Title: Positron Emission Tomography (PET) for Staging Cervical Cancer: Clinical Effectiveness and Guidelines for Use Date: 16 July 2008 Research question: 1. What is the clinical effectiveness of positron emission tomography for staging cervical cancer? 2. What are the guidelines for use of positron emission tomography for staging cervical cancer? Methods: A limited literature search was conducted on key health technology assessment resources, including PubMed, the Cochrane Library (Issue 3, 2008, University of York Centre for Reviews and Dissemination (CRD) databases, ECRI, EuroScan, international HTA agencies, and a focused Internet search. Results include articles published between 2004 and the present, and are limited to English language publications only. Filters were applied to limit the retrieval to systematic reviews, guidelines and non-randomized studies. Internet links are provided, where available. Results: HTIS reports are organized so that the higher quality evidence is presented first. Therefore, health technology assessment reports, systematic reviews and meta-analyses are presented first. These are followed by randomized controlled trials (RCTs), observational studies, and evidence-based guidelines. One health technology assessment, one systematic review, 11 observational studies, and three guidelines were identified pertaining to the clinical effectiveness and guidelines for the use of PET for the staging of cervical cancer. No RCTs were identified. Additional information that may be of interest has been included in the Appendix. Disclaimer: The Health Technology Inquiry Service (HTIS) is an information service for those involved in planning and providing health care in Canada. HTIS responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. HTIS responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report. Copyright: This report contains CADTH copyright material and may contain material in which a third party owns copyright. This report may be used for the purposes of research or private study only. It may not be copied, posted on a web site, redistributed by email or stored on an electronic system without the prior written permission of CADTH or applicable copyright owner. Links: This report may contain links to other information on available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners own terms and conditions.
Health technology assessments 1. Matchar DB, Kulasingam SL, Havrilesky L, Mann LO, Myers ER, McCrory DC, et al. Positron emission testing for six cancers (brain, cervical, small cell lung, ovarian, pancreatic and testicular). In: Technology assessment [database online]. Baltimore: Centers for Medicare & Medicaid Services; 2004. Available: http://www.cms.hhs.gov/determinationprocess/downloads/id21ta.pdf See section 3.2 Cervical cancer Systematic reviews and meta-analyses 2. Selman TJ. Diagnostic accuracy of tests for lymph node status in primary cervical cancer: a systematic review and meta-analysis. CMAJ 2008;178(7). PubMed: PM 18362381 Available: http://www.cmaj.ca/cgi/reprint/178/7/855?ck=nck. Randomized controlled trials No literature identified. Observational studies 3. Yildirim Y, Sehirali S, Avci ME, Yilmaz C, Ertopcu K, Tinar S, et al. Integrated PET/CT for the evaluation of para-aortic nodal metastasis in locally advanced cervical cancer patients with negative conventional CT findings. Gynecol Oncol 2008;108(1):154-9. PubMed: PM17945337 4. Unger JB, Lilien DL, Caldito G, Ivy JJ, Charrier A, Bellaire B. The prognostic value of pretreatment 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography scan in women with cervical cancer. Int J Gynecol Cancer 2007;17(5):1062-7. PubMed: PM17367319 5. Choi HJ, Roh JW, Seo SS, Lee S, Kim JY, Kim SK, et al. Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma: a prospective study. Cancer 2006;106(4):914-22. PubMed: PM16411226 6. Chou HH, Chang TC, Yen TC, Ng KK, Hsueh S, Ma SY, et al. Low value of [18F]-fluoro- 2-deoxy-D-glucose positron emission tomography in primary staging of early-stage cervical cancer before radical hysterectomy. J Clin Oncol 2006;24(1):123-8. PubMed: PM16382121 7. Xue F, Lin LL, Dehdashti F, Miller TR, Siegel BA, Grigsby PW. F-18 fluorodeoxyglucose uptake in primary cervical cancer as an indicator of prognosis after radiation therapy. Gynecol Oncol 2006;101(1):147-51. PubMed: PM16263155 8. Freudenberg LS, Fischer M, Antoch G, Jentzen W, Gutzeit A, Rosenbaum SJ, et al. Dual modality of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography in patients with cervical carcinoma of unknown primary. Med Princ Pract 2005;14(3):155-60. PubMed: PM15863988 PET for Staging Cervical Cancer 2
