Evidence for the use PET for radiation therapy planning in patients with cervical cancer: a systematic review

• Published in: Hematology/oncology and stem cell therapy 2011, Vol.4 (4), p.173-181
• Main Authors: Salem, Ahmed, Salem, Abdel-Fattah, Al-Ibraheem, Akram, Lataifeh, Isam, Almousa, Abdelatief, Jaradat, Imad
• Format: Article
• Language: English
• Subjects: Brachytherapy; Databases, Factual; Female; Hematology, Oncology and Palliative Medicine; Humans; Multimodal Imaging; Positron-Emission Tomography; Radiotherapy Dosage; Tomography, X-Ray Computed; Uterine Cervical Neoplasms - diagnostic imaging; Uterine Cervical Neoplasms - radiotherapy
• ISSN: 1658-3876
• DOI: 10.5144/1658-3876.2011.173

BACKGROUND AND OBJECTIVE In recent years, the role of positron emission tomography (PET) in the staging and management of gynecological cancers has been increasing. The aim of this study was to systematically review the role of PET in radiotherapy planning and brachytherapy treatment optimization in patients with cervical cancer. DESIGN AND SETTING Systematic literature review. METHODS Systematic review of relevant literature addressing the utilization of PET and/or PET-computed tomography (CT) in external-beam radiotherapy planning and brachytherapy treatment optimization. We performed an extensive PubMed database search on 20 April 2011. Nineteen studies, including 759 patients, formed the basis of this systematic review. RESULTS PET/ PET-CT is the most sensitive imaging modality for detecting nodal metastases in patients with cervical cancer and has been shown to impact external-beam radiotherapy planning by modifying the treatment field and customizing the radiation dose. This particularly applies to detection of previously uncovered paraaortic and inguinal nodal metastases. Furthermore, PET/ PET-CT guided intensity-modulated radiation therapy (IMRT) allows delivery of higher doses of radiation to the primary tumor, if brachytherapy is unsuitable, and to grossly involved nodal disease while minimizing treatment-related toxicity. PET/ PET-CT based brachytherapy optimization allows improved tumor-volume dose distribution and detailed 3D dosimetric evaluation of risk organs. Sequential PET/ PET-CT imaging performed during the course of brachytherapy form the basis of “adaptive” brachytherapy in cervical cancer. CONCLUSIONS This review demonstrates the effectiveness of pretreatment PET/ PET-CT in cervical cancer patients treated by radiotherapy. Further prospective studies are required to define the group of patients who would benefit the most from this procedure.