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Original Article
Impact of post-therapy positron emission tomography on prognostic stratification and surveillance after chemoradiotherapy for cervical cancer
Article first published online: 1 MAR 2011
DOI: 10.1002/cncr.25991
Copyright © 2011 American Cancer Society
Additional Information
How to Cite
Siva, S., Herschtal, A., Thomas, J. M., Bernshaw, D. M., Gill, S., Hicks, R. J. and Narayan, K. (2011), Impact of post-therapy positron emission tomography on prognostic stratification and surveillance after chemoradiotherapy for cervical cancer. Cancer, 117: 3981–3988. doi: 10.1002/cncr.25991
Publication History
- Issue published online: 19 AUG 2011
- Article first published online: 1 MAR 2011
- Manuscript Accepted: 7 DEC 2010
- Manuscript Revised: 6 DEC 2010
- Manuscript Received: 12 OCT 2010
- Abstract
- Article
- References
- Cited By
Keywords:
- fluorodeoxyglucose positron emission tomography;
- cervix cancer;
- surveillance;
- radiotherapy;
- survival;
- prognostic factors
A single post-therapy 18F-fluorodeoxyglucose positron emission tomography scan is a powerful predictor of survival after chemoradiotherapy of cervical cancer. Disease recurrence will rarely be detected by routine clinical follow-up after a complete metabolic response.
Abstract
BACKGROUND:
A study was undertaken to investigate the detection of relapse and survival outcomes in patients with cervical cancer treated with curative intent chemoradiotherapy, and evaluated with a post-therapy 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scan.
METHODS:
Between January 2002 and June 2007, 105 consecutive patients were prospectively enrolled into a registry study designed to assess outcomes of chemoradiotherapy. A FDG-PET scan was performed between 3 and 12 months (median, 4.9 months) post-treatment at clinician discretion. Tumor response was graded as complete metabolic response, partial metabolic response, or progressive metabolic disease.
RESULTS:
Median follow-up was 36 months. At post-therapy FDG-PET, 73 (70%) patients had complete metabolic response, 10 (9%) had partial metabolic response, and 22 (21%) had progressive metabolic disease. Overall survival at 3 years was 77% in all patients, and 95% for those with complete metabolic response. On multivariate analysis, complete metabolic response (P < .0001) and pretreatment tumor volume (P = .041) were strong predictors for overall survival. The number of involved lymph nodes (P < .005) and International Federation of Gynecology and Obstetrics stage (P = .04) were predictive of relapse-free survival. In total, 18 patients relapsed at a single site, and 13 underwent salvage, with a 3-year survival of 67%. Patients with complete metabolic response had a distant failure rate 36-fold less than those with partial metabolic response (P < .0001). After complete metabolic response, only 1 patient (1.6%) relapsed without symptoms and was detected through physical examination.
CONCLUSIONS:
The presence of a complete metabolic response at post-therapy FDG-PET is a powerful predictor for survival after chemoradiation. The very low rate of recurrence in patients with a complete metabolic response justifies a conservative follow-up approach for these patients, because relapse is usually symptomatic and not detected by routine clinical review. Cancer 2011. © 2011 American Cancer Society.