9. Lin LL, Mutic S, Malyapa RS, Low DA, Miller TR, Vicic M, et al. Sequential FDG-PET brachytherapy treatment planning in carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2005;63(5):1494-501. PubMed: PM16154713 10. Park W, Park YJ, Huh SJ, Kim BG, Bae DS, Lee J, et al. The usefulness of MRI and PET imaging for the detection of parametrial involvement and lymph node metastasis in patients with cervical cancer. Jpn J Clin Oncol 2005;35(5):260-4. PubMed: PM15886267 11. Roh JW, Seo SS, Lee S, Kang KW, Kim SK, Sim JS, et al. Role of positron emission tomography in pretreatment lymph node staging of uterine cervical cancer: a prospective surgicopathologic correlation study. Eur J Cancer 2005;41(14):2086-92. PubMed: PM16125928 12. Unger JB, Ivy JJ, Ramaswamy MR, Charrier A, Connor P. Whole-body [18F]fluoro-2- deoxyglucose positron emission tomography scan staging prior to planned radical hysterectomy and pelvic lymphadenectomy. Int J Gynecol Cancer 2005;15(6):1060-4. PubMed: PM16343182 13. Wright JD, Dehdashti F, Herzog TJ, Mutch DG, Huettner PC, Rader JS, et al. Preoperative lymph node staging of early-stage cervical carcinoma by [18F]-fluoro-2- deoxy-d-glucose-positron emission tomography. Cancer 2005;104(11):2484-91. PubMed: PM16270319 Guidelines and recommendations 14. Scottish Intercollegiate Guidelines(SIGN). Management of cervical cancer: a national clinical guideline. In: Guidelines [database online]. Edinburgh: SIGN; 2008. Available: http://www.sign.ac.uk/pdf/sign99.pdf See section 4: Diagnosis and Staging and section 4.3.7: PET Summary with regulatory alert available: National Guideline Clearinghouse. Management of cervical cancer: a national clinical guideline. In: Guideline.gov [database online]. Rockville (MD): NGC; 2008. NGC:006233. Available: http://www.guideline.gov/summary/summary.aspx?doc_id=12110&nbr=006233&string=c ervix+or+cerical+or+uterine 15. National Comprehensive Cancer Network. Cervical cancer [guideline]. In: NCCN clinical practice guidelines in oncology [database online]. Fort Washington (PA): NCCN; 2008. Available: http://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf See section on staging, pg MS-2 16. American College of Radiology. Invasive cancer of the cervix [guideline]. In: ACR appropriateness criteria [database online]. Reston(VA): ACR; 2005. Available: http://www.acr.org/secondarymainmenucategories/quality_safety/app_criteria/pdf/exper tpanelonwomensimaging/invasivecancerofthecervixdoc5.aspx See section 4: Diagnosis and Staging and section 4.3.7: PET Summary available: National Guideline Clearinghouse. Invasive cancer of the cervix [guideline]. In: Guideline.gov [database online]. Rockville(MD): NGC; 2005. NGC:004159. Available: http://www.guideline.gov/summary/pdf.aspx?doc_id=8305&stat=1&string=pet+and+cerv ical PET for Staging Cervical Cancer 3
Prepared by: Kristen Moulton, B.A., Research Assistant Raymond Banks, M.L.S., Information Specialist Health Technology Inquiry Service Email: htis@cadth.ca Tel: 1-866-898-8439 PET for Staging Cervical Cancer 4
Appendix further information: Policy or coverage information 17. Aetna. Positron emission tomography (PET) [guideline]. In: Clinical Policy Bulletin [database online]. Hartford (CT): Aetna; 2008. Policy #0071. Available: http://www.aetna.com/cpb/medical/data/1_99/0071.html See section II-oncologic indications 18. CIGNA HealthCare. Positron emission tomography (PET) [guideline]. In: CIGNA healthcare coverage position [database online]. Hartford (CT): CIGNA; 2008. Available: http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medic al/mm_0091_coveragepositioncriteria_positron_emission_tomography.pdf Observational studies 19. Schwarz JK, Siegel BA, Dehdashti F, Grigsby PW. Association of posttherapy positron emission tomography with tumor response and survival in cervical carcinoma. JAMA 2007;298(19):2289-95. PubMed: PM18029833 20. Chung HH, Kim SK, Kim TH, Lee S, Kang KW, Kim JY, et al. Clinical impact of FDG- PET imaging in post-therapy surveillance of uterine cervical cancer: from diagnosis to prognosis. Gynecol Oncol 2006;103(1):165-70. PubMed: PM16574205 21. Lin LL, Yang Z, Mutic S, Miller TR, Grigsby PW. FDG-PET imaging for the assessment of physiologic volume response during radiotherapy in cervix cancer. Int J Radiat Oncol Biol Phys 2006;65(1):177-81. PubMed: PM16545921 22. Grigsby PW, Siegel BA, Dehdashti F, Rader J, Zoberi I. Posttherapy [18F] fluorodeoxyglucose positron emission tomography in carcinoma of the cervix: response and outcome. J Clin Oncol 2004;22(11):2167-71. PubMed: PM15169804 Review articles 23. Rembielak A, Price P. The role of PET in target localization for radiotherapy treatment planning. Onkologie 2008;31(1-2):57-62. PubMed: PM18268401 24. Lai CH, Yen TC, Chang TC. Positron emission tomography imaging for gynecologic malignancy [review]. Curr Opin Obstet Gynecol 2007;19(1):37-41. PubMed: PM17218850 25. Kumar R, Chauhan A, Jana S, Dadparvar S. Positron emission tomography in gynecological malignancies. Expert Rev Anticancer Ther 2006;6(7):1033-44. PubMed: PM16831075 26. Rajendran JG, Greer BE. Expanding role of positron emission tomography in cancer of the uterine cervix. J Natl Compr Canc Netw 2006;4(5):463-9. PubMed: PM16687094 27. Wolfson AH. Magnetic resonance imaging and positron-emission tomography imaging in the 21st century as tools for the evaluation and management of patients with invasive cervical carcinoma. Semin Radiat Oncol 2006;16(3):186-91. PubMed: PM16814160 PET for Staging Cervical Cancer 5
28. Yen TC, Lai CH. Positron emission tomography in gynecologic cancer. Semin Nucl Med 2006;36(1):93-104. PubMed: PM16356798 29. Nakamoto Y, Saga T, Fujii S. Positron emission tomography application for gynecologic tumors. Int J Gynecol Cancer 2005;15(5):701-9. PubMed: PM16174216 PET for Staging Cervical Cancer 6