Utility of 18F-FDG-PET/CT imaging in patients with recurrent gynecological malignancies prior to pelvic exenteration.

BACKGROUND: In patients with recurrent gynecologic malignancies isolated to the pelvis, pelvic exenteration is a potential option. 18F-Fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT), is often used to confirm no evidence of metastatic disease.

OBJECTIVE: To assess the impact of PET/CT on clinical management of patients with recurrent gynecologic malignancies being considered for pelvic exenteration.

METHODS: Patients with recurrent gynecological malignancies who underwent PET/CT imaging between 2011 and 2014 were identified. All were considered for pelvic exenteration and underwent conventional imaging with CT +/- pelvic MRI. Patient anthropometric data, disease sites, histology, stage, treatment received, and treatment plan based on PET/CT findings were extracted.

RESULTS: A total of 40 patients met inclusion criteria. In 15 (37.5%) of these patients, results of PET/CT changed the original plan of pelvic exenteration owing to metastatic disease/unresectability (11/15) or no evidence of disease on PET/CT imaging (4/15). Twenty-five (62.5%) patients had their planned surgery after PET/CT with 19 (76%) patients undergoing a completed exenteration procedure. Six (24%) patients with PET/CT indicating isolated pelvic recurrence ultimately had intra-operative findings of extra-pelvic metastasis or nodal disease and therefore the planned surgery was aborted.

CONCLUSION: In nearly 40% of patients with recurrent gynecologic malignancies being considered for radical salvage surgery, PET/CT can significantly alter the originally intended treatment and hence may reduce the number of futile surgical procedures.