Phase II Study Of PET Image-Guided IMRT To 60 Gy For Positive Para-Aortic Lymph Nodes In Cervix Cancer

Main Category: Radiology / Nuclear Medicine
Also Included In: Cervical Cancer / HPV Vaccine;  Cancer / Oncology;  Clinical Trials / Drug Trials
Article Date: 22 Sep 2008 - 3:00 PDT

email to a friend   printer friendly   opinions  

The purpose of this research was to evaluate the feasibility and toxicity of Positron emission tomography (PET) Image-Guided irradiation (IMRT) of FDG-PET positive pelvic and para-aortic lymph nodes to 60 Gy in patients with carcinoma of the cervix.

Patients with cervical cancer may have para-aortic node metastasis which occurs in 5-30% of patients depending on the clinical stage of their disease. Survival in patients with para-aortic lymph node metastases is poor regardless of presenting clinical stage of their disease, with an overall two year survival of about 25%.

Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) has been found to have high sensitivity and specificity in the detection of pelvic and para-aortic lymph node metastases and has been shown to significantly impact prognosis.

Typical radiation doses to the para-aortic lymph nodes are about 45-50 Gy. Dose escalation beyond 45 Gy has been limited because of increased toxicity with increased dose and increased volume of irradiated small bowel. We hypothesised that dose escalation to the para-aortic lymph nodes could be performed with acceptable toxicity and may improve survival.

In this prospective Phase II study, 24 patients received PET-Guided IMRT to deliver 60 Gy to the PET positive pelvic and para-aortic lymph nodes. Patients received external irradiation to the pelvis and para-aortic region, intracavitary brachytherapy, and concurrent chemotherapy with weekly cisplatin.

The results of this study suggest that PET Image-Guided IMRT to 60 Gy to pelvic and para-aortic lymph nodes with concurrent chemotherapy results in elimination of nodal disease in most patients (89%), but survival is poor (23% at 3 years) due to the development of distant metastatic disease. The acute grades 3 and 4 toxicities were 58% and 33%, respectively. One patient died from complications of therapy.

Grigsby Perry et al. Mallinckrodt Institute of Radiology, St Louis, USA

About ESTRO 27

ESTRO 27 (September 14th to 18th, 2008) offered an outstanding scientific programme combining lectures from eminent invited speakers, proffered papers and poster discussions, teaching lectures on a wide range of topics including clinical issues, brachytherapy, radiobiology, physics and technology as well as debates on controversial topics and clinical case discussions, a special poster reception, poster discussion sessions and electronic poster viewing.

ESTRO 27 hosted the largest European exhibition in Radiotherapy with participation from all the leading manufacturers.

ESTRO 27

ESTRO (European Society for Therapeutic Radiology and Oncology)

• Additional
• References
• Citations