Department of Radiation Oncology, Lausanne University Hospital Lausanne, Switzerland.
Front Oncol. 2013 Feb 26;3:34. doi: 10.3389/fonc.2013.00034. eCollection 2013.
In locally advanced cervical cancer, (18)F-fluorodeoxyglucose (FDG) positron emission tomography - computed tomography (PET/CT) has become important in the initial evaluation of disease extent. It is superior to other imaging modalities for lymph node status and distant metastasis. PET-defined cervical tumor volume predicts progression-free and overall survival. Higher FDG uptake in both primary and regional lymph nodes is strongly predictive of worse outcome. FDG-PET is useful for assessing treatment response 3 months after completing concurrent chemo-radiotherapy (CRT) and predicting long-term survival, and in suspected disease recurrence. In the era of image-guided adaptive radiotherapy, accurately defining disease areas is critical to avoid irradiating normal tissue. Based on additional information provided by FDG-PET, radiation treatment volumes can be modified and higher doses to FDG-positive lymph nodes safely delivered. FDG-PET/CT has been used for image-guided brachytherapy of FDG-avid tumor volume, while respecting low doses to bladder and rectum. Despite survival improvements due to CRT in cervical cancer, disease recurrences continue to be a major problem. Biological rationale exists for combining novel non-cytotoxic agents with CRT, and drugs targeting specific molecular pathways are under clinical development. The integration of these targeted therapies in clinical trials, and the need for accurate predictors of radio-curability is essential. New molecular imaging tracers may help identifying more aggressive tumors. (64)Cu-labeled diacetyl-di(N(4)-methylthiosemicarbazone) is taken up by hypoxic tissues, which may be valuable for prognostication and radiation treatment planning. PET/CT imaging with novel radiopharmaceuticals could further impact cervical cancer treatment as surrogate markers of drug activity at the tumor microenvironment level. The present article reviews the current and emerging role of PET/CT in the management of cervical cancer.
在局部晚期宫颈癌中，（18）F-氟代脱氧葡萄糖（FDG）正电子发射断层扫描-计算机断层扫描（PET/CT）在疾病程度的初始评估中变得非常重要。它在淋巴结状态和远处转移方面优于其他成像方式。PET 定义的宫颈肿瘤体积可预测无进展生存期和总生存期。原发灶和区域淋巴结中摄取 FDG 更高，预示着预后更差。FDG-PET 可用于评估同步放化疗（CRT）后 3 个月的治疗反应，预测长期生存，并用于疑似疾病复发。在图像引导自适应放疗时代，准确定义疾病区域对于避免照射正常组织至关重要。基于 FDG-PET 提供的其他信息，可以修改放射治疗体积，并安全地向 FDG 阳性淋巴结给予更高剂量。FDG-PET/CT 已用于 FDG 摄取肿瘤体积的图像引导近距离放疗，同时尽量减少对膀胱和直肠的低剂量照射。尽管 CRT 提高了宫颈癌的生存率，但疾病复发仍然是一个主要问题。将新型非细胞毒性药物与 CRT 联合使用具有生物学依据，并且正在开发针对特定分子途径的药物。将这些靶向治疗整合到临床试验中，并准确预测放射治疗的效果是至关重要的。新的分子成像示踪剂可能有助于识别更具侵袭性的肿瘤。（64）Cu 标记的二乙酰二（N（4）-甲基硫代半卡巴腙）被摄取到缺氧组织中，这可能对预后和放射治疗计划有价值。新型放射性药物的 PET/CT 成像可能会进一步影响宫颈癌的治疗，成为肿瘤微环境水平药物活性的替代标志物。本文综述了 PET/CT 在宫颈癌管理中的当前和新兴作用。
