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Zola P, Ciccone G, Piovano E, Fuso L, Di Cuonzo D, Castiglione A, Pagano E, Peirano E, Landoni F, Sartori E, Narducci F, Bertetto O, Ferrero A. Effectiveness of Intensive Versus Minimalist Follow-Up Regimen on Survival in Patients With Endometrial Cancer (TOTEM Study): A Randomized, Pragmatic, Parallel Group, Multicenter Trial. J Clin Oncol 2022; 40:3817-3827. [PMID: 35858170 DOI: 10.1200/jco.22.00471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE In the absence of clear evidence from randomized trials, the intensity of follow-up regimens after surgical treatment of endometrial cancer is highly variable in clinical practice. To reduce this uncertainty, we conducted a randomized trial to test whether an intensive (INT) versus a minimalist (MIN) follow-up regimen improves overall survival (OS) in patients undergoing operation for endometrial cancer. METHODS The TOTEM study was a large, pragmatic randomized trial, conducted in 42 hospitals (in Italy and France) including patients surgically treated for endometrial cancer, in complete clinical remission, International Federation of Gynecology and Obstetrics stage I-IV. After stratification by center and risk of relapse (low or high), patients were randomly assigned (1:1) to INT or MIN hospital-based follow-up regimens. The study was powered to demonstrate an absolute improvement of 5% of the 5-year OS with the INT regimen. RESULTS In total, 1,871 patients were randomly assigned between November 2008 and July 2018, and 1,847 patients (98.7%) were available for the final analysis (60% low risk). After a median follow-up of 69 months, the 5-year OS was 90.6% in the INT and 91.9% in the MIN arms (hazard ratio, 1.13, 95% CI, 0.86 to 1.50, P = .380). No differences in OS were found in subgroup analyses considering age, cancer treatment, risk of relapse, and degree of adherence of the center to the scheduled follow-up. The probability of detecting a relapse was slightly higher in the INT arm (hazard ratio, 1.17; 95% CI, 0.92 to 1.48; P = .194). CONCLUSION An INT follow-up in endometrial cancer-treated patients does not improve OS, even in high-risk patients. According to available evidence, there is no need to routinely add vaginal cytology, laboratory, or imaging investigations to the MIN regimens used in this trial.
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Affiliation(s)
- Paolo Zola
- Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Giovannino Ciccone
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Elisa Piovano
- SC Ginecologia e Ostetricia n. 3, AOU Città della Salute e della Scienza di Torino, Ospedale Sant'Anna, Torino, Italy
| | - Luca Fuso
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Torino, Italy
| | - Daniela Di Cuonzo
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Anna Castiglione
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Eva Pagano
- Epidemiologia Clinica e Valutativa, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Elena Peirano
- Dipartimento di Scienze Chirurgiche, Università degli studi di Torino, Torino, Italy
| | - Fabio Landoni
- Clinica Ginecologica UNIMIB, Ospedale San Gerardo, Monza, Italy
| | - Enrico Sartori
- Divisione di Ostetricia e Ginecologia, Università di Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Fabrice Narducci
- Département de Cancérologie Gynécologique, Centre Oscar Lambret, Lille, France
| | - Oscar Bertetto
- AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Annamaria Ferrero
- SCDU Ginecologia e Ostetricia, AO Ordine Mauriziano Torino, Torino, Italy
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Ezendam NPM, de Rooij BH, Kruitwagen RFPM, Creutzberg CL, van Loon I, Boll D, Vos MC, van de Poll-Franse LV. ENdometrial cancer SURvivors' follow-up carE (ENSURE): Less is more? Evaluating patient satisfaction and cost-effectiveness of a reduced follow-up schedule: study protocol of a randomized controlled trial. Trials 2018; 19:227. [PMID: 29661218 PMCID: PMC5902894 DOI: 10.1186/s13063-018-2611-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/27/2018] [Indexed: 11/12/2022] Open
Abstract
Background It has often been hypothesized that the frequency of follow-up visits for patients with early-stage endometrial cancer could be decreased. However, studies evaluating effects of a reduced follow-up schedule among this patient group are lacking. The aim of this study is to assess patient satisfaction and cost-effectiveness of a less frequent follow-up schedule compared to the schedule according to the Dutch guideline. Methods In this multicenter randomized controlled trial, patients diagnosed in the Netherlands with stage 1A and 1B low-risk endometrial cancer, for whom adjuvant radiotherapy is not indicated (n = 282), are randomized. Patients allocated to the intervention group receive four follow-up visits during three years. Patients allocated to the control group receive 10–13 follow-up visits during five