Early Diagnosis Of Recurrence Research Articles

Squamous cell carcinoma antigen (SCC-Ag) during follow-up of cervical cancer patients: Role in the early diagnosis of recurrence

ObjectiveThe aim of this study was to assess the potential benefit of routine squamous cell carcinoma antigen (SCC-Ag) assessment during follow-up of patients after treatment for early cervical cancer with regard to early diagnosis of cancer recurrence before clinical signs and symptoms occur. MethodsAll clinical, pathological, and serological data of patients referred to the Department of Gynecologic Oncology between July 1999 and June 2014, were retrospectively collected and analyzed. The SCC-Ag levels of 197 patients with diagnosis of stage I or II cervical squamous carcinoma, were performed. ResultsIn the univariate analysis, serum SCC-Ag was not significantly associated with grading (p=0.85), LVSI (p=0.95) and FIGO stage (p=0.83) but it was significantly associated with recurrence of disease (p<0.001). The Cox multivariate analyses showed that serum SCC-Ag level was an independent and statistically significant prognostic factor for OS and PFS. The median time interval between SCC-Ag test and diagnosis of recurrence were 0.3 and 1.8months for positive and negative SCC-Ag groups respectively (p=0.01). Considering patients with recurrence, no significant difference in terms of DFS and OS was found between women with high or low SCC-Ag levels. ConclusionsSerum SCC-Ag reflects the response to treatment, and rising antigen levels often precede the clinical detection of recurrent disease, and may lead to early diagnosis. However such an advantage does not seem to improve the cure rate of patients with elevated SCC-Ag levels, most likely due to the lack of curative salvage treatments.

Treatment options and prognosis for repeatedly recurrent giant cell tumor of the spine.

Giant cell tumor of the spine has high rate of postoperative recurrence. There are not much published studies on repeatedly recurrent GCTS (RRGCTS). Also, there are controversies as to the prognostic factors and treatment options for RRGCTS. A retrospective survival analysis between 2000 and September 2014 was performed on the 74 times of in-hospital treatment of the 21 patients. Recurrence-free survival was defined as the time between the date of surgery and the date of recurrence. Factors with P values <0.05 in univariate analysis were subjected to multivariate analysis by means of proportional hazard analysis. A total of 21 patients comprising ten males and 11 females with a mean age of 29.7years (range 15-49) were included, with a total of 74 times of surgery performed. Eighteen patients had no evidence of disease. Univariate and multivariate analysis suggested that total spondylectomy and bisphosphonate therapy were independent prognostic factors for better RFS in RRGCTS patients. Patients of RRGCTS are suitable for further surgical treatment with relatively good healing process and restoration of nervous function. Early diagnosis of recurrence may be associated with better prognosis. Total spondylectomy in combination with bisphosphonate therapy could reduce postoperative recurrence rate.

Managing noninvasive recurrences after definitive treatment for muscle-invasive bladder cancer or high-grade upper tract urothelial carcinoma.

Approximately 50% of patients with muscle invasive urothelial carcinoma will relapse with distant recurrence. Though rates of local recurrence after definitive therapy have improved, management remains a challenge. In this review, treatment strategies for this cohort are re-examined in an effort to enhance patient outcomes. Urothelial carcinoma continues to demonstrate high rates of recurrence and low rates of survival. Similarly to the treatment of primary urothelial cancer, treatment of recurrence focuses on cytology, stage, and clinical characteristics. Current areas of interest have focused on identification and causes/predictors of recurrence. Limited progress has been achieved in differentiating management of recurrent urothelial carcinoma from the treatment of primary urothelial carcinoma. However, there may be an increasing role for endoscopic and organ conserving therapies for carefully selected patients with recurrent noninvasive urothelial carcinoma. Identifying those at risk for early recurrence and early diagnosis of recurrence may be the most beneficial future strategies. The treatment regimen for noninvasive bladder recurrence after radical nephroureterectomy for upper tract urothelial carcinoma should include intravesical chemotherapy or Bacillus Calmette-Guerin to prevent further bladder recurrence or tumor progression. We do not advocate diversion sparing techniques for local recurrence after radical cystectomy. Metastasectomy for distant/metastatic urothelial carcinoma recurrence represents a promising area of future study.

