MRI and PET/CT can help spare patients with clinically operable cervical cancer from unnecessary high-morbidity treatment, however, pretreatment imaging does not lead to increased survival of these patients, a new study shows.
We developed a decision-analytic model to determine the value of pretreatment imaging in the patients with stage 1B cervical cancer, said Pari Pandharipande, MD, MPH, of Massachusetts General Hospital in Boston, and lead author of the study. What we found was that PET/CT alone best triages patients to the correct primary therapy, she said. The percentage of patients triaged to optimal first line therapy was 89% with PET/CT, Dr. Pandharipande said. That compared to 82% with no imaging, 75% with MRI and PET/CT and 68% with MRI.
These patients are treated with either surgery, chemoradiation or surgery followed by chemoradiation (trimodality therapy). When MRI and PET/CT are combined, it best prevents undesired triage to high-morbidity trimodality therapy, said Dr. Pandharipande. The study found that the percentage of patients spared trimodality therapy were 95% when both MRI and PET/CT were used, 92% with PET/CT alone, 91.6% with MRI alone, and 82% with no imaging, she said.
While imaging helps define the extent of disease and thus helps determine appropriate treatment, the study found that 5-year survival estimates were similar (about 92%) regardless of whether the patient had no pretreatment imaging, or pretreatment imaging with PET/CT alone, MRI alone or both PET/CT and MRI.
MRI and PET/CT are commonly used to guide management decisions for patients with early cervical cancer, said Dr. Pandharipande. This study provides us with an evidence-based approach to the role of preoperative imaging for these patients, she said.
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American Roentgen Ray Society