Posttherapy surveillance monitoring of cervical cancer by FDG-PET

Int J Radiat Oncol Biol Phys. 2003 Mar 15;55(4):907-13. doi: 10.1016/s0360-3016(02)04287-6.


Purpose: To evaluate the effect of irradiation and chemotherapy for carcinoma of the uterine cervix on posttreatment tumor uptake of the glucose analog (18)F-fluorodeoxyglucose (FDG) imaged by positron emission tomography (PET) and to assess the utility of FDG-PET for surveillance monitoring.

Materials and methods: This was a retrospective review of 76 patients with a new diagnosis of carcinoma of the uterine cervix who underwent pre- and posttreatment whole-body FDG-PET. Posttreatment FDG-PET was performed 2.4-10.4 months (median 4.2) after irradiation completion.

Results: After treatment, persistent abnormal FDG uptake in the cervix was found in 18% (14 of 76), in the pelvic lymph nodes in 16% (9 of 55), in the paraaortic lymph nodes in 45% (5 of 11), and in the supraclavicular lymph nodes in 75% (3 of 4). Eleven patients developed new sites of increased FDG uptake. In relation to the findings on posttreatment PET, the 2-year progression-free survival rate was 86% for patients with no abnormal FDG uptake at any site and 40% for those with persistent abnormal uptake; there were no survivors at 2 years among patients who developed new sites of abnormal FDG uptake (p <0.0001). A multivariate analysis of prognostic factors demonstrated that any posttreatment abnormal FDG uptake (persistent or new) was the most significant prognostic factor (p <0.0001) for death from cervical carcinoma.

Conclusions: FDG-PET is a valuable tool to evaluate the response of primary cervical carcinoma and lymph node metastasis to treatment and for the surveillance of patients after initial therapy.

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / drug therapy
  • Adenocarcinoma / radiotherapy
  • Carcinoma / diagnostic imaging*
  • Carcinoma / drug therapy
  • Carcinoma / radiotherapy
  • Carcinoma / secondary
  • Carcinoma, Adenosquamous / diagnostic imaging
  • Carcinoma, Adenosquamous / drug therapy
  • Carcinoma, Adenosquamous / radiotherapy
  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / drug therapy
  • Carcinoma, Squamous Cell / radiotherapy
  • Disease Progression
  • Disease-Free Survival
  • Female
  • Fluorodeoxyglucose F18* / pharmacokinetics
  • Humans
  • Lymphatic Metastasis / diagnostic imaging
  • Multivariate Analysis
  • Neoplasm Recurrence, Local
  • Radiopharmaceuticals* / pharmacokinetics
  • Retrospective Studies
  • Tomography, Emission-Computed
  • Uterine Cervical Neoplasms / diagnostic imaging*
  • Uterine Cervical Neoplasms / drug therapy
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / radiotherapy


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18