Posttherapy surveillance monitoring of cervical cancer by FDG-PET.
OBJECTIVE
To evaluate the effect of irradiation and chemotherapy for carcinoma of the uterine cervix on posttreatment tumor uptake of the glucose analog (18)F-fluorodeoxyglucose (FDG) imaged by positron emission tomography (PET) and to assess the utility of FDG-PET for surveillance monitoring.


METHODS
This was a retrospective review of 76 patients with a new diagnosis of carcinoma of the uterine cervix who underwent pre- and posttreatment whole-body FDG-PET. Posttreatment FDG-PET was performed 2.4-10.4 months (median 4.2) after irradiation completion.


RESULTS
After treatment, persistent abnormal FDG uptake in the cervix was found in 18% (14 of 76), in the pelvic lymph nodes in 16% (9 of 55), in the paraaortic lymph nodes in 45% (5 of 11), and in the supraclavicular lymph nodes in 75% (3 of 4). Eleven patients developed new sites of increased FDG uptake. In relation to the findings on posttreatment PET, the 2-year progression-free survival rate was 86% for patients with no abnormal FDG uptake at any site and 40% for those with persistent abnormal uptake; there were no survivors at 2 years among patients who developed new sites of abnormal FDG uptake (p <0.0001). A multivariate analysis of prognostic factors demonstrated that any posttreatment abnormal FDG uptake (persistent or new) was the most significant prognostic factor (p <0.0001) for death from cervical carcinoma.


CONCLUSIONS
FDG-PET is a valuable tool to evaluate the response of primary cervical carcinoma and lymph node metastasis to treatment and for the surveillance of patients after initial therapy.
Grigsby
Perry W
PW
Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA. grigsbyp@netscape.net
Siegel
Barry A
BA
Dehdashti
Farrokh
F
Mutch
David G
DG
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary; D018196:Carcinoma, Adenosquamous / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies; D014055:Tomography, Emission-Computed; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18