC, one (7%) patient was not evaluable because 18FDG-PET/CT evidenced metastases to the liver undetected by previous CT/MRI. Patients had a median age of 59 years, a median Karnofsky performance status of 100%, and a prevalence of squamous cell carcinoma histology (85%). SIB was delivered on 23 positive lymph nodes. IMRT median dose to the pelvis was 48.6 Gy in 27 fractions, SIB median dose 54 Gy in 27 fractions, HDR-BT boost median dose 21 Gy in 3 fractions. After a median follow-up of 30 months, 2-year local control and distant control were 86% and 86%, respectively. There were no grade 4 acute and/or late toxicities.

Conclusions

The 18FDG-PET/CT influenced stage assessment and RT treatment planning due to its high specificity in distant metastases and nodal involvement detection. The IMRT with SIB for positive nodes was an effective therapy with acceptable toxicity in LACC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jemal A, Bray F, Center MM et al (2011) Global Cancer statistics cervical cancer. CA Cancer J Clin 61:69–90

    Article  Google Scholar 

  2. Chemoradiotherapy for Cervical Cancer Meta-analysis Collaboration (CCCMAC) (2010) Reducing uncertainties about the effect of chemoradiotherapy for cervical cancer: individual patients data meta-analysis. Cochrane Database Syst Rev 1:CD008285

    Google Scholar 

  3. Vargo JA, Kim H, Choi S et al (2014) Extended field intensity modulated radiation therapy with concomitant boost for lymph node-positive cervical cancer: analysis of regional control and recurrence patterns in the positron emission tomography/computed tomography era. Int J Radiat Oncol Biol Phys 1;90(5):1091–1098

    Article  Google Scholar 

  4. Haie-Meder C, Mazeron R, Magné N (2010) Clinical evidence on PET-CT for radiation therapy planning in cervix and endometrial cancers. Radiother Oncol 96:351–355

    Article  Google Scholar 

  5. Mirpour S, Mhlanga JC, Logeswaran P et al (2013) The role of PET/CT in the management of cervical cancer. AJR Am J Roentgenol 201(2):W192–W205

    Article  Google Scholar 

  6. Cihoric N, Tapia C, Krüger K et al (2014) IMRT with 18FDG-PET\CT based simultaneous integrated boost for treatment of nodal positive cervical cancer. Radiat Oncol 25(9):83

    Article  Google Scholar 

  7. Macchia G, Cilla S, Deodato F et al (2015) Inensity-modulated extended-field chemoradiation plus simultaneous integrated boost in the pre-operative treatment of locally advanced cervical cancer: a dose escalation study. Br J Radiol 88(1055):20150385

    Article  Google Scholar 

  8. Esthappan J, Chaudhari S, Santanam L et al (2008) Prospective clinical trial of positron emission tomography/computed tomography image-guided intensity-modulated radiation therapy for cervical carcinoma with positive para-aortic lymph nodes. Int J Radiat Oncol Biol Phys 15 72(4):1134–1139

    Article  Google Scholar 

  9. Lazzari R, Cecconi A, Jereczek-Fossa BA et al (2014) The role of [18F]FDG-PET/CT in staging and treatment planning for volumetric modulated Rapidarc radiotherapy in cervical cancer: experience of the European Institute of Oncology, Milan, Italy. Ecancermedicalscience 5(8):405

    Google Scholar 

  10. Gerinsky T, Rey A, Roche B et al (1993) Overall treatment time in advanced cervical carcinomas: a critical parameter in treatment outcome. Int J Radiat Oncol Biol Phys 27(5):1051–1056

    Article  Google Scholar 

  11. Perez CA, Grigsby PW, Castro-Vita H et al (1995) Carcinoma of the uterine cervix. Impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy. Int J Radiat Oncol Biol Phys 32(5):1275–1288

    Article  CAS  Google Scholar 

  12. Benerjee R, Kamrava M (2014) Brachytherapy in the treatment of cervical cancer: a review. Int J Womens Health 28(6):555–564

    Google Scholar 

  13. Lindegaard JC, Assenholt M, Ramlov A et al (2017) Early clinical outcome of coverage probability based treatment planning for simultaneous integrated boost of nodes in locally advanced cervical cancer. Acta Oncol 56(11):1479–1486

    Article  Google Scholar 

  14. Viswanathan AL, Dimopoulos J, Kirisits C et al (2007) Computed tomography versus magnetic resonance imaging-based contouring in cervical cancer brachytherapy: results of a prospective trial and preliminary guidelines for standardize contours. Int J Radiat Oncol Biol Phys 68(2):491–498

    Article  Google Scholar 

  15. Viswanathan AN, Beriwal S, De Los Santos J et al (2012) The American Brachytherapy Society treatment recommendations for locally advanced carcinoma of the cervix part II: high dose-rate brachytherapy. Brachytherapy 11(1):47–52

    Article  Google Scholar 

  16. Marks LB, Yorke ED, Jackson A et al (2010) The use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 76(3 Suppl):S10–19

    Article  Google Scholar 

  17. Liu L, Bassano DA, Prasad SC et al (2003) The linear-quadratic model and fractionated stereotactic radiotherapy. Int J Radiat Oncol Biol Phys 57:827–832

    Article  Google Scholar 

  18. Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92(3):205–216

    Article  CAS  Google Scholar 

  19. Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481

    Article  Google Scholar 

  20. Herrera FG, Prior JO (2013) The role of PET/CT in cervical cancer. Front Oncol 3:34

    Article  Google Scholar 

  21. Arnesen MR, Rekstad BL, Strokke C et al (2016) Short-course PET based simultaneous integrated boost for locally advanced cervical cancer. Radiat Oncol 12(11):39

    Article  Google Scholar 

  22. Feng CH, Hasan Y, Kopec M et al (2016) Simultaneously integrated boost (SIB) spares OAR and reduce treatment time in locally advanced cervical cancer. J Appl Clin Med Phys 15(5):76–89

    Article  Google Scholar 

  23. McKay MJ, Tauban KL, Foroudi F et al (2018) Molecular imaging using PET/CT for radiotherapy planning of adult cancers: current status and expanding applications. Int J Radiat Oncol Biol Phys 102(4):783–791

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiotherapy Oncology Centre, “S. Maria” Hospital, Terni, Italy

    Lorena Draghini, Marco Italiani, Fabio Trippa, Fabio Arcidiacono, Michelina Casale & Ernesto Maranzano

  2. Radiation Oncology Centre, Ospedali Riuniti Umberto I°, Ancona, Italy

    Sara Costantini, Lisa Vicenzi & Giovanna Mantello

  3. Nuclear Medicine Service, “S. Maria” Hospital, Terni, Italy

    Fabio Loreti

Authors
  1. Lorena Draghini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara Costantini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa Vicenzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco Italiani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fabio Loreti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fabio Trippa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fabio Arcidiacono
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michelina Casale
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giovanna Mantello
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ernesto Maranzano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ernesto Maranzano.

Ethics declarations

Conflict of interest

All authors declare that there is no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Draghini, L., Costantini, S., Vicenzi, L. et al. Positron emission tomography for staging locally advanced cervical cancer and assessing intensity modulated radiotherapy approach. Radiol med 124, 819–825 (2019). https://doi.org/10.1007/s11547-019-01023-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-019-01023-x

Keywords

Search

Navigation