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 per cent with PET/CT, Dr. Pandharipande said. That compared to 82 per cent with no imaging, 75 per cent with MRI and PET/CT and 68 per cent 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 per cent when both MRI and PET/CT were used, 92 per cent with PET/CT alone, 91.6 per cent with MRI alone, and 82 per cent with no imaging, she said.

While imaging helps define the extent of disease and thus helps determine appropriate treatment, the study found that five-year survival estimates were similar (about 92 per cent) 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.

The full results of this study will be presented on Wednesday, April 16, 2008 during the American Roentgen Ray Society's annual meeting in Washington, DC.

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