Hot topic.

Everyone wants to choose wisely when it comes to imaging. This practical Canadian phase 3 trial randomized 171 women with locally-advanced (FIGO IB-IVA) cervical cancer 2:1 to initial staging with PET-CT versus CT. The primary endpoint was rate of change in treatment fields from initial plan for pelvic radiation (i.e., rate of discovery of disease outside the pelvis). That happened in 39% (34% larger definitive fields + 5% palliative fields) of patients after PET-CT and only 25% (20% larger definitive fields + 5% palliative fields) after CT. This suggests close to 15% of women receiving not-so-fun definitive chemo with pelvic radiation have unrecognized PET-avid disease outside their treatment fields if staged with CT alone. TBL: Keep this data in your back pocket for your next eviCore call, just don’t mention it was left to suffer a p-value of 0.06 after failing to accrue. Because, honestly, who wants their patient with locally-advanced cervical cancer to be randomized to no PET? | Elit, JAMA 2018