Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
CoxHealth, Springfield, MO, USA.
Gynecol Oncol. 2022 Jul;166(1):173-180. doi: 10.1016/j.ygyno.2022.04.018. Epub 2022 May 7.
To describe the management and outcomes of cervical cancer patients initially treated with radiation who had partial metabolic response (PMR) on three-month post-radiation F-fluorodeoxyglucose positron emissions tomography (FDG-PET).
Cervical cancer patients treated with radiation between 1997 and 2013 who had PMR on initial post-therapy FDG-PET were identified from a prospectively maintained database. Descriptive statistics were used to summarize patient demographics, tumor characteristics, surveillance methods, and treatment modalities. Kaplan-Meier methods were used to estimate progression-free (PFS) and overall survival (OS) for patients who underwent cervical biopsy prior to additional therapies and for patients who were managed with chemotherapy, radiation, surgery or no intervention.
PMR was identified in 81/542 (15%) women on initial post-radiation PET. Thirty women underwent cervical biopsy, of whom 14 (47%) had persistent cancer. Nine underwent treatment, (three surgery, five chemotherapy alone and one chemotherapy and radiation) but all died of disease; PFS and OS were similar whether women had surgery, chemoradiation therapy, or no treatment. A second surveillance FDG-PET had PPV and NPV of 91% and 75% for progression, respectively, and identified the 19% percent of patients with persistent disease outside of the cervix. Cervical biopsy had a higher PPV (100%) and lower NPV (62.5%) for progression. At the end of the study period, 46 (57%) patients were dead of disease, including all 8 patients (100%) with para-aortic or supraclavicular involvement.
If PMR is identified on three-month FDG-PET following completion of radiation for cervical cancer, repeat FDG-PET and/or biopsy are indicated to detect persistence and assist in counseling. PMR predicts poor outcomes, particularly for those with positive cervical biopsies and lymphatic involvement.
描述初始接受放疗且在三个月后正电子发射断层扫描（FDG-PET）中表现出部分代谢缓解（PMR）的宫颈癌患者的管理和结局。
从一个前瞻性维护的数据库中确定了 1997 年至 2013 年期间接受放疗且初始治疗后 FDG-PET 显示 PMR 的宫颈癌患者。使用描述性统计来总结患者的人口统计学、肿瘤特征、监测方法和治疗方式。使用 Kaplan-Meier 方法估计在接受进一步治疗前进行宫颈活检的患者和接受化疗、放疗、手术或不干预的患者的无进展生存期（PFS）和总生存期（OS）。
在初始放疗后 PET 中，81/542（15%）名女性中发现了 PMR。30 名女性接受了宫颈活检，其中 14 名（47%）仍有癌症。9 名女性接受了治疗（3 名手术，5 名单独化疗，1 名化疗和放疗），但均因疾病死亡；是否进行手术、放化疗或不治疗，患者的 PFS 和 OS 相似。第二次 FDG-PET 监测对进展的阳性预测值（PPV）和阴性预测值（NPV）分别为 91%和 75%，并确定了 19%的患者在宫颈外存在持续性疾病。宫颈活检对进展的 PPV（100%）更高，NPV（62.5%）更低。在研究结束时，46 名（57%）患者死于疾病，包括所有 8 名（100%）有腹主动脉旁或锁骨上淋巴结受累的患者。
如果在宫颈癌放疗完成后三个月的 FDG-PET 中发现 PMR，则需要重复 FDG-PET 和/或活检以检测持续性并协助咨询。PMR 预示着不良结局，尤其是对于那些宫颈活检阳性和有淋巴受累的患者。