Practice Guideline for the Surveillance of Patients After Curative Treatment of Colon and Rectal Cancer.

Current evidence suggests improved rates of curative secondary treatment following identification of recurrence among patients who participate in a surveillance program after initial curative resection of colon or rectal cancer. The newer data show that surveillance CEA, chest and liver imaging,and colonoscopy can also improve survival through early diagnosis of recurrence; thus, these modalities are now included in the current guideline. Although the optimum strategy of surveillance for office visits, CEA, chest and liver imaging, and colonoscopy is not yet defined, routine surveillance does improve the detection of recurrence that can be resected with curative intent. Recommended surveillance schedules are shown in Table 4. However, the factors to be considered when recommending surveillance include underlying risk for recurrence, patient comorbidity, and the ability to tolerate major surgery to resect recurrent disease or palliative chemotherapy, performance status, physiologic age, preference, and compliance. The success of surveillance for early detection of curable recurrence will depend on patient and provider involvement to adhere to the surveillance schedule and avoid unnecessary examination. It should be noted that, after curative resection of colorectal cancer, patients are still at risk for other common malignancies(lung, breast, cervix, prostate) for which standard screening recommendations should be observed and measures to maintain general health (risk reduction for cardiovascular disease, eg, cessation of smoking, control of blood pressure and diabetes mellitus, balanced diet, regular exercise and sleep, and flu vaccines) should be recommended.

Pathologie tumorale de la moelle et de ses enveloppes chez l’adulte et l’enfant

Intraductal tumors are rare tumors exhibiting slow progression and varied and nonspecific clinical symptoms. Tumors affecting the cord envelopes mainly develop from nerve sheaths and meninges (meningioma and schwannoma respectively). The most frequent intramedullary tumors are gliomas (astrocytoma in children and ependymoma in adults), but there are many other tumors that are not so rare. The diagnosis is made primarily by magnetic resonance imaging (MRI). Imaging is useful to determine the location of the injury. Tumor location to an anatomical space (epidural and intradural intramedullary) provides the best diagnostic approach. Therapeutic monitoring with MRI allows early diagnosis of recurrence or surveillance of residual tumor tissue.

АНАЛІЗ РЕЗУЛЬТАТІВ КОМПЛЕКСНОГО ЛІКУВАННЯ ЕНДОМЕТРІОЗУ ЖІНОЧИХ СТАТЕВИХ ОРГАНІВ.

&lt;p&gt;Нами проведено аналіз результатів комплексного лікування 86 пацієнток з зовнішнім генітальним ендометріозом. Контрольну групу склали 25 здорових жінок. Першим етапом лікування було лапароскопічне органозберігаюче втручання з наступним призначенням з першого менструального циклу гормонотерапії оргаметрилом у безперервному режимі в дозі 5-7,5 мг. Хірургічне лікування ендометріозу полягало у видаленні видимих ділянок ендометріозу і відновленні нормальних анатомічних взаємовідносин у порожнині таза. З метою діагностики в доопераційному періоді та з метою ранньої діагностики рецидивування ендометріозу проводили в динаміці гінекологічне обстеження, УЗД, визначення СА 125. Запропонована терапія дозволила зменшити симптоми ендометріозу та відновити репродуктивну функцію жінки.&lt;br /&gt;&lt;br /&gt;&lt;/p&gt;

Addressing challenges in future surveillance after surgery for early-stage cervical cancer.

This study examines surveillance after early-stage cervical cancer surgery. Since the 1980s, the value of surveillance has been discussed continuously. The main question explored is whether surveillance serves the purpose of ensuring early diagnosis of recurrence. A retrospective cohort study included 389 women with cervical cancer who underwent surgery as the primary treatment modality at the Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark, from 1996 to 2011. We used data from patient files and the Danish National Pathology Data Bank. The cumulative risk was estimated by the Kaplan-Meier method and tested by the log-rank test. Forty-three women (11%) had recurrence. Only 27% of the recurrent cases were diagnosed at a scheduled surveillance appointment, but they were often asymptomatic and seemed to have a better outcome after treatment compared with the recurrent cases diagnosed at self-referral.The 5-year survival was overall 91.3%, recurrence-free survival was 96%, and cancer-specific survival was 54%. The median recurrence-free interval was 23 months (range, 4-144) for the symptomatic patients and 14 months (range, 4-48) for the asymptomatic patients. The median survival after recurrence was 12 months (range, 2-132) for the symptomatic patients and 156 months (range, 40-180) for the asymptomatic patients. At the moment, neither the value of surveillance nor the significance of self-referral related to survival after recurrence is known. In this study, those who are diagnosed with recurrence before symptom onset seem to fare better in terms of 5-year survival than those who are diagnosed after self-referral because of symptoms.

Changing operative strategy from abdominoperineal resection to sphincter preservation in T3 low rectal cancer after downstaging by neoadjuvant chemoradiation: a preliminary report.

The objective of this study is to assess oncological outcome after changing operative strategy from abdominoperineal resection (APR) to sphincter preservation (SP) in T3 low rectal carcinomas downstaged by neoadjuvant chemoradiation (nCRT). This was a prospective observational study performed at academic medical centers. Patients with T3 rectal carcinoma, (<1 cm from the top of anal sphincter) received long-course neoadjuvant chemoradiation. Decision before chemoradiation was APR in all patients. Patients who had successful downstaging were included in the study. Low anterior resection (LAR) was performed after 8-11 weeks from completion of nCRT. Follow-up duration ranged from 4 to 6 years. Salvage surgery was done for local recurrence when possible. The primary endpoint of the study was disease-free survival. Secondary endpoints were morbidity, mortality, continence, and oncologic results of salvage surgery after recurrence. LAR with colorectal or coloanal anastomosis were done in 9 and 36 patients, respectively. After a mean follow-up of 57 months (range 48-70), local recurrences was reported in 4 patients (8.8 %), one of them had also distant metastasis while 2 patients (4.4 %) had only distant metastasis. Disease-free and overall survival rates were 87 and 89 %, respectively. Three of 4 patients with local recurrence (the fourth had liver metastasis) underwent salvage APR with free safety margins. Follow-up after salvage surgery for 31, 33, and 37 months revealed no recurrences. Wexner continence score ≤4 was noted in 39 patients; while major incontinence (Wexner score >12) was noted in 2 patients. For selected patients of T3 low rectal cancer, changing operative strategy from APR to SP after downstaging by nCRT can be done in motivated patients with good sphincter function. Disease-free survival rates and continence are comparable to patients had APR and to previous publications with decision made before nCRT. With strict follow-up, early diagnosis of recurrence and salvage surgery with free resection margins can be achieved.

Follow-up after gastrectomy for cancer: results of an international web round table.

Oncological follow-up after radical gastrectomy for cancer still represents a discrepancy in the field, with many retrospective series demonstrating that early diagnosis of recurrence does not result in an improvement in patient survival; yet, many centers with high quality of care still provide routine patient follow-up after surgery by clinical and instrumental controls. This was the topic for a web round table entitled "Rationale and limits of oncological follow-up after gastrectomy for cancer" that was launched one year before the 10(th) International Gastric Cancer Congress. Authors having specific expertise were invited to comment on their previous publications to provide the subject for an open debate. During a three-month-long discussion, 32 authors from 12 countries participated, and 2299 people visited the dedicated web page. Substantial differences emerged between the participants: authors from Japan, South Korea, Italy, Brazil, Germany and France currently engage in instrumental follow-up, whereas authors from Eastern Europe, Peru and India do not, and British and American surgeons practice it in a rather limited manner or in the context of experimental studies. Although endoscopy is still considered useful by most authors, all the authors recognized that computed tomography scanning is the method of choice to detect recurrence; however, many limit follow-up to clinical and biochemical examinations, and acknowledge the lack of improved survival with early detection.

Free circulating DNA as a biomarker of colorectal cancer

ObjectivesThe purpose of this study is to evaluate the sensitivity and specificity of free circulating DNA (FCDNA) as a biomarker in patients suffering from colorectal cancer (CRC), investigating both its prognostic value correlated with stage of disease and its potential role in early recurrence diagnosis. MethodsThe quantification of plasma DNA was achieved through the use of real time quantitative polymerase chain reaction (PCR) amplification of the RNAse P gene. The study enrolled patients undergoing surgery for primary CRC, at different stages of disease; samples were collected before surgery and during follow-up examinations every 3 months after surgery. Data were statistically analyzed using Software Packages SPSS® for Windows. ResultsFCDNA was detectable in all pre-operative samples and the mean value was 47.8 ng/mL. FCDNA values increased progressively related to UICC stage of disease, although statistical significance was demonstrated only when comparing patients by pT stage. The analysis of postoperative samples showed a significant decrease of FCDNA quantity after radical surgery and in specific cases a rise preceding disease recurrence. ConclusionsThis study shows that absolute quantification of FCDNA in CRC patients could have a prognostic value, being related to stage of disease, and could be used as potential tool for early detection of recurrences.

Alternatives for the Intensive Follow-Up After Curative Resection of Colorectal Cancer. Potential Novel Biomarkers for the Recommendations

Early diagnosis of recurrence and metastasis of colorectal cancer following surgery of curative intent is of vital importance in terms of survival and quality of life. The consistent implementation of appropriate patient follow-up strategy is therefore essential. Debates over the methodology, evaluation and strategy of follow-up have been known for many years, and continue today. By introducing several follow-up models, the present paper offers different options featuring certain individual, national and international, conceptual and financial aspects. Colorectal cancer is an important public health concern due to its destructive nature and frequency, it is therefore essential to develop new monitoring strategies, involving new biomarkers and extensive clinical validation. Since the recurrence rate is very high in high-risk patients, the improvement of individual patient risk estimates and the utilization of a corresponding follow-up model require broad international co-operation and common practice, along with the determination of optimal levels of evidence.

PRM17 - An evaluation of medication errors in a large teaching hospital

early treatment response evaluation in 82 (67.21%) of the patients, for staging in 65 (53.28%) patients, late treatment responseevaluation in 48 (39.34%) patients, for restaging in 40 (32.79%) patients. PET/CT was not used for diagnosis and radiation treatment response evaluation. Major histologic subtype was found to be infiltrating ductal carcinoma (IDC) (91%). liver was the most common metastatic site among all (41 patients) 85.37% in 35 patients, lung in 30 patients (73.17%), bone in 25 patients (60.98%), around 3 patients were having lesions in brain, adrenal and ovaries, around (4.88%) 2 patients were presented with lesion in atrium. Recurrence was present in 31(76%) patients, chest wall invasion in 10 patients (24%). Maximum number of patients around 21 patients had lesions in ipsilateral axillary nodes (51.22%), 16 in supraclavicular nodes (39.02%) and 13 patients (31.71%) in contralateral nodes. Treatment plan was altered in 55 patients (45.08%), whereas supported in 67 patients (54.92%). CONCLUSIONS: The clinical utility of PET/CT may lead to a change in the routine diagnostic algorithm and follow-up protocols for patients with cancer by providing correct and early diagnosis of recurrence as well as by establishing its precise significance for further clinical management.

1303 SIGNIFICANT VARIABILITY IN 10-YEAR CUMULATIVE RADIATION EXPOSURE INCURRED ON DIFFERENT SURVEILLANCE REGIMENS FOLLOWING SURGERY FOR PT1 RENAL CANCERS – YET ANOTHER REASON TO STANDARDIZE PROTOCOLS?

for this article http://dx.doi.org/10.1016/j.juro.2013.07.072 available at http://jurology.com/ Editorial Comment: The last decades witnessed increasing concern regarding radiation exposure risks, either after therapeutic interventions or in surveillance protocols after oncologic surgery. In patients with renal cell carcinoma (RCC) the knowledge and recommendations on surveillance protocols (test and frequency) are mostly based on retrospective series and risk adapted systems. The lack of uniformity resulted in a wide variation in radiation exposure for the 2 index cases defined in this study (pT1a clear cell RCC, Fuhrman grade 2 and pT1b clear cell RCC, Fuhrman grade 3) in several analyzed surveillance regimens. With the trend to diagnose RCC in early stages and in younger individuals, a lower rate of metastatic events is expected, although longer followup might be indicated. Although the index patients defined in this study are considered at low risk for recurrence based on the recent American Urological Association RCC followup guidelines, intuition suggests that the biological potential of both tumors might be different. Individual demographic and medical conditions will dictate the need for early diagnosis of recurrence or an abstention policy. Lastly, while a large body of literature is available on the high/rapid exposure risk of cancer development, little is known about the cumulative effects of low regular exposure. The challenge in coming years will be to find balance between radiation risk and timely/effective diagnosis of recurrence. Identification of patterns of recurrence according to distinct tumor stages and individualized risk, including supplementary pathological features (eg nomograms), should be explored and tested to determine the subpopulation in which a more intensive followup regimen will be beneficial despite increased exposure risk. M. Pilar Laguna, M.D., Ph.D.

Circulating levels of HER-2/neu oncoprotein in breast cancer

HER-2/neu, also known as c-erbB-2/neu, is an oncogene located in chromosome 17 which encodes HER-2/neu, a transmembrane protein belonging to the EGFR family. The external domain of this protein is released by the cell and can be studied in serum by immunoassay. HER-2/neu in serum is a specific tumor marker and only slight elevations may be found in the absence of malignancy, mainly in association with liver diseases. Likewise, the highest concentrations of this oncoprotein are found in patients with breast cancer, but lower concentrations may be found in other malignancies, particularly ovarian, prostate and lung cancer (mainly adenocarcinomas). HER-2/neu assay sensitivity in patients with untreated primary loco-regional breast cancer is <10% and seems to be related to overexpression in tissue as well as to the most important prognostic factors: tumor size and nodal involvement. Serial HER-2/neu determinations after surgery seem to be useful in the early diagnosis of recurrence, mainly in patients with HER-2/neu overexpression in tissue, but additional studies are necessary to confirm these results. HER-2/neu sensitivity (proportion of patients with abnormal values) in patients with metastasis is around 40%-45%, with a clear relationship to tissue overexpression and to site (higher in visceral metastases) and number of metastases. The clinical utility of HER-2/neu in patients with advanced disease is mainly for therapeutic monitoring. Likewise, in most of the studies published, a relationship has been found between serum HER-2/neu levels (either pretreatment or at follow-up) with tumor response.

Is genetic screening indicated in apparently sporadic pheochromocytomas and paragangliomas?

Pheochromocytoma (Pheo) is usually considered a sporadic disease. Recently, an increasing rate of genetically based tumors has been reported. However, the need for systematic screening of unsuspected germline mutations in apparently sporadic forms is still debated. This study aimed to assess the effective rate of germline mutations causing Pheo and Paraganglioma (PGL), and the role of systematic genetic screening. Demographics, clinical, and genetic evaluation were performed in a series of 71 patients with Pheo and/or PGL. Twelve patients had evident inherited/familial disease at presentation: NF1 (n = 4); MEN2 (n = 4), and familial Pheo/PGL (n = 4). Among 59 patients with apparently sporadic disease, unsuspected germline mutations occurred in 8 cases: TMEM127 (n = 4), SDHB (n = 2), VHL (n = 1), SDHC (n = 1). No differences were found between hereditary and sporadic disease concerning age, sex, and tumor size; bilateral Pheo and/or PGL and recurrences occurred most often in hereditary disease. Hereditary Pheo and/or PGL are frequent (28.2%). Inheritance is evident at presentation only in 16.9% of cases; 13.6% of apparently sporadic variants are genetically determined. Despite increased costs, systematic genetic screening might be useful because it might lead to a stricter follow-up, early diagnosis of recurrences in index cases and presymptomatic detection of disease in relatives.

The Follow-up After Radical Surgery of Colorectal Cancer: Is it Time for a “Tailored” Strategy?

The problem of the surveillance for colorectal cancer after radical surgery is a widely debated argument. Like for other solid tumors, the issue is divided in 2 main routes: the early diagnosis of recurrence and the early diagnosis of a second primary cancer. Genetic and molecular features have been recognized as useful tools to measure these risks, however, the instruments are still insufficient to design a personalized strategy for the patient. In an era of "tailored therapies" in oncology, even the follow-up of the surgically treated patient for colorectal cancer should enter "a tailor's shop in which several competent tailors" should be available to manage a complex problem.

OC01.04: Analysis of brain structure by MRI voxel based morphometry (VBM) and neurodevelopment in preterm born infants with and without IUGR

tumors (BOT), to determine the ability of ultrasound (US) to diagnose new and recurring BOT, and to assess differences in US variables between new and recurrent BOT. Methods: The cohort involved a subgroup of participants in an international multi-center ultrasound study on ovarian masses (IOTA phase 2). Patients with a history of BOT with a further ovarian tumor or a first diagnosis of BOT were included. The gold standard was the histological diagnosis of the ovarian mass. Results: 20 patients with a history of BOT and an ovarian mass and 93 patients with newly diagnosed BOTs were included. In 17 (85%) patients with a previous BOT, a recurrent BOT was found. In the remaining 3 cases (15%) the recurrent tumor was benign. All recurrent BOT histotypes matched the primary BOT. No BOT recurred as invasive primary tumor or with invasive peritoneal implants. Subjective assessment of US findings was a better method for identifying BOT in patients with a history of BOT than in patients with newly diagnosed BOT (sensitivity 76% [13/17] vs. 41% [38/93]). Patients with BOT recurrence were younger (median 35 years vs. 53) and had smaller tumors (median 41 mL vs. 548) with more papillations (mean 2.06 vs. 1.44) than patients with newly diagnosed BOT. Recurrent tumors were more often anechoic and less often homogeneous with low-level echogenicity, reflecting the higher percentage of serous BOT among the recurrent BOTs than among newly diagnosed BOTs (71% vs. 56%). The early ultrasound diagnosis of recurrence permitted conservative treatment of recurrence in 65% [11/17] patients. Conclusions: BOT history is a strong predictor of BOT in a recurrent ovarian mass. US is highly accurate in diagnosing BOT recurrence and so can be used for follow up after fertility sparing procedures where early diagnosis of recurrence is essential for conservative re-treatment.

Cholin-PET/CT zur Bildgebung des Prostatakarzinoms

Die PET- und PET/CT-Diagnostik mit [11C]- und [18F]-markierten Cholinderivaten wird zunehmend zur bildgebenden Diagnostik des Prostatakarzinoms eingesetzt. Die PET/CT mit radioaktiv markierten Cholinderivaten kann zum aktuellen Zeitpunkt für die Diagnose des primären Prostatakarzinoms nicht empfohlen werden. Die Cholin-PET/CT kann aber hilfreiche Informationen bei klinischem Verdacht auf Prostatakarzinom mit wiederholt negativen Biopsien in Vorbereitung auf eine gezielte Re-Biopsie liefern. Zunehmende Evidenz besteht für die Wertigkeit der PET und PET/CT mit radioaktiv markierten Cholinderivaten für das Re-Staging von Patienten mit einem biochemischen Rezidiv nach primärer lokaler Therapie. Erfolgversprechende Ergebnisse sind für diese Patientengruppe publiziert worden. Die Detektionsrate der Cholin-PET/CT zeigt eine lineare Abhängigkeit vom PSA-Serumwert. Für PSA-Serumwerte von kleiner 1 ng/ml können ca. ⅓ der Rezidive nachgewiesen werden. Durch eine Lokalisierung der Rezidiverkrankung bei diesen Patienten werden individualisierte Therapieansätze möglich. Präliminäre Studien zum Einsatz der [11C]Cholin-PET/CT zur Ermittlung des Therapieansprechens unter anti-hormoneller Therapie haben vielversprechende Ergebnisse erbracht. Klinische Multicenterstudien sind notwendig, um den Wert der Cholin-PET/CT für die Rezidivdiagnostik des Prostatakarzinoms weiter zu evaluieren und zu validieren, ebenso wie Leitlinien und Analysen zur Kosteneffizienz.

Management of colorectal cancer follow-up in elderly patients

Background Follow-up of surgically treated colorectal cancer patients is not supported by objectively certain data. Despite the thousands of investigations reported in the literature, only six randomized prospective studies and two meta-analysis of randomized studies provide data suggesting clear conclusions until today. The main goal of colorectal follow-up is to improve patient survival by early diagnosis of recurrence during the asymptomatic stage when radical surgical treatment is more viable [1]. However the reduction of global mortality from colorectal cancer achieved by follow-up, radical second-surgery and therefore new and definite patient recovery calculated in our patients in follow-up on 5 years disease free interval was only 2.6 % according to the findings of other authors [2,3]. In our recent study carried out on a group of 280 patients in our follow-up the average age was 69.5 demonstrating that the age must be carefully considered in order to establish the follow-up timing and modality and to calculate the cost-benefit ratio. In our experience the far from brilliant results obtained led us to change our follow-up in 2006 and make it less intensive, tailoring it to the stage of the disease, the reliability of the diagnostic methods, times of recurrences and no less important, the age of patients. In the aged obviously the surgical and/or adjuvant and neoadjuvant treatments are to be considered with caution and local and general controindications to every type of therapy carefully evaluated. The age is a fundamental part of ASA, POSSUM and PST and could condition the therapeutical strategies. On the other hand many reports confirm the possibility of performing safe operation for liver and lung metastases or local recurrences in the elderly without a statistical higher rate of morbidity and mortality compounding with younger adults. Lastly, in our policy we have considered the agreement of elderly patients to modality and timing of follow-up on the basis of a study carried out with the collaboration of a psychological team. On the basis of those experiences we also believe that in some patients and circumstances a major involvement of family doctors substituting the institutional follow-up staff is necessary.

Application of 18F-FDG PET/CT in cervical cancer with elevated levels of serum squamous cell carcinoma antigen during the follow-up

Accurate and early diagnosis of recurrence for cervical cancer after the treatment and aggressive salvage treatment could improve the prognosis of this disease. Serum squamous cell carcinoma antigen (SCCAg) is the most commonly used tumor marker for the detection of asymptomatic recurrence of cervical cancer. This study was to evaluate the application and value of (18)F-FDG PET/CT in cervical cancer with elevated of serum SCCAg level during the follow-up. Thirty-one patients with cervical cancer with elevated serum SCCAg level during the follow-up undergoing (18)F-FDG PET/CT in Sun Yat-sen University Cancer Center between August 2005 and November 2008 were entered into this retrospective study. The pathological types, the serum SCCAg level, PET/CT results, results of other imaging modalities, pathological and clinical follow-ups were recorded. All 31 patients'pathological examination showed squamous cell carcinoma, including three adenosquamous carcinoma. Lesions of all patients were examined by PET/CT. Three patients had local recurrence in the uterus or vagina, 28 had metastatic disease. Of these 31 patients, three were confirmed to have local recurrent disease, 27 were verified to have metastatic disease and one was diagnosed as primary lung squamous cell carcinoma by pathological or clinical manifestations. The total detection rate of PET/CT for malignancy was 100% (31/31); the diagnostic accuracy of PET/CT for recurrent cervical cancer was 96.8% (30/31). The levels of serum SCCAg during the follow-up were 1.5-37.8 ng/ml. There was no relation between the level of serum SCCAg and the maximum standard uptake value (SUVmax) of PET/CT. Compared with other imaging modalities, PET/CT was more efficient in detecting recurrence and finding more lesions. An elevated level of SCCAg in cervical cancer during the follow-up indicates tumor recurrence. PET/CT is efficient in detecting the recurrence and has high diagnostic accuracy.