Statement of the Uterus Commission of the Gynecological Oncology Working Group (AGO) on Neoadjuvant Chemotherapy Prior to Definitive Radiochemotherapy in Patients with Locally Advanced Cervical Cancer.

The presentation of the results of the prospective randomized international multicenter GCIG INTERLACE trial at the 2023 congress of the European Society of Medical Oncology (ESMO) is likely to change the therapy for locally advanced cervical cancer. In the GCIG INTERLACE trial, six cycles of neoadjuvant chemotherapy administered weekly and consisting of carboplatin AUC2 and paclitaxel 80 mg/m 2 followed by definitive radiochemotherapy with pelvic radiotherapy (40 - 50.4 Gray) and cisplatin (40 mg/m 2 once a week for 5 weeks) and brachytherapy (total dose EQD2 at least 78 Gy at point A) (experimental arm) were compared with definitive radiochemotherapy alone (standard arm) in patients with locally advanced cervical cancer (Fédération Internationale de Gynécologie et d'Obstétrique [FIGO] 2008 stage IB1/node positive, IB2, II, IIIB and IVA) and was found to be significantly superior with significantly longer recurrence-free survival (hazard ratio [HR] 0.65; 95% confidence interval [CI] 0.64 - 0.91; p = 0.013) and significantly longer overall survival rates (HR 0.61; 95% CI: 0.40 - 0.91; p = 0.04) after 5 years' follow-up. After considering the results of the GCIG INTERLACE trial published at the congress, the Uterus Commission of the AGO is of the opinion that neoadjuvant chemotherapy with carboplatin AUC2 and paclitaxel 80 mg/m 2 d1, q7, x6 may be offered to patients with locally advanced cervical cancer (FIGO stage IB1/node positive, IB2, II, IIIB and IVA) in addition to the current standard therapy after the patient has been informed about the risks, with the decision taken on a case-by-case basis. However, before this approach can be discussed at guideline level or defined as the new therapy standard, it will be necessary to wait until the data from the full publication are available.

Value of PET imaging for radiation therapy.

This comprehensive review written by experts in their field gives an overview on the current status of incorporating positron emission tomography (PET) into radiation treatment planning. Moreover, it highlights ongoing studies for treatment individualisation and per-treatment tumour response monitoring for various primary tumours. Novel tracers and image analysis methods are discussed. The authors believe this contribution to be of crucial value for experts in the field as well as for policy makers deciding on the reimbursement of this powerful imaging modality.

Value of PET imaging for radiation therapy.

This comprehensive review written by experts in their field gives an overview on the current status of incorporating positron emission tomography (PET) into radiation treatment planning. Moreover, it highlights ongoing studies for treatment individualisation and per-treatment tumour response monitoring for various primary tumours. Novel tracers and image analysis methods are discussed. The authors believe this contribution to be of crucial value for experts in the field as well as for policy makers deciding on the reimbursement of this powerful imaging modality.

Improved diagnosing of small hepatocellular carcinomas by echo-enhanced power Doppler sonography in patients with cirrhosis.

BACKGROUND AND AIMS: Echo-enhanced power Doppler sonography is an increasingly used procedure for the differentiation of liver tumours. The aim of this prospective study was to investigate the accuracy of echo-enhanced power Doppler sonography in comparison with conventional ultrasound and fundamental power Doppler sonography in diagnosing hepatocellular carcinomas and regenerative nodules in patients with cirrhosis. SUBJECTS AND METHODS: Eighty-seven patients with cirrhosis and 90 liver tumours at conventional ultrasound were included in the study, selected from 103 consecutive patients with a mean age of 60 years (range 23-87 years) who presented to our department from January 1998 through January 2002. Sonography was performed by an experienced examiner, who was unaware of the clinical diagnosis. The exact diagnosis was based upon histological evidence from biopsy examination, laboratory results, and/or a follow-up of at least 18 months. RESULTS: There were 65 hepatocellular carcinomas, 21 regenerative nodules, and four metastases in the study group. Only 43% of the carcinomas (mainly nodules > 3 cm in diameter) could be classified correctly by conventional ultrasound or fundamental power Doppler sonography. However, 46% of the malign lesions (mainly nodules < 3 cm in diameter) were not differentiable. All non-differentiable tumours were classified correctly by echo-enhanced power Doppler sonography. The overall sensitivity of echo-enhanced power Doppler sonography with respect to diagnosing hepatocellular carcinoma was 89%; its specificity was 60%. The corresponding values for regenerative nodules were 71% and 100%, respectively. CONCLUSIONS: Only hepatocellular carcinomas greater than 3 cm in size can be diagnosed with a high accuracy by conventional ultrasound or fundamental power Doppler sonography. However, small malignant lesions in cirrhotic livers are often not differentiable with these techniques. With echo-enhanced power Doppler sonography, the differentiation of small hepatocellular carcinomas can be improved. However, histology is the standard of reference.