Impact of post‐therapy positron emission tomography on prognostic stratification and surveillance after chemoradiotherapy for cervical cancer

Abstract

The presence of a complete metabolic response at post-therapy FDG-PET is a powerful predictor for survival after chemoradiation. The very low rate of recurrence in patients with a complete metabolic response justifies a conservative follow-up approach for these patients, because relapse is usually symptomatic and not detected by routine clinical review.

15-Year Experience of 18F-FDG PET Imaging in Response Assessment and Restaging After Definitive Treatment of Merkel Cell Carcinoma

“…The results from our restaging cohort further support the sensitivity of 18 F-FDG PET imaging in MCC and demonstrate the high impact that this imaging modality has on ongoing management of these patients. This is comparable to the high impact 18 F-FDG PET imaging has on several more common malignancies evaluated by our institution and others (10)(11)(12)21,22). Although routine surveillance is generally not recommended in diseases with a low likelihood of relapse, such as non-Hodgkin lymphoma achieving a CMR (23), continued post-treatment surveillance with restaging 18 F-FDG PET imaging may be important to monitor ongoing response to treatment and to identify, in a timely manner, recurrent disease that may be suitable for salvage treatment in this disease.…”

“…As the clinical role of PET has continued to evolve, there has been increasing evidence reporting a strong correlation with metabolic response and prognosis after chemoradiation in malignancy. Our institution has previously reported the powerful prognostic stratification achieved by 18 F-FDG PET metabolic response across a range of cancer types (7)(8)(9)(10)(11)(12).…”

18F-FDG PET/CT following chemoradiation of uterine cervix cancer provides powerful prognostic stratification independent of HPV status: a prospective cohort of 105 women with mature survival data

“…Patient characteristics, staging, treatment, toxicities and follow-up details were prospectively recorded in our institutional database. Irradiation techniques have been previously described [6]. In brief, conventionally fractionated external beam radiotherapy was planned to 40 -45 Gy to the pelvis with a nodal boost of 6 -10 Gy or 5.4 -9 Gy as required depending on nodal location and volume, with four to six cycles of weekly concurrent cisplatin chemotherapy at a dose of 40 mg/m 2 .…”

“…Definitive chemoradiation is a standard treatment option for patients with locally advanced disease [3]. In this setting, posttherapy response on 18 F-FDG PET scanning has been reported by our group and others to independently predict patient outcomes after chemoradiation [4][5][6][7]. Infection with specific subtypes of human papilloma virus (HPV) has been suggested to be of prognostic significance in patients treated with radiotherapy.…”

“…The purpose of this study was to report the long-term 5-year survival outcomes and patterns of failure in our previously reported cohort of patients who underwent posttherapy FDG PET/CT scanning after chemoradiation for locally advanced cervical cancer [6]. Additionally, we report a post-hoc analysis of the impact of pretreatment HPV infection status on patient outcomes and the association between HPV status and metabolic response.…”