Women in Ontario who are newly diagnosed with locally advanced cervix cancer may receive additional imaging as a result of a clinical study involving McMaster University researchers.
The study showed that patients who received positron emission tomography–computed tomography (PET) imaging as well as conventional computed tomography (CT) imaging were twice as likely to have a change in their treatment.
The findings were published by the Journal of the American Medical Association (JAMA) Network Open.
"This trial was a team effort," said Lorraine Elit, co-principal investigator of the study, professor of obstetrics and gynecology at McMaster and a gynecologic oncologist at the Juravinski Cancer Centre.
"It is an example of how physicians who treat women with cervical cancer can work together to carry out a high-quality study, the results of which ultimately change practice in our province. As a result of our research, the access to PET scans for women with this disease has expanded in Ontario."
The study, co-ordinated by Ontario Clinical Oncology Group and funded by Cancer Care Ontario, ran from 2010 to 2014 and enrolled 171 women at six regional cancer centres, including Princess Margaret and Odette Sunnybrook in Toronto, Juravinski in Hamilton as well as hospitals in London, Ottawa and Thunder Bay.
Study participants were over the age of 18 and newly diagnosed. Half the women received a CT, which shows abnormalities or disease in the body area scanned. The other half received a CT plus a PET scan, which reveals "hot spots" of cell activity or growth that can indicate cancer. About twice as many women who had both tests had more extensive tumours in the abdomen and treatment changed as a result.
Study author Mark Levine, a professor of oncology and director of the Ontario Clinical Oncology Group at McMaster, noted that although previous studies showed PET could detect more tumours than usual tests, the Ontario randomized trial is the first to evaluate whether PET leads to a change in clinical management.
Cervical cancer is the fourth most commonly diagnosed cancer in women, accounting for approximately 7.5 per cent of female cancer deaths worldwide. Approximately 40 per cent of patients with cervical cancer present with locally advanced disease, defined as cancer that extends beyond the cervix to the vagina, parametrium, and/or lymph nodes.
Staging is key to patient management as undetected disease outside the radiation field can result in undertreatment or overtreatment if the undetected disease is disseminated. Historically, noninvasive testing using CT with or without magnetic resonance imaging (MRI) was performed to determine whether cervical cancer was locally advanced.
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