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Original Article
Utility of 18F-FDG-PET/CT imaging in patients with recurrent gynecological malignancies prior to pelvic exenteration
  1. Soyoun Rachel Kim1,
  2. Yoo-Young Lee1,2,
  3. Harinder Brar1,2,
  4. Arianne Albert3,
  5. Allan Covens1,4,5,
  6. Ur Metser4,5 and
  7. Taymaa May1,2
  1. 1 Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
  2. 2 Division of Gynecologic Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
  3. 3 Women’s Health Research Institute, Vancouver, British Columbia, Canada
  4. 4 Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
  5. 5 Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Taymaa May, Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5S, Canada; aymaa.May{at}uhn.ca

Abstract

Background In patients with recurrent gynecologic malignancies isolated to the pelvis, pelvic exenteration is a potential option. 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), is often used to confirm no evidence of metastatic disease.

Objective To assess the impact of PET/CT on clinical management of patients with recurrent gynecologic malignancies being considered for pelvic exenteration.

Methods Patients with recurrent gynecological malignancies who underwent PET/CT imaging between 2011 and 2014 were identified. All were considered for pelvic exenteration and underwent conventional imaging with CT +/- pelvic MRI. Patient anthropometric data, disease sites, histology, stage, treatment received, and treatment plan based on PET/CT findings were extracted.

Results A total of 40 patients met inclusion criteria. In 15 (37.5%) of these patients, results of PET/CT changed the original plan of pelvic exenteration owing to metastatic disease/unresectability (11/15) or no evidence of disease on PET/CT imaging (4/15). Twenty-five (62.5%) patients had their planned surgery after PET/CT with 19 (76%) patients undergoing a completed exenteration procedure. Six (24%) patients with PET/CT indicating isolated pelvic recurrence ultimately had intra-operative findings of extra-pelvic metastasis or nodal disease and therefore the planned surgery was aborted.

Conclusion In nearly 40% of patients with recurrent gynecologic malignancies being considered for radical salvage surgery, PET/CT can significantly alter the originally intended treatment and hence may reduce the number of futile surgical procedures.

https://doi.org/10.1136/ijgc-2018-000091

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    Footnotes

    • 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 Research ethics board (REB) approvals were obtained from the treating hospitals.

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