18F-FDG-PET/CT guided external beam radiotherapy volumes in inoperable uterine cervical cancer

Judit A Adam, Hester Arkies, Karel Hinnen, Lukas J Stalpers, Jan H van Waesberghe, Jaap Stoker, Rob van Os, Janna J Laan, Constantijne H Mom, Berthe L van Eck-Smit

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: In patients with advanced stage cancer of the uterine cervix who undergo irradiation with curative intent, there is the necessity to treat all suspicious nodes on imaging. Our hypothesis was that adding fluorodeoxyglucose positron emission computer tomography/computer tomography (FDG-PET/CT) to the imaging workup would alter the external beam radiotherapy (EBRT) treatment plan, either resulting in an extended external beam radiotherapy (EBRT) field to the para-aortal region or an additional boost to suspicious nodes. Since extended field radiotherapy or additional boost can cause toxicity, our secondary aim was to assess the incidence of severe late bowel toxicity in patients treated with extended para-aortal EBRT-field and boost compared to elective pelvic radiotherapy.

METHODS: Eighty-eight patients were enrolled. First, the optimal radiation treatment plan (EBRT and boost) was retrospectively determined based on magnetic resonance imaging (MRI) or FDG-PET/CT. Second, the severe bowel toxicity caused by the extended para-aortal field was assessed, based on the executed radiotherapy.

RESULTS: Based on MRI 8/88 patients would receive EBRT with para-aortic extension, this was 21/88 for FDG-PET/CT. Based on MRI 47/704 lymph node regions would receive additional boost, while based on PET/CT 91/704. Late severe bowel toxicity was seen in 12/84 patients, 6/65 in the group who received elective pelvic irradiation and 6/19 with para-aortal EBRT and boost at common iliac and/or para-aortal lymph nodes. Significant worse overall survival was seen of patients who needed para-aortal irradiation.

CONCLUSIONS: Addition of FDG-PET/CT leads to an extension of the elective EBRT volume and more suspicious lymph nodes receive a boost. However, when deciding to intensify radiation therapy, late severe bowel toxicity has to be taken into account.

Original languageEnglish
Pages (from-to)420-428
Number of pages9
JournalThe Quarterly Journal of Nuclear Medicine and Molecular Imaging
Volume62
Issue number4
DOIs
Publication statusPublished - Dec 2018

Cite this

@article{781698cbe96e4a7faf000258cb0ddb8b,
title = "18F-FDG-PET/CT guided external beam radiotherapy volumes in inoperable uterine cervical cancer",
abstract = "BACKGROUND: In patients with advanced stage cancer of the uterine cervix who undergo irradiation with curative intent, there is the necessity to treat all suspicious nodes on imaging. Our hypothesis was that adding fluorodeoxyglucose positron emission computer tomography/computer tomography (FDG-PET/CT) to the imaging workup would alter the external beam radiotherapy (EBRT) treatment plan, either resulting in an extended external beam radiotherapy (EBRT) field to the para-aortal region or an additional boost to suspicious nodes. Since extended field radiotherapy or additional boost can cause toxicity, our secondary aim was to assess the incidence of severe late bowel toxicity in patients treated with extended para-aortal EBRT-field and boost compared to elective pelvic radiotherapy.METHODS: Eighty-eight patients were enrolled. First, the optimal radiation treatment plan (EBRT and boost) was retrospectively determined based on magnetic resonance imaging (MRI) or FDG-PET/CT. Second, the severe bowel toxicity caused by the extended para-aortal field was assessed, based on the executed radiotherapy.RESULTS: Based on MRI 8/88 patients would receive EBRT with para-aortic extension, this was 21/88 for FDG-PET/CT. Based on MRI 47/704 lymph node regions would receive additional boost, while based on PET/CT 91/704. Late severe bowel toxicity was seen in 12/84 patients, 6/65 in the group who received elective pelvic irradiation and 6/19 with para-aortal EBRT and boost at common iliac and/or para-aortal lymph nodes. Significant worse overall survival was seen of patients who needed para-aortal irradiation.CONCLUSIONS: Addition of FDG-PET/CT leads to an extension of the elective EBRT volume and more suspicious lymph nodes receive a boost. However, when deciding to intensify radiation therapy, late severe bowel toxicity has to be taken into account.",
keywords = "Adult, Aged, Aged, 80 and over, Female, Fluorodeoxyglucose F18, Humans, Lymphatic Metastasis, Middle Aged, Neoplasm Staging, Positron Emission Tomography Computed Tomography, Radiotherapy, Image-Guided, Retrospective Studies, Survival Analysis, Uterine Cervical Neoplasms/diagnostic imaging",
author = "Adam, {Judit A} and Hester Arkies and Karel Hinnen and Stalpers, {Lukas J} and {van Waesberghe}, {Jan H} and Jaap Stoker and {van Os}, Rob and Laan, {Janna J} and Mom, {Constantijne H} and {van Eck-Smit}, {Berthe L}",
year = "2018",
month = "12",
doi = "10.23736/S1824-4785.18.03083-2",
language = "English",
volume = "62",
pages = "420--428",
journal = "The Quarterly Journal of Nuclear Medicine and Molecular Imaging",
issn = "1824-4785",
publisher = "Edizioni Minerva Medica S.p.A.",
number = "4",

}

18F-FDG-PET/CT guided external beam radiotherapy volumes in inoperable uterine cervical cancer. / Adam, Judit A; Arkies, Hester; Hinnen, Karel; Stalpers, Lukas J; van Waesberghe, Jan H; Stoker, Jaap; van Os, Rob; Laan, Janna J; Mom, Constantijne H; van Eck-Smit, Berthe L.

