Defining the priority of using 18F-FDG PET for recurrent cervical cancer.
PET with 18F-FDG has shown its potential in cervical cancer. For maximizing the benefits of this new imaging technology, we aimed to define the prognostic features of recurrent cervical cancer patients for selecting appropriate candidates using 18F-FDG PET.


METHODS
Patients enrolled were from 2 independent prospective studies investigating the role of 18F-FDG PET in cervical cancer patients after definitive treatment with documented failure (CTRP-018) or unexplained elevated tumor marker serum levels (CTRP-016) and proven relapse after PET. A total of 55 eligible patients received PET and CT or MRI. Lesion status was determined from pathologic results or clinical follow-up. The benefits calculated were based on treatment that was modified because of the PET findings. The Cox proportional hazards ratio (HR) was used to select independent prognostic covariates.


RESULTS
Thirty-six (65.5%) patients had treatment that was modified due to PET. Primary radiation (HR = 14.62; 95% confidence interval [CI] = 2.74-77.92), squamous cell carcinoma antigen (SCC-Ag) > or = 4 ng/mL (HR = 5.82; 95% CI = 1.53-22.04), and presence of symptoms (HR = 6.24; 95% CI = 1.99-19.61) at recurrence were significant factors associated with poor survival. A scoring system using these covariates defined 3 distinct prognostic groups: score < or = 1 (HR = 1.00); score = 2 (HR = 6.91; 95% CI = 1.49-32.14); and score = 3 (HR = 60.46; 95% CI = 9.68-378.09) (P < 0.0001).


CONCLUSIONS
Using this risk score, 18F-FDG PET may offer maximal benefits by selecting appropriate recurrent cervical cancer patients for salvage therapy with precise restaging information.
Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Tzu-Chen
TC
Yen
Lai-Chu
LC
See
Ting-Chang
TC
Chang
Kuan-Gen
KG
Huang
Koon-Kwan
KK
Ng
Simon G
SG
Tang
Yu-Chen
YC
Chang
Swei
S
Hsueh
Chien-Sheng
CS
Tsai
Ji-Hong
JH
Hong
Cheng-Tao
CT
Lin
Angel
A
Chao
Shih-Ya
SY
Ma
Wuu-Jyh
WJ
Lin
Ying-Kai
YK
Fu
Chi-Chen
CC
Fan
Chyong-Huey
CH
Lai
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D049268:Positron-Emission Tomography / Q000379:methods* / Q000706:statistics & numerical data; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18