years, according to the Dutch guideline. Patients are asked to fill out a questionnaire at baseline and after 6, 12, 36, and 60 months. Primary outcomes include patient satisfaction with follow-up care and cost-effectiveness. Secondary outcomes include healthcare use, adherence to schedule, health-related quality of life, fear of recurrence, anxiety and depression, information provision, recurrence, and survival. Linear regression analyses will be used to assess differences in patient satisfaction with follow-up care between intervention and control group. Discussion We anticipate that patients in the intervention arm have a similar satisfaction with follow-up care and overall outcomes, but lower healthcare use and costs than patients in the control arm. No differences are expected in quality-adjusted life-years and satisfaction, but the reduced schedule is expected to be cost-saving when implemented in the Netherlands. Trial registration ClinicalTrials.gov, NCT02413606. Registered on 10 April 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2611-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicole P M Ezendam
- The Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands. .,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
| | - Belle H de Rooij
- The Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Roy F P M Kruitwagen
- Department of Gynecology and GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Carien L Creutzberg
- Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ingrid van Loon
- Department of Obstetrics and Gynaecology, Amphia hospital, Breda, The Netherlands
| | - Dorry Boll
- Department of Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - M Caroline Vos
- Department of Obstetrics and Gynaecology, Elisabeth-TweeSteden Hospital, Tilburg and Waalwijk, The Netherlands
| | - Lonneke V van de Poll-Franse
- The Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Fuso L, Evangelista A, Pagano E, Piovano E, Perotto S, Mazzola S, Bertoldo E, La Porta MR, Rosmino C, Furbatto G, Abate S, Di Costanzo G, Trossarelli G, Baù MG, Carnino F, Gambaro G, Piantanida P, Alabiso O, Galletto L, Zavallone L, Rossi A, Barbero M, Tessa M, Katsaros D, Danese S, Brignolo P, Gorzegno G, Grillo R, Apolone G, Ciccone G, Zola P. Variation in gynecological oncology follow-up practice: Attributable to cancer centers or to patient characteristics? A Piedmont Regional Oncology Network Study. Tumori 2018; 97:551-8. [DOI: 10.1177/030089161109700502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Although guidelines recommend minimalist follow-up, there is wide variability in gynecological oncology practice. The aims of this study were to describe between-center differences in the follow-up of endometrial, ovarian, and uterine cervical cancer; to identify the determinants of test prescription; to estimate the related costs; and to assess the weight of center habits and patient characteristics as sources of unexplained variability. Methods and study design The medical records of patients treated between August 2004 and July 2005 for gynecological malignancies and followed up for the detection of recurrent disease were retrospectively collected from 29 centers of the Piedmont Oncology Network. Multivariate multilevel analyses were performed to study the determinants of test prescription and costs. Results Analyses were performed on 351 patients (median follow-up: 578 days). The unexplained variability in computed tomography prescriptions (26%), ultrasound prescriptions (17%), and total cost of follow-up (15%) can be attributed to center habits, independenty of the clinical characteristics of the patients. Conclusions Much of the unexplained variability in the follow-up for gynecological malignancies is attributable to different habits of centers belonging to a cancer network. These results prompted us to design a multicenter randomized controlled trial to compare minimalist versus intensive follow-up programs in endometrial cancer.
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Affiliation(s)
- Luca Fuso
- Gynecology and Obstetrics Academic
Department, Azienda Ospedaliera Ordine Mauriziano, Turin
| | - Andrea Evangelista
- Unit of Cancer Epidemiology, Azienda
Ospedaliera US Giovanni Battista, CPO Piemonte, CeRMS, Turin
| | - Eva Pagano
- Unit of Cancer Epidemiology, Azienda
Ospedaliera US Giovanni Battista, CPO Piemonte, CeRMS, Turin
| | - Elisa Piovano
- Gynecology and Obstetrics Academic
Department, Azienda Ospedaliera Ordine Mauriziano, Turin
| | - Stefania Perotto
- Gynecology and Obstetrics Academic
Department, Azienda Ospedaliera Ordine Mauriziano, Turin
| | - Simona Mazzola
- Gynecology and Obstetrics Academic
Department, Azienda Ospedaliera Ordine Mauriziano, Turin
| | | | | | | | | | - Sergio Abate
- Gynecology and Obstetrics, Azienda
Ospedaliera Santa Croce e Carle, Cuneo
| | | | | | - Maria Grazia Baù
- Gynecology and Obstetrics, Azienda
Ospedaliera OIRM-Sant'Anna, Turin
| | | | | | - Paola Piantanida
