Surgical staging of para-aortic LN in patients with locally advanced cervix cancer and no evidence of metastases in preoperative PET/CT imaging

5083 Background: In three comprehensive cancer centers, patients with LACC were systematically staged using conventional and PET-CT imaging before chemoradiotherapy. If patients had no uptake in the PA area, laparoscopic extraperitoneal PA surgery was then performed to define radiation field limits more accurately. The aim of this study was to evaluate the therapeutic impact of this management. Methods: A prospective multicenter series of 237 patients treated from 2004 to 2011 for LACC with a negative PET-CT of the PA area and undergoing laparoscopic PA lymphadenectomy. Radiation fields were extended to PA area when PA nodes were involved. Chemoradiotherapy modalities were homogeneous between Institutions. Patients with a poor prognosis histologic subtype, peritoneal carcinomatosis or ovarian metastasis were excluded. Results: Clinical stages were IB2 (n=79), IIA (n=10), IIB (n=120), III (n=23), IVA (n=5). The histologic types were squamous carcinoma (n=197), adenocarcinoma (n=34) and others (n=6). Twenty-nine (11%) patients had nodal involvement (false negative PET-CT results): 16 with PA nodal metastasis measuring > 5 mm and 13 < 5 mm. With a median follow-up of 18 (range, 0-67) months, disease-free survival (DFS) at 2 years in patients without and with PA involvement was respectively 76% (68%-83%) and 61% (37%-80%)(p=.007). DFS at 2 years in patients without PA involvement or with PA metastasis measuring < or > 5 mm was respectively 76% (68%-83%), 89% (57%-98%) and 38% (14%-68%)(p=.0006). Conclusions: This is the largest series of patients reported undergoing such strategy. We obtained a similar survival rate for patients with PA nodal metastasis < 5 mm and patients without PA lymph node involvement suggesting that this strategy is highly efficient in such patients. Conversely, the survival of patients with PA nodal involvement > 5 mm remained poor, despite no extrapelvic disease at PET-CT imaging in this subgroup. Other treatment modalities should be evaluated for these patients.

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Comparison of combined 18 F-FDG and 18 F-NaF PET/CT vs. 18 F-FDG PET/CT imaging in initial metastatic workup in cases of locally advanced breast cancer (LABC)

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2014.02.170 ◽

2014 ◽

Vol 40 (5) ◽

pp. 660

Author(s):

Gurpreet Singh ◽

J. Mohanroop ◽

Baljinder Singh

Keyword(s):

Breast Cancer ◽

Advanced Breast Cancer ◽

Fdg Pet ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Ct Imaging ◽

Advanced Breast ◽

Pet Ct ◽

Fdg Pet Ct

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How should we stage and tailor treatment strategy in locally advanced cervical cancer? Imaging versus para-aortic surgical staging

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001351 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1434-1443

Author(s):

Alejandra Martinez ◽

Martina Aida Angeles ◽

Denis Querleu ◽

Gwenael Ferron ◽

Christophe Pomel

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Locally Advanced ◽

Surgical Staging ◽

Advanced Cervical Cancer ◽

Locally Advanced Cervical Cancer ◽

Node Metastasis ◽

Pet Ct

Para-aortic lymph node status at initial assessment is the most important prognostic factor and a key point for the therapeutic strategy in patients with locally advanced cervical cancer. Undiagnosed lymph node metastasis is a major clinical problem as the finding of positive para-aortic lymph nodes leads to treatment modification, with a possible impact on disease free survival. When aortic lymph node disease is discovered, radiotherapy is extended to the para-aortic area, and other treatment modalities may be considered. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is the most accurate imaging examination to assess para-aortic extension in patients with locally advanced cervical cancer. The gold standard to identify para-aortic extension remains histologic evaluation of the lymph nodes. Indeed, PET/CT fails to detect approximately 10–15% of patients with negative PET/CT aortic nodes who have lymph node metastasis on pathologic staging. Patients with positive pelvic lymph nodes have para-aortic extension in 25–30% of cases, and surgical staging will lead to treatment modification and probably to improved para-aortic and distant control. Surgical staging also avoids unnecessary toxicity associated with extended field radiation in approximately 75% of patients with pelvic lymph node metastasis. The best modality to identify para-aortic extension is histological evaluation of the lymph nodes, but the survival benefit of surgical staging remains controversial. On the other hand, current studies include a majority of patients without pelvic lymph node spread, who are likely to be those who will benefit the least from surgical staging.

