Abstract
In locally advanced cervical cancer, 18F-fluorodeoxyglucose (FDG) positron emission tomography – computed tomography (PET/CT) has become important in the initial evaluation of disease extent. It is superior to other imaging modalities for lymph node status and distant metastasis. PET-defined cervical tumor volume predicts progression-free and overall survival. Higher FDG uptake in both primary and regional lymph nodes is strongly predictive of worse outcome. FDG-PET is useful for assessing treatment response 3 months after completing concurrent chemo-radiotherapy (CRT) and predicting long-term survival, and in suspected disease recurrence. In the era of image-guided adaptive radiotherapy, accurately defining disease areas is critical to avoid irradiating normal tissue. Based on additional information provided by FDG-PET, radiation treatment volumes can be modified and higher doses to FDG-positive lymph nodes safely delivered. FDG-PET/CT has been used for image-guided brachytherapy of FDG-avid tumor volume, while respecting low doses to bladder and rectum. Despite survival improvements due to CRT in cervical cancer, disease recurrences continue to be a major problem. Biological rationale exists for combining novel non-cytotoxic agents with CRT, and drugs targeting specific molecular pathways are under clinical development. The integration of these targeted therapies in clinical trials, and the need for accurate predictors of radio-curability is essential. New molecular imaging tracers may help identifying more aggressive tumors. 64Cu-labeled diacetyl-di(N(4)-methylthiosemicarbazone) is taken up by hypoxic tissues, which may be valuable for prognostication and radiation treatment planning. PET/CT imaging with novel radiopharmaceuticals could further impact cervical cancer treatment as surrogate markers of drug activity at the tumor microenvironment level. The present article reviews the current and emerging role of PET/CT in the management of cervical cancer.
Highlights
Cervical cancer is the second most common cancer among women in the world, and a leading cause of cancer mortality, affecting mainly the under deserved populations of sub-Saharan Africa, Central and Latin America, and South-Central Asia (Ferlay et al, 2010a,b)
Clinical staging of cervical cancer is based on the International Federation of Gynaecology and Obstetrics (FIGO) system, which was revised in 2009 (Pecorelli et al, 2009)
After CRT as definitive treatment of locally advanced cervical cancer there is sufficient evidence to support the use of positron emission tomography – computed tomography (PET/computed tomography (CT)) for the assessment of treatment response
Summary
Cervical cancer is the second most common cancer among women in the world, and a leading cause of cancer mortality, affecting mainly the under deserved populations of sub-Saharan Africa, Central and Latin America, and South-Central Asia (Ferlay et al, 2010a,b). Clinical staging of cervical cancer is based on the International Federation of Gynaecology and Obstetrics (FIGO) system, which was revised in 2009 (Pecorelli et al, 2009). This staging system is based on physical examination and inspection with scarce radiographic evaluation, aiming to be introduced in non-developed nations with limited access to imaging studies. New research strategies have focused on the development of tumor biomarkers aiming to combine CRT with new molecular targets. In this setting FDG-PET/CT and other molecular tracers might help to identify more aggressive tumors
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