- Gynecology and Obstetrics, Ospedale
Maggiore della Carità, Novara
| | - Oscar Alabiso
- Medical Oncology, Ospedale Maggiore
della Carità, Novara
| | - Luciano Galletto
- Gynecology and Obstetrics, Ospedale
Civile Edoardo Agnelli, Pinerolo
| | | | - Annalisa Rossi
- Radiotherapy, Azienda Ospedaliera
Ordine Mauriziano, Turin
| | | | - Maria Tessa
- Radiotherapy, Ospedale Cardinal
Massaia, Asti
| | - Dionyssios Katsaros
- Gynecology and Obstetrics Academic
Department, Azienda Ospedaliera OIRM-Sant'Anna, Turin
| | - Saverio Danese
- Gynecology and Obstetrics, Azienda
Ospedaliera OIRM-Sant'Anna, Turin
| | | | | | - Raffaella Grillo
- Medical Oncology, Centro Oncologico
ed Ematologico Subalpino, Azienda Ospedaliera San Giovanni Battista, Turin
| | - Giovanni Apolone
- Oncology Department, Istituto di
Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Giovannino Ciccone
- Unit of Cancer Epidemiology, Azienda
Ospedaliera US Giovanni Battista, CPO Piemonte, CeRMS, Turin
| | - Paolo Zola
- Gynecology and Obstetrics Academic
Department, Azienda Ospedaliera Ordine Mauriziano, Turin
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Leeson S, Beaver K, Ezendam N, Mačuks R, Martin-Hirsch P, Miles T, Jeppesen M, Jensen P, Zola P. The future for follow-up of gynaecological cancer in Europe. Summary of available data and overview of ongoing trials. Eur J Obstet Gynecol Reprod Biol 2017; 210:376-380. [DOI: 10.1016/j.ejogrb.2017.01.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/07/2017] [Accepted: 01/16/2017] [Indexed: 11/17/2022]
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Smits A, Lopes A, Das N, Bekkers R, Kent E, Mccullough Z, Galaal K. Nurse-Led Telephone Follow-up: Improving Options for Women With Endometrial Cancer. Cancer Nurs 2015; 38:232-8. [DOI: 10.1097/ncc.0000000000000177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Tergas AI, Havrilesky LJ, Fader AN, Guntupalli SR, Huh WK, Massad LS, Rimel B. Cost analysis of colposcopy for abnormal cytology in post-treatment surveillance for cervical cancer. Gynecol Oncol 2013; 130:421-5. [DOI: 10.1016/j.ygyno.2013.05.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/15/2013] [Accepted: 05/26/2013] [Indexed: 01/13/2023]
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Siva S, Herschtal A, Thomas JM, Bernshaw DM, Gill S, Hicks RJ, Narayan K. Impact of post-therapy positron emission tomography on prognostic stratification and surveillance after chemoradiotherapy for cervical cancer. Cancer 2011; 117:3981-8. [DOI: 10.1002/cncr.25991] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 12/06/2010] [Accepted: 12/07/2010] [Indexed: 11/06/2022]
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Rettenmaier NB, Rettenmaier CR, Wojciechowski T, Abaid LN, Brown JV, Micha JP, Goldstein BH. The utility and cost of routine follow-up procedures in the surveillance of ovarian and primary peritoneal carcinoma: a 16-year institutional review. Br J Cancer 2010; 103:1657-62. [PMID: 21045830 PMCID: PMC2994227 DOI: 10.1038/sj.bjc.6605963] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The purpose of this study was to evaluate the number of ovarian cancer and primary peritoneal cancer (PPC) progressive disease cases identified via routine follow-up procedures and the corresponding cost throughout a 16-year period at a single medical institution. Methods: Previously undiagnosed epithelial ovarian (n=241), PPC (n=23), and concurrent ovarian and uterine (n=24) cancer patients were treated and then followed via CA-125, imaging (e.g., CT scan, chest X-ray), physical examination and vaginal cytology. Results: In the group of 287 patients, there were 151 cases of disease progression. Serial imaging detected the highest number of progressive disease cases (66 initial and 45 confirmatory diagnoses), but the cost was rather high ($13 454 per patient recurrence), whereas CA-125 testing (74 initial and 20 corroborative diagnoses) was the least expensive ($3924) per recurrent diagnosis. The total cost of surveillance during the 16-year period was nearly $2 400 000. Conclusion: Ultimately, serial imaging and the CA-125 assay detected the highest number of ovarian cancer and PCC progressive disease cases in comparison to physical examination and vaginal cytology, but nevertheless, all of the procedures were conducted at a considerable financial expense.
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Affiliation(s)
- N B Rettenmaier
- Department of Molecular, Cell and Developmental Biology, UCLA College of Letters and Science, Los Angeles, CA, USA
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Sartori E, Pasinetti B, Chiudinelli F, Gadducci A, Landoni F, Maggino T, Piovano E, Zola P. Surveillance procedures for patients treated for endometrial cancer: a review of the literature. Int J Gynecol Cancer 2010; 20:985-92. [PMID: 20683406 DOI: 10.1111/igc.0b013e3181e2abcc] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The aim of this review was to analyