Role of [¹⁸F]fluoro-2-deoxy-D-glucose positron emission tomography in re-recurrent cervical cancer

Abstract

Cervical cancer patients with histologically documented re-recurrence after curative salvage therapy or unexplained tumor marker elevation (negative computed tomography and/or magnetic resonance imaging [CT-MRI]) proven to be a re-recurrence when a further attempt for cure (or control of cancer) appeared feasible were enrolled. Lesion status was determined from pathology or clinical follow-up for at least 12 months. Management decisions were recorded with CT-MRI alone and incorporating [18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), respectively. The benefits calculated were based on clinical impact because of the FDG-PET findings. Cox proportional hazards model was used to select independent prognostic covariates. Of the 26 patients who were eligible for analysis, 12 (46.2%) patients had positive impacts due to PET. Squamous cell carcinoma (SCC, P = 0.029), re-recurrence at distant metastasis only (P = 0.012), and level of SCC antigen < or = 4 ng/mL (P = 0.005) were significantly associated with better survival. A scoring system using these covariates defined three distinct prognostic groups (P = 0.0001). Patients with score 0 had a 36-month cumulative survival rate of 80%. Using this prognostic scoring system, FDG-PET may facilitate selecting appropriate management for the individual patient with re-recurrent cervical cancer.

Outcomes and prognosis of patients with recurrent cervical cancer after radical hysterectomy

“…The use of FDG-PET which has shown superior ability to CT/MRI in detecting nodal, distant soft tissue metastasis lesion and more accurately detecting the presence and location of cancer cell, helps clinicians in selecting appropriate and individualized patients for curative salvage treatment [17,18]. In selected cases such as supraclavicular or para-aortic nodal metastasis detected by FDG-PET and where more aggressive curative salvage therapy after recurrence e.g.…”

Molecular imaging in the management of gynecologic malignancies

“…The benefits of FDG-PET exceed those of CT-MRI mainly because of the ability of FDG-PET to identify extra-pelvic metastases and its higher sensitivity and specificity [56]. Overall FDG-PET has a positive impact on 46% patients in cervical cancer patients with histologically documented rerecurrence after curative salvage therapy or unexplained tumor marker elevation [57].…”

Molecular imaging in the management of cervical cancer

“…21 PET and integrated PET/CT are valuable tools for assessing prognosis 22e24 and primary staging, 23e32 the determination of the treatment goal (curative or palliative) in patients with PALN 31 or SLN 32 metastasis as detected by CT/MRI (Table 1 23e32 ) and the treatment response after the completion of concurrent chemoradiation, 33 and documenting recurrent cervical cancer, 34 unexplained posttreatment elevations in tumor markers, 35 and follow-up after salvage therapy. 36 An early study demonstrated the significant sensitivity of PET for detecting PLN metastasis over MRI. 37 Goyal et al reported that using PET/CT alone could avoid multimodality therapy for the treatment of operable stage IB1eIIA1 cervical cancer.…”