Clinical impact of FDG-PET imaging in post-therapy surveillance of uterine cervical cancer: From diagnosis to prognosis

Objectives.To evaluate the ability of whole-body 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) scan to detect recurrent cervical cancer in women during follow-up after definitive treatment.Methods.We retrospectively reviewed the whole-body FDG-PET scan of the women who had reached complete response after primary treatment for detection of recurrent cervical cancer between September 1, 2001 and October 31, 2004.Results.One hundred twenty-one consecutive patients were registered for the current study and seventy-six women were diagnosed as recurrence, twenty of which were asymptomatic. The FDG-PET scan detected 73 (96.1%) patients among 76 patients with recurrent disease and discriminated 38 (84.4%) patients among 45 patients without recurrence. The sensitivity, specificity and accuracy of the FDG-PET scan in assessment of recurrence among patients with cervical cancer were 96.1%, 84.4% and 91.7% respectively. Sixteen patients with no evidence of distant metastasis on FDG-PET scan received pelvic exenteration; complete response was achieved in 6 (37.5%) patients, and all are alive with no evidence of disease. The FDG-PET scan detected FDG-avid lesions in 17 (85.0%) of the 20 asymptomatic patients with recurrent disease, and 8 (40.0%) patients received therapy with curative intent; complete response was achieved in five (25.0%) patients and all are alive with no evidence of disease. Three-year overall survival of this study was 85.6%.Conclusions.The whole-body FDG-PET scan is a sensitive post-therapy surveillance modality for detection of recurrent cervical cancer even in asymptomatic patients and aids in deciding treatment plans and, eventually, may have favorable impact on prognosis and survival.