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-[(18)F]-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.