Jocelyn S Chapman1, I-Chow Hsu2, Pamela N Peters3,4, William E Pierson1, Lee-May Chen1, Antonio C Westphalen5. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, USA. 2. Department of Radiation Oncology, University of California, San Francisco, San Francisco, USA. 3. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, USA. Pamela.peters@ucsf.edu. 4. Department of Obstetrics and Gynecology, University of California San Francisco, 550 16th Street, 7th Floor, Mailstop 0132, San Francisco, CA, 94143, USA. Pamela.peters@ucsf.edu. 5. Department of Radiology and Biomedical Imaging, Department of Urology, University of California, San Francisco, San Francisco, CA, 94143, USA.
Abstract
PURPOSE: We aimed to examine utilization patterns of positron emission tomography scans (PET or PET/CT) beyond 6 months after cervical cancer treatment. We investigated survival outcomes of asymptomatic patients with PET-detected recurrence. METHODS: We performed a retrospective review of 283 patients with stage IA-IVA cervical cancer treated with primary chemoradiation. The 107 patients (37.8%) with recurrence were categorized as "asymptomatic PET-detected recurrence" (n = 23) or "standard detection" (n = 84) and we compared clinical characteristics and outcomes using multivariate logistic regression analysis. RESULTS: Late post-treatment PET (≥ 6 months after treatment) was performed in 35.3% (n = 100). Indications for late post-treatment PET included restaging in setting of known recurrence (23.6%), follow up of prior ambiguous imaging findings (9.7%), and new symptoms or exam findings (6.7%). However, late post-treatment PET was most commonly performed outside of current imaging guidelines, in asymptomatic patients without suspicion for recurrence (60.0%), presumably for surveillance. The median time to recurrence was 12.1 months (IQR 7.3-26.6). 23 patients (21.5%) had recurrence detected late post-treatment PET while asymptomatic (n = 23/107). Patients with asymptomatic PET-detected recurrence had improved survival by 26.3 months compared to the standard detection cohort (50.3 vs 24.0 months, p = 0.0015). On multivariate analysis, predictors of survival after recurrence were presence of distant metastases at diagnosis (p = 0.010) and asymptomatic PET-detected recurrence (p = 0.039). CONCLUSIONS: PET imaging in asymptomatic patients beyond 6 months after treatment may have clinical benefit and warrants further study. Detection of recurrence by PET in asymptomatic patients ≥ 6 months after chemoradiation was associated with prolonged survival by more than 2 years.
PURPOSE: We aimed to examine utilization patterns of positron emission tomography scans (PET or PET/CT) beyond 6 months after cervical cancer treatment. We investigated survival outcomes of asymptomatic patients with PET-detected recurrence. METHODS: We performed a retrospective review of 283 patients with stage IA-IVA cervical cancer treated with primary chemoradiation. The 107 patients (37.8%) with recurrence were categorized as "asymptomatic PET-detected recurrence" (n = 23) or "standard detection" (n = 84) and we compared clinical characteristics and outcomes using multivariate logistic regression analysis. RESULTS: Late post-treatment PET (≥ 6 months after treatment) was performed in 35.3% (n = 100). Indications for late post-treatment PET included restaging in setting of known recurrence (23.6%), follow up of prior ambiguous imaging findings (9.7%), and new symptoms or exam findings (6.7%). However, late post-treatment PET was most commonly performed outside of current imaging guidelines, in asymptomatic patients without suspicion for recurrence (60.0%), presumably for surveillance. The median time to recurrence was 12.1 months (IQR 7.3-26.6). 23 patients (21.5%) had recurrence detected late post-treatment PET while asymptomatic (n = 23/107). Patients with asymptomatic PET-detected recurrence had improved survival by 26.3 months compared to the standard detection cohort (50.3 vs 24.0 months, p = 0.0015). On multivariate analysis, predictors of survival after recurrence were presence of distant metastases at diagnosis (p = 0.010) and asymptomatic PET-detected recurrence (p = 0.039). CONCLUSIONS: PET imaging in asymptomatic patients beyond 6 months after treatment may have clinical benefit and warrants further study. Detection of recurrence by PET in asymptomatic patients ≥ 6 months after chemoradiation was associated with prolonged survival by more than 2 years.
Authors: Cary Lynn Siegel; Rochelle F Andreotti; Higinia Rosa Cardenes; Douglas L Brown; David K Gaffney; Neil S Horowitz; Marcia C Javitt; Susanna I Lee; Donald G Mitchell; David H Moore; Gautam G Rao; Henry D Royal; William Small; Mahesh A Varia; Catheryn M Yashar Journal: J Am Coll Radiol Date: 2012-06 Impact factor: 5.532
Authors: P Zola; L Fuso; S Mazzola; E Piovano; S Perotto; A Gadducci; L Galletto; F Landoni; T Maggino; F Raspagliesi; E Sartori; G Scambia Journal: Gynecol Oncol Date: 2007-09-14 Impact factor: 5.482
Authors: Donald G Mitchell; Marcia C Javitt; Phyllis Glanc; Genevieve L Bennett; Douglas L Brown; Theodore Dubinsky; Mukesh G Harisinghani; Robert D Harris; Neil S Horowitz; Pari V Pandharipande; Harpreet K Pannu; Ann E Podrasky; Henry D Royal; Thomas D Shipp; Cary Lynn Siegel; Lynn Simpson; Jade J Wong-You-Cheong; Carolyn M Zelop Journal: J Am Coll Radiol Date: 2013-11 Impact factor: 5.532
Authors: A J Lin; F Dehdashti; L S Massad; P H Thaker; M A Powell; D G Mutch; J K Schwarz; S Markovina; B A Siegel; P W Grigsby Journal: Clin Oncol (R Coll Radiol) Date: 2021-02-11 Impact factor: 4.126
Authors: David Cibula; Lukáš Dostálek; Jiri Jarkovsky; Constantijne H Mom; Aldo Lopez; Henrik Falconer; Giovanni Scambia; Ali Ayhan; Sarah H Kim; David Isla Ortiz; Jaroslav Klat; Andreas Obermair; Giampaolo Di Martino; Rene Pareja; Ranjit Manchanda; Jan Kosťun; Ricardo Dos Reis; Mehmet Mutlu Meydanli; Diego Odetto; Rene Laky; Ignacio Zapardiel; Vit Weinberger; Klára Benešová; Martina Borčinová; Fernando Cardenas; Emelie Wallin; Luigi Pedone Anchora; Huseyin Akilli; Nadeem R Abu-Rustum; Salim Abraham Barquet-Muñoz; Veronika Javůrková; Daniela Fischerová; Luc R C W van Lonkhuijzen Journal: Gynecol Oncol Date: 2021-12-23 Impact factor: 5.304