DOI: 10.1007/s00259-018-3957-8Pages: 1-8

Roles of posttherapy 18F-FDG PET/CT in patients with advanced squamous cell carcinoma of the uterine cervix receiving concurrent chemoradiotherapy

1. Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Department of Nuclear Medicine and Molecular Imaging Center

2. Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Gynecologic Cancer Research Center

3. Keelung Chang Gung Memorial Hospital, Department of Nuclear Medicine

4. Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Department of Radiation Oncology

5. Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Department of Obstetrics and Gynecology

6. Chang Gung University, Department of Medical Imaging and Radiological Sciences

Correspondence to:
Chyong-Huey Lai
Tel: 886-3-3281200
Email: sh46erry@ms6.hinet.net

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Abstract

Purpose

To assess the clinical roles of [18F]fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) performed 2-3 months after completion of concurrent chemoradiotherapy (CCRT), along with pretherapy characteristics, in patients with advanced squamous cell carcinoma of the uterine cervix enrolled in a prospective randomized clinical trial.

Methods

Posttherapy PET/CT in patients with advanced FIGO stage or positive pelvic or para-aortic lymph node (PALN) defined on pretherapy PET/CT was classified as positive, equivocal, or negative. Overall survival (OS) rates between patients with different PET/CT results are compared. Pretherapy characteristics are examined for association with posttherapy PET/CT results and for prognostic significance in patients with equivocal or negative PET/CT.

Results

PET/CT scans (n = 55) were positive, equivocal and negative in 9, 13 and 33 patients, respectively. All patients with positive scans were confirmed to have residual or metastatic disease and died despite salvage therapies. There is a significant OS difference between patients with positive and equivocal scans (P < .001) but not between patients with equivocal and negative scans (P = .411). Positive pretherapy PALN is associated with positive posttherapy PET/CT (P = .033) and predicts a poorer survival in patients with equivocal or negative posttherapy PET/CT (P < .001).

Conclusions

Positive PET/CT 2-3 months posttherapy implies treatment failure and novel therapy is necessary to improve outcomes for such patients. A more intense posttherapy surveillance may be warranted in patients with positive pretherapy PALN.

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  • Accepted: Jan 19, 2018
  • Online: Feb 22, 2018

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