In: The Quarterly Journal of Nuclear Medicine and Molecular Imaging, Vol. 62, No. 4, 12.2018, p. 420-428.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - 18F-FDG-PET/CT guided external beam radiotherapy volumes in inoperable uterine cervical cancer

AU - Adam, Judit A

AU - Arkies, Hester

AU - Hinnen, Karel

AU - Stalpers, Lukas J

AU - van Waesberghe, Jan H

AU - Stoker, Jaap

AU - van Os, Rob

AU - Laan, Janna J

AU - Mom, Constantijne H

AU - van Eck-Smit, Berthe L

PY - 2018/12

Y1 - 2018/12

N2 - BACKGROUND: In patients with advanced stage cancer of the uterine cervix who undergo irradiation with curative intent, there is the necessity to treat all suspicious nodes on imaging. Our hypothesis was that adding fluorodeoxyglucose positron emission computer tomography/computer tomography (FDG-PET/CT) to the imaging workup would alter the external beam radiotherapy (EBRT) treatment plan, either resulting in an extended external beam radiotherapy (EBRT) field to the para-aortal region or an additional boost to suspicious nodes. Since extended field radiotherapy or additional boost can cause toxicity, our secondary aim was to assess the incidence of severe late bowel toxicity in patients treated with extended para-aortal EBRT-field and boost compared to elective pelvic radiotherapy.METHODS: Eighty-eight patients were enrolled. First, the optimal radiation treatment plan (EBRT and boost) was retrospectively determined based on magnetic resonance imaging (MRI) or FDG-PET/CT. Second, the severe bowel toxicity caused by the extended para-aortal field was assessed, based on the executed radiotherapy.RESULTS: Based on MRI 8/88 patients would receive EBRT with para-aortic extension, this was 21/88 for FDG-PET/CT. Based on MRI 47/704 lymph node regions would receive additional boost, while based on PET/CT 91/704. Late severe bowel toxicity was seen in 12/84 patients, 6/65 in the group who received elective pelvic irradiation and 6/19 with para-aortal EBRT and boost at common iliac and/or para-aortal lymph nodes. Significant worse overall survival was seen of patients who needed para-aortal irradiation.CONCLUSIONS: Addition of FDG-PET/CT leads to an extension of the elective EBRT volume and more suspicious lymph nodes receive a boost. However, when deciding to intensify radiation therapy, late severe bowel toxicity has to be taken into account.

AB - BACKGROUND: In patients with advanced stage cancer of the uterine cervix who undergo irradiation with curative intent, there is the necessity to treat all suspicious nodes on imaging. Our hypothesis was that adding fluorodeoxyglucose positron emission computer tomography/computer tomography (FDG-PET/CT) to the imaging workup would alter the external beam radiotherapy (EBRT) treatment plan, either resulting in an extended external beam radiotherapy (EBRT) field to the para-aortal region or an additional boost to suspicious nodes. Since extended field radiotherapy or additional boost can cause toxicity, our secondary aim was to assess the incidence of severe late bowel toxicity in patients treated with extended para-aortal EBRT-field and boost compared to elective pelvic radiotherapy.METHODS: Eighty-eight patients were enrolled. First, the optimal radiation treatment plan (EBRT and boost) was retrospectively determined based on magnetic resonance imaging (MRI) or FDG-PET/CT. Second, the severe bowel toxicity caused by the extended para-aortal field was assessed, based on the executed radiotherapy.RESULTS: Based on MRI 8/88 patients would receive EBRT with para-aortic extension, this was 21/88 for FDG-PET/CT. Based on MRI 47/704 lymph node regions would receive additional boost, while based on PET/CT 91/704. Late severe bowel toxicity was seen in 12/84 patients, 6/65 in the group who received elective pelvic irradiation and 6/19 with para-aortal EBRT and boost at common iliac and/or para-aortal lymph nodes. Significant worse overall survival was seen of patients who needed para-aortal irradiation.CONCLUSIONS: Addition of FDG-PET/CT leads to an extension of the elective EBRT volume and more suspicious lymph nodes receive a boost. However, when deciding to intensify radiation therapy, late severe bowel toxicity has to be taken into account.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Fluorodeoxyglucose F18

KW - Humans

KW - Lymphatic Metastasis

KW - Middle Aged

KW - Neoplasm Staging

KW - Positron Emission Tomography Computed Tomography

KW - Radiotherapy, Image-Guided

KW - Retrospective Studies

KW - Survival Analysis

KW - Uterine Cervical Neoplasms/diagnostic imaging

U2 - 10.23736/S1824-4785.18.03083-2

DO - 10.23736/S1824-4785.18.03083-2

M3 - Article

VL - 62

SP - 420

EP - 428

JO - The Quarterly Journal of Nuclear Medicine and Molecular Imaging

JF - The Quarterly Journal of Nuclear Medicine and Molecular Imaging

SN - 1824-4785

IS - 4

ER -