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Evaluation of early response to concomitant chemoradiotherapy by interim 18F-FDG PET/CT imaging in patients with locally advanced oesophageal carcinomas

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-012-2325-3 ◽

2013 ◽

Vol 40 (4) ◽

pp. 477-485 ◽

Cited By ~ 15

Author(s):

Xavier Cuenca ◽

Christophe Hennequin ◽

Elif Hindié ◽

Sofia Rivera ◽

Laetitia Vercellino ◽

...

Keyword(s):

Fdg Pet ◽

Locally Advanced ◽

Early Response ◽

Ct Imaging ◽

Concomitant Chemoradiotherapy ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison withT2weighted and PET/CT imaging

British Journal of Radiology ◽

10.1259/bjr/68424021 ◽

2012 ◽

Vol 85 (1013) ◽

pp. 577-586 ◽

Cited By ~ 76

Author(s):

I Song ◽

S H Kim ◽

S J Lee ◽

J Y Choi ◽

M J Kim ◽

...

Keyword(s):

Rectal Cancer ◽

Diffusion Weighted Imaging ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Neoadjuvant Chemoradiation ◽

Ct Imaging ◽

Chemoradiation Therapy ◽

Pet Ct ◽

Viable Tumour

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The Impact of 68Gallium DOTA PET/CT in Managing Patients With Sporadic and Familial Pancreatic Neuroendocrine Tumours

Frontiers in Endocrinology ◽

10.3389/fendo.2021.654975 ◽

2021 ◽

Vol 12 ◽

Author(s):

Daniel J. Cuthbertson ◽

Jorge Barriuso ◽

Angela Lamarca ◽

Prakash Manoharan ◽

Thomas Westwood ◽

...

Keyword(s):

Functional Imaging ◽

Neuroendocrine Tumours ◽

Locally Advanced ◽

Ct Imaging ◽

Imaging Findings ◽

Imaging Data ◽

Cross Sectional ◽

Pet Ct ◽

Pancreatic Neuroendocrine Tumours ◽

The Impact

ObjectivePancreatic neuroendocrine tumours (panNETs) arise sporadically or as part of a genetic predisposition syndrome. CT/MRI, endoscopic ultrasonography and functional imaging using Octreoscan localise and stage disease. This study aimed to evaluate the complementary role of 68Gallium (68Ga)-DOTA PET/CT in managing patients with panNETs.DesignA retrospective study conducted across three tertiary UK NET referral centres.MethodsDemographic, clinical, biochemical, cross-sectional and functional imaging data were collected from patients who had undergone a 68Ga-DOTA PET/CT scan for a suspected panNET.ResultsWe collected data for 183 patients (97 male): median (SD) age 63 (14.9) years, 89.1 vs. 9.3% (n=163 vs. 17) alive vs. dead (3 data missing), 141 sporadic vs. 42 familial (MEN1, n=36; 85.7%) panNETs. Non-functional vs. functional tumours comprised 73.2 vs. 21.3% (n=134 vs. 39) (10 missing). Histological confirmation was available in 89% of individuals (n=163) but tumour grading (Ki67 classiifcation) was technically possible only in a smaller cohort (n=143): grade 1, 50.3% (n=72); grade 2, 46.2% (n=66) and grade 3, 3.5% (n=5) (40 histopathological classification either not technically feasible or biopsy not perfomed). 60.1% (n=110) were localised, 14.2% (n=26) locally advanced and 23.5% (n=43) metastatic (4 missing). 224 68Ga-DOTA PET/CT scans were performed in total for: diagnosis/staging 40% (n=88), post-operative assessment/clinical surveillance 53% (n=117) and consideration of peptide receptor radionuclide therapy (PRRT) 8% (n=17) (2 missing). PET/CT results confirmed other imaging findings (53%), identified new disease sites (28.5%) and excluded suspected disease (5%). Overall, 68Ga-DOTA PET/CT imaging findings provided additional information in 119 (54%) patients and influenced management in 85 (39%) cases.Conclusion68Ga-DOTA PET/CT imaging more accurately stages and guides treatment in patients with sporadic/familial panNETs with newly diagnosed/recurrent disease.

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