Until the late 1990s, the International Federation of Gynecology and Obstetrics (FIGO) staging protocols for cervical cancer represented the standard of care. Those protocols entailed the use of three primary diagnostic tools: chest radiography, intravenous urography, and barium enemas. Today, those staging protocols remain the gold standard, but few cancer centers still use them, preferring instead to rely heavily on CT and MRI studies. That change in practice was undocumented until Hedvig Hricak, MD, PhD, chair of the Department of Radiology at Memorial Sloan-Kettering Cancer Center, New York City, led a 1999 effort to demonstrate the efficacy of cross-sectional imaging in cervical cancer. She had long noticed the drop in FIGO staging, so Hricak organized a clinical trial to compare CT/MRI protocols with the FIGO protocols. Her desire to conduct such a clinical trial was, as she describes it, a natural outgrowth of a multidecade career mainly devoted to the imaging of gynecological and urological cancer. In early 1999, Hricak presented her proposal to the American College of Radiology Imaging Network (ACRIN), which agreed to conduct the clinical trial under the title ACRIN 6651: the role of radiology in the pretreatment evaluation of invasive cervical cancer. ACRIN 6651 ultimately came to involve a consortium of the nation’s top cancer centers, gynecological oncologists, cancer surgeons, and radiologists. Although ACRIN 6651 closed before accomplishing any of its primary aims (advances in medicine overtook it, which hurt efforts to recruit sufficient numbers of patients), the short-lived clinical trial nonetheless proved invaluable, not only because it yielded the first documented evidence of the near-abandonment of the FIGO staging protocols, but because it helped accustom cancer-oriented radiologists to participation in multidisciplinary, multicenter research endeavors. “Promoting the use of radiology consortia for investigations of cancer care has occurred only rarely in the past,” Hricak says. “It’s difficult to explain why that was. ACRIN 6651, from the beginning, was a team approach. In that regard, it has been absolutely marvelous; superb in changing the culture and getting radiology excited about collaboration in clinical trials.” At Memorial Sloan-Kettering Cancer Center, radiologists now routinely participate in clinical trials. “Here, there are many opportunities for both collaborative and independent effort,” Hricak says. “There are a number of projects where radiology joins the team and provides proper readings or whatever other radiological evaluation is needed. Then there are a number of research projects in which radiologists lead as the principal investigators, with clinicians then joining the study by bringing in patients.” Hricak concludes, “What this adds up to is a two-way street for radiology.”
Rich Smith is a contributing writer for Decisions in Axis Imaging News.