Detection of Recurrent Cervical Cancer and Prediction of Its Patient Survival with Serum Squamous-Cell Carcinoma-Antigen and 2-[18F] Fluoro-2-Deoxy-d-Glucose-Positron Emission Tomography/Computed Tomography

Abstract

Aim: To evaluate the usefulness of serum squamous-cell carcinoma antigen (SCC-Ag) and 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) for the detection of recurrent squamous-cell carcinoma (SqCC) of the uterine cervix, and its prediction of patient survival. Methods: FDG-PET/CT was performed for patients with serum SCC-Ag levels elevated to ≥1.5 ng/mL (Group 1) and those with suspicious recurrences without any increase in serum SCC-Ag levels (Group 2). The results were analyzed on the basis of histological data, disease progression and/or clinical follow-up. Recurrence was defined as evidence of recurrent lesions within 6 months of FDG-PET/CT. The outcome was determined using medical records. Results: In total, 88 consecutive patients with cervical SqCC cancer with suspected recurrence (62 in Group 1 and 26 in Group 2) were enrolled. Recurrences were observed in 55 patients (77.4% (48/62) in Group 1 vs. 26.9% (7/26) in Group 2, p < 0.001). The overall sensitivity, specificity and accuracy of serum SCC-Ag were 87.3%, 57.6% and 76.1%, respectively, and those of FDG-PET/CT were 98.2%, 90.9% and 95.5%, respectively; the corresponding values were 97.9%, 92.9% and 96.8% for Group 1 and 100%, 89.5% and 92.3% for Group 2. Surgical resection was performed for 16 patients. At the end of the study, 40.3% (25/62) of Group 1 patients and 88.5% (23/26) of Group 2 patients were alive (p < 0.001). The survival of patients who underwent surgical resection for recurrent tumors was higher than that of patients who did not undergo resection (62.5% (10/16) vs. 17.9% (7/39), p = 0.001). Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) derived from FDG-PET/CT showed significantly different in-patient survival. Conclusions: Serum SCC-Ag could predict tumor recurrence and the survival of patients with SqCC cervical cancer. As such, the surgical resection of limited recurrent disease, as determined using FDG-PET/CT, might improve the survival of patients with cervical cancer. MTV and TLG may serve as a prognostic biomarker of survival in patients with recurrent cervical cancer.

18F-FDG PET/computed tomography scan in patients with suspicion of recurrent neuroendocrine carcinoma of the cervix

“…They usually develop local advance and lymphatic spread initially, and by hematogenous dissemination in the late stages. This is supported by the results of several studies investigating 18 F-FDG PET/CT in recurrent cervical cancer, which reported that the most frequent site of recurrence was in lymph nodes [ 13 , 21 , 22 ]. However, cervical neuroendocrine carcinoma exhibits more aggressive behavior and has a different metastatic pattern from cervical cancer with early distal metastases.…”

“…18 F-FDG PET/CT has emerged as a useful imaging technique for the detection of recurrent cervical cancer. The reported sensitivity and specificity of 18 F-FDG PET/CT were 93-100% and 59-90.9%, respectively [20,21]. However, the potential of 18 F-FDG PET/CT in recurrent cervical neuroendocrine carcinoma was barely investigated before.…”

Retrospective Comparison of the Dosimetric Parameters of Brachytherapy and Sbrt Plans in Cervical Cancer

“…Birincil tedavi başarısız olduğunda, nüks hastalıkta başarı şansı oldukça azdır. Bu nedenle, kanser nüksünün erken tespiti sağ kalım başarısını etkileyebilir 2 . Lokal ileri serviks kanserinin primer tedavisi kemoradyoterapidir.…”