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The role of positron emission tomography in the selection of patients for salvage hysterectomy following chemoradiotherapy for locally advanced cervical cancer
  1. Chrishanthi Rajasooriyar1,2,
  2. Ming-Yin Lin1,
  3. Rashi Kalra1,3,
  4. Andrew Lim1 and
  5. Kailash Narayan1
  1. 1 Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  2. 2 Department of Clinical Oncology, Teaching Hospital, Jaffna, Sri Lanka
  3. 3 Royal Women’s Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Chrishanthi Rajasooriyar, Teaching Hospital, Jaffna, Sri Lanka; idarajasooriyar{at}gmail.com

Abstract

Background Patients selection for salvage hysterectomy following chemoradiotherapy of cervical cancer is vital to avoid significant morbidity. The purpose of this study was to describe the role of post-treatment F18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography scanning (FDG-PET/CT) in patient selection for salvage hysterectomy.

Methods This was a retrospective analysis of 49 patients with cervical cancer treated between January 1996 and December 2012 who were candidates for salvage hysterectomy.

Results Three groups were defined based on institutional treatment guidelines, as experience in using post-treatment FDG-PET/CT to guide management evolved. Group 1 consisted of 15 patients who underwent planned hysterectomy based on clinical, cytological, or histological suspicion. Of these, only three (20%) patients had residual disease on histology. Group 2 consisted of 13 patients who had post-treatment FDG-PET/CT 3–6 months after the completion of chemoradiotherapy due either to suspicion of recurrence on examination or patients thought to be at high risk of recurrence at the primary site. Of these, eight patients had hysterectomy and four patients showed positive histology for residual tumor. Group 3 had 21 patients who showed isolated FDG uptake at the primary site on first FDG-PET/CT scanning at 6 months. A subsequent FDG-PET/CT scan after 3 months showed disease progression in seven and complete metabolic response in 14, and surgery was avoided in all patients.

Conclusion FDG-PET/CT scanning at 6 months after radiotherapy is a good tool for assessing treatment response in patients with cervical cancer. In patients with persistent uptake on 6 months post-treatment FDG-PET/CT, repeat imaging at a 3-month interval helps in selecting patients for salvage hysterectomy.

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Footnotes

  • Contributors All authors have contributed significantly with data collection, analysis and manuscript writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Clinical research committee of the Peter MacCallum Cancer Centre, Melbourne, Australia, approval number 13/148R.

  • Provenance and peer review Not commissioned, externally peer reviewed.

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