Positron emission tomography in evaluating the feasibility of curative intent in cervical cancer patients with limited distant lymph node metastases

Objective: Clinical outcomes of cervical cancer patients with distant lymph node (LN) metastases are poor. [¹⁸F] fluorodeoxyglucose positron emission tomography (PET) or PET/computed tomography (CT) scans could potentially benefit treatment plan. Methods: Patients with cervical cancer whose CT/magnetic resonance imaging (MRI)-based imaging showed limited metastases to para-aortic lymph node (PALN), inguinal (ILN), and/or supraclavicular (SLN) were prospectively enrolled to evaluate whether PET or PET/CT influenced management. The clinical impact of PET or PET/CT was determined on a patient basis. Results: Between November 2001 and April 2007, 47 patients were enrolled for suspected metastasis to PALN with (n = 8) or without other distant nodal involvement (n = 31), ILN (n = 6), or SLN metastasis (n = 2). Additional PET or PET/CT had positive clinical impact in 21 (44.7%) of the 47 study patients, 23 had no impact, and three had negative impact. Positive impact included disclosing additional curable sites (n = 8), down-staging (n = 6), offering metabolic biopsy (n = 4) or change to palliation (n = 3). The 2-year overall survival (OS) of the study patients was 56.9% with median follow-up time of 47.0 months (range: 8-71 months) in surviving patients. The 2-year OS rates for PALN (based on histology or CT/MRI-PET consensus) and histology-proven SLN metastasis were 50.6% and 24.7%, respectively. Two (40.0%) of the five patients with histology-proven ILN metastases had no evidence of disease. Conclusions: PET or PET/CT added benefit to primary treatment planning in cervical cancer with MRI-defined suspected distant nodal metastasis.