Pretreatment MRI and PET/CT for cervical cancer may direct more women to optimal therapy choices and spare many women potential long-term morbidity and complications of trimodality therapy (surgery followed by chemoradiation), according to a study performed at the Institute for Technology Assessment in Boston, MA.
An interdisciplinary team of investigators developed a decision-analytic model to determine the value of pretreatment imaging with MRI and/or PET/CT in patients with FIGO Stage IB cervical cancer. “Stage IB cervical cancer, in the absence of pre-treatment imaging, is treated with surgery. As surgery cannot completely resect the cancer in many of these patients, they receive post-surgical chemoradiation, i.e. trimodality therapy,” said Pari Pandharipande, MD, lead author of the study. “The goal of pre-treatment imaging is to identify these patients noninvasively, spare them surgery and have them treated with chemoradiation alone,” she said. Study results showed that while imaging does not improve survival, PET/CT resulted in the highest percentage of patients receiving correct primary therapy (89%) and use of both MRI and PET/CT spared the most patients of trimodality therapy (95%).
“Pretreatment imaging can triage patients to optimal primary treatment choices that minimize the risk of long-term complications and morbidity while preserving chances for survival,” said Dr. Pandharipande. “Because both over- and underestimation of disease extent can result in adverse patient outcomes, determining the extent of disease accurately up front is critical. For example, when patients are subjected to pelvic surgery, and then are radiated in the same operative field, complication rates can increase by a substantial percentage, as compared to if they were simply treated with surgery alone or chemoradiation alone. Our study shows how pre-treatment imaging may improve chances of correctly receiving surgery or chemoradiation instead of both,” said Dr. Pandharipande.
“MRI and PET/CT are expensive, but long-term consequences of trimodality therapy can severely affect long-term quality of life and are also expensive. Further study of these long-term consequences is needed to more precisely consider the cost implications of upfront MRI and PET/CT,” she said.
“Currently there are no specific guidelines that prescribe MRI or PET/CT for determining a plan of action for the treatment of stage IB cervical cancer patients. It remains important for patients to make imaging and treatment decisions with their gynecologic-oncologist on a case-by-case basis,” said Dr. Pandharipande.
“My goal as a researcher in radiology is to continue to objectively look at what we do and how it impacts patient care. A better understanding of what happens to people after they receive imaging tests both improves patient care directly and focuses further research efforts in areas most influential to patient outcomes,” she said.
- Pandharipande et al. MRI and PET/CT for Triaging Stage IB Clinically Operable Cervical Cancer to Appropriate Therapy: Decision Analysis to Assess Patient Outcomes. American Journal of Roentgenology, 2009; 192 (3): 802 DOI: 10.2214/AJR.08.1224
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