Clinical impact of FDG PET-CT on the management of patients with locally advanced cervical carcinoma

• Cervical carcinoma is one of the commonest cancers in women worldwide.
• Locally advanced cervical carcinoma is usually treated with chemo-radiotherapy.
• FDG PET-CT can have a major impact on management in up to one-third of patients.
• It may alter treatment intent or radiotherapy-planning by detecting occult disease.
• PET nodal status at diagnosis is an important predictor of relapse-free survival.

AimTo evaluate the impact of staging FDG PET-CT on the initial management of patients with locally advanced cervical carcinoma (LACC) and any prognostic variables predicting survival.Materials and methodsRetrospective analysis of consecutive patients undergoing FDG PET-CT for staging of LACC in a single tertiary referral centre, between April 2008 and August 2011. Comparison was made between MRI and PET-CT findings and any subsequent impact on treatment intent or radiotherapy planning was evaluated.ResultsSixty-three patients underwent FDG PET-CT for initial staging of LACC. Major impact on management was found in 20 patients (32%), a minor impact in five (8%), and no impact in 38 (60%). In those patients where PET-CT had a major impact, 12 had more extensive local nodal involvement, five had occult metastatic disease, two had synchronous tumours, and one patient had equivocal lymph nodes on MRI characterized as negative. PET-positive nodal status at diagnosis was found to be a statistically significant predictor of relapse-free survival (p < 0.05).ConclusionStaging FDG PET-CT has a major impact on the initial management of approximately one-third of patients with LACC by altering treatment intent and/or radiotherapy planning. PET-defined nodal status is a poor prognostic indicator.