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The Role of ¹⁸F-FDG PET in Assessing Therapy Response in Cancer of the Cervix and Ovaries

¹ Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri; ² Washington University School of Medicine, St. Louis, Missouri; ³ Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri; ⁴ Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, St. Louis, Missouri; and ⁵ Division of Nuclear Medicine, Vanderbilt University Medical Center, Nashville, Tennessee

Correspondence: For correspondence or reprints contact: Dominique Delbeke, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 21st Ave. S. and Garland, Nashville, TN 37232-2675. E-mail: dominique.delbeke{at}vanderbilt.edu

For locally advanced cervical cancer, the current literature supports the use of ¹⁸F-FDG PET for assessing treatment response 3 mo after the completion of concurrent chemoradiation. ¹⁸F-FDG PET can provide reliable long-term prognostic information for these patients and, in the future, may be used to guide additional therapy. Investigational areas include the use of ¹⁸F-FDG PET for monitoring response during radiotherapy and chemotherapy in the metastatic and neoadjuvant settings. For ovarian masses, the performance of ¹⁸F-FDG PET in the detection of borderline tumors is limited, and the presence of physiologic ¹⁸F-FDG uptake in normal ovaries of premenopausal women poses another limitation. Preliminary data suggest that the performance of ¹⁸F-FDG PET and ¹⁸F-FDG PET/CT is superior to that of CT alone in initial staging, but the sensitivity of both in the detection of carcinomatosis is limited. Preliminary data also suggest that ¹⁸F-FDG PET may be promising for early prediction of response to chemotherapy and for prediction of response after the completion of chemotherapy. ¹⁸F-FDG PET and ¹⁸F-FDG PET/CT are most helpful in the evaluation of patients with suspected recurrent ovarian carcinoma, especially when CA-125 levels are rising and CT findings are normal or equivocal. PET and CT are complementary, and PET/CT should be used when available. Preliminary data suggest that the addition of ¹⁸F-FDG PET/CT to the evaluation of these patients changes management in approximately a third and reduces overall treatment costs by accurately identifying patients who will or will not benefit from surgery.

Key Words: therapy response • cancer • cervix • ovary

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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