Chen Min-Yu, Chou Hung-Hsueh, Liu Feng-Yuan, Chen Chao-Yu, Lin Gigin, Yang Lan-Yan, Pan Yu-Bin, Jung Shih-Ming, Wu Ren-Chin, Huang Yi-Ting, Tsai Jason Chien-Sheng, Yen Tzu-Chen, Lai Chyong-Huey, Chang Ting-Chang
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St. Kueishan, Taoyuan, 333, Taiwan.
Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Eur J Nucl Med Mol Imaging. 2016 Apr;43(4):663-74. doi: 10.1007/s00259-015-3229-9. Epub 2015 Oct 31.
Small-cell cervical cancer (SCCC) is rare and prone to metastasize. We conducted a prospective study to evaluate the role of (18)F-FDG PET in the management of this aggressive malignancy.
Patients with untreated primary, histologically confirmed SCCC were enrolled. (18)F-FDG PET (or PET/CT) was performed immediately after MRI or CT, for primary staging, monitoring response to treatment or restaging when there was suspicion of recurrence. The clinical impact of PET was determined on a scan basis.
A total of 25 patients were recruited and 43 PET scans were performed. The PET images were obtained for primary staging (25 patients), monitoring response (10 patients) and restaging when there was suspicion of recurrence (8 patients). The median follow-up time in event-free patients was 109.3 months (range 97.5 - 157.7 months). A positive impact of PET was found in 8 (18.6 %) of the 43 scans, which included detection of additional regions of distal lymph node (LN) metastasis (one primary staging scan, two restaging scans), bone metastasis (two primary staging scans, one monitoring response scan), and exclusion of false-positive lesions on MRI (one primary staging scan, one restaging scan). On the other hand, one negative impact was recorded as one false-positive lesion on a restaging PET scan. One positive impact was noted for monitoring response (bone metastasis). The impact of three scans was indeterminate. The positive impact of down-staging in avoiding overtreatment but finding additional distal LN (except one on restaging) or bone metastases had no beneficial effect on long-term survival.
The results of this preliminary study suggest that PET is useful in the management of SCCC. PET could have more value in detecting occult metastases if future novel therapies are able to offer better control of extensive SCCC.
小细胞宫颈癌（SCCC）较为罕见且易于转移。我们开展了一项前瞻性研究，以评估¹⁸F-FDG PET在这种侵袭性恶性肿瘤管理中的作用。
纳入未经治疗的原发性、组织学确诊的SCCC患者。在MRI或CT检查后立即进行¹⁸F-FDG PET（或PET/CT）检查，用于初始分期、监测治疗反应或在怀疑复发时进行再分期。PET的临床影响基于每次扫描来确定。
共招募了25例患者，进行了43次PET扫描。获取PET图像用于初始分期（25例患者）、监测反应（10例患者）以及在怀疑复发时进行再分期（8例患者）。无事件患者的中位随访时间为109.3个月（范围97.5 - 157.7个月）。在43次扫描中有8次（18.6%）发现PET有积极影响，其中包括检测到额外的远处淋巴结（LN）转移区域（1次初始分期扫描、2次再分期扫描）、骨转移（2次初始分期扫描、1次监测反应扫描）以及排除MRI上的假阳性病变（1次初始分期扫描、1次再分期扫描）。另一方面，在1次再分期PET扫描中记录到1次负面影响，为1例假阳性病变。在监测反应（骨转移）方面发现1次积极影响。3次扫描的影响不确定。降期在避免过度治疗但发现额外远处LN（再分期时除外1例）或骨转移方面的积极影响对长期生存没有益处。
这项初步研究结果表明PET在SCCC的管理中是有用的。如果未来新疗法能够更好地控制广泛期SCCC，PET在检测隐匿性转移方面可能具有更大价值。
