Defining the Priority of Using 18F-FDG PET for Recurrent Cervical Cancer

Defining the Priority of Using ¹⁸F-FDG PET for Recurrent Cervical Cancer

Tzu-Chen Yen, MD, PhD¹, Lai-Chu See, PhD², Ting-Chang Chang, MD³, Kuan-Gen Huang, MD³, Koon-Kwan Ng, MD⁴, Simon G. Tang, MD, MSc⁵, Yu-Chen Chang, MD¹, Swei Hsueh, MD⁶, Chien-Sheng Tsai, MD⁵, Ji-Hong Hong, MD, PhD⁵, Cheng-Tao Lin, MD³, Angel Chao, MD³, Shih-Ya Ma, MD¹, Wuu-Jyh Lin, PhD⁷, Ying-Kai Fu, PhD⁷, Chi-Chen Fan, MSc⁸ and Chyong-Huey Lai, MD³

¹ Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
² Biostatistics Consulting Center/Department of Public Health, Chang Gung University, Taoyuan, Taiwan
³ Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
⁴ Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
⁵ Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
⁶ Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
⁷ Institute of Nuclear Energy Research, Taoyuan, Taiwan
⁸ Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan

View larger version (58K):

[in a new window]

FIGURE 1. A 25-y-old woman with poorly differentiated squamous cell carcinoma of uterine cervix, FIGO stage IIIb, underwent concurrent chemoradiation therapy. Three months later, a left neck mass was palpated. Abdominopelvic MRI and chest CT showed no definite abnormal findings except an enlarged supraclavicular LN. Balancing between salvage RT and palliation treatment, PET was performed and suggested nodal metastases at the left supraclavicular, the bilateral upper and lower paraaortic, and the bilateral pelvic regions. After the left supraclavicular and paraaortic nodal metastases were confirmed histopathologically, she received palliation treatment.

View larger version (54K):

[in a new window]

FIGURE 2. A 52-y-old woman with poorly differentiated squamous cell carcinoma of uterine cervix, FIGO stage IIa, underwent concurrent chemoradiation therapy. Four months after complement of treatment, an elevated serum SCC-Ag of 2.23 ng/mL was noted. Abdominopelvic MRI and chest RT showed negative findings. Two months later, her serum SCC-Ag level was 7.36 ng/mL. Conventional images still showed negative findings. A PET scan was then obtained and disclosed a metastatic lesion in the right lower lung. She subsequently received pneumonectomy and was well for 1 y.

View larger version (14K):

[in a new window]

FIGURE 3. Kaplan–Meier curves for 2-y OS rates in patients with recurrent cervical cancer. Patients are categorized by risk score of $≤$ 1 (bold solid line), 2 (thin solid line), and 3 (dashed line) (P < 0.0001).