Affiliation:
1. Russian Scientific Center of Roentgenoradiology of the Ministry of Healthcare of the Russian Federation
2. Russian Scientific Center of Roentgenoradiology of the Ministry of Healthcare of the Russian Federation;
Privolzhsky Research Medical University
3. Polyclinic №1 of the office of the President of the Russian Federation
Abstract
Early detection of cervical (CC) and endometrial (EC) cancer recurrence in previously irradiated areas remains a difficult task for clinicians and radiologists. 18F-FDG PET-CT scope and limits in this matter are not clear yet.Purpose. To determine 18F-FDG PET-CT significance and diagnostic value in differential diagnosis of locoregional recurrence and post-radiation tissue changes in CC and EC patients with suspected relapse in preirradiated zones.Materials and methods. Follow-up data, including multiparametric MRI (T1-WI, T2-WI, DWI, DCE) and 18FFDG PET-CT full descriptions, were studied in 51pts., in 25(49%) CC and 26 (51%) EC Ia–IIIc FIGO, with suspected loco-regional recurrence in pre-irradiated area, 4–96 months after the end of treatment.Adjuvant combined radiotherapy (conformal pelvic EBRT – 3D-CRT, IMRT, VMAT, endovaginal 192Ir HDR brachytherapy) was performed in 33 (64,7%) pts. after radical surgery, adjuvant chemoradiation with Cisplatin 40 mg/m2 or Carboplatin AUC2 weekly – in 8 (24.2%) of them. 18 (35,3%) pts. were treated with definitive chemoradiation, median EQD2 for HR-CTV D90 81.6 ± 4.4 Gy (CI 95% 72.4 Gy – 93.7 Gy) and 54.6 ± 3.3 Gy (CI 95% 48.8–64.2 Gy) for metastatic pelvic and paraaortic lymph nodes.Indications for 18F-FDG PET-CT (Biograph True64, Siemens, 3.8–4.7 MBq/kg, total 169–356 MBq) in all pts. were suspicious clinical, cytological, complex ultrasound, and multiparametric MRI findings in pre-irradiated zones. Any areas of 18F-FDG pathologically increased uptake were considered hypermetabolic lesions, positive for cancer recurrence.Results. No evidence of loco-regional recurrence in pre-irradiated zones was confirmed in 32 (62.7%) pts. Clinical, morphological and radiological signs of progression were obtained in 16 (31.3%) 18F-FDG PET-CTpositive patients, with SUVmax 2.86–8.8 in this subgroup. 18F-FDG PET-CT false-positive results were obtained in 6 (11.8%) patients, false-negative – in 1 (1.9%) heavy pre-treated CC patient. 18F-FDG PET-CT sensitivity was 94.1%, specificity – 84.2%, positive predictive value – 72.7%, negative predictive value – 96.9%.Conclusions. 18F-FDG-PET-CT has a high diagnostic value in the differential diagnosis of loco-regional relapses and post-radiation tissue changes in CC and EC patients with suspected progression in pre-irradiated zones. But 18F-FDG-PET-CT findings evaluation and interpretation requires a multidisciplinary discussion and consensus for this cohort of patients.
Subject
Radiology, Nuclear Medicine and imaging,Radiological and Ultrasound Technology
Reference22 articles.
1. Kaprin A.D., Starinsky V.V., Shakhzadova A.O. Oncological care for the population of Russian Federation in 2021. M.: P.A. Herzen – branch of the Federal State Budgetary Institution “NMITs Radiology” of the Ministry of Health of Russia. 2022. 239 p. ISBN 978-5-85502-275-9. (In Russian)
2. Kreynina Y.M., Titova V.A., Burnashkina S.P. Modern approaches to the use of magnetic resonance imaging in the planning and monitoring of high-power brachytherapy for gynecological cancer. P.A. Herzen Journal of Oncology. 2014; 3 (2): 81–81. (In Russian)
3. Titova V.A., Panshin G.A., Shevchenko L.N., Kreinina Yu.M., Kaskulova M.Kh. Postoperative conformal radiation therapy for ervical and uterine cancer: the role of contact radiation therapy. Difficult patient. 2019; 17 (8–9): 33–36. http://doi.org/10.24411/2074-1995-2019-10060 (In Russian)
4. Aksenova S.P., Nudnov N.V., Kreynina Yu.M. Magnetic Resonance Imaging of the Vagina and Pelvic Organs in Women who Underwent Antitumor Treatment for Female Genital Cancer. Medical Visualization. 2017; 2: 131–139. https://doi.org/10.24835/1607-0763-2017-2-131-139 (In Russian)
5. Ashrafyan L.A., Tyo S.A., Ogryzkova V.L., Kreynina Yu.M., Alyoshikova O.I. Three-Dimensional Echography in Cervical Cancer. Medical Visualization. 2003; 2: 68–73. (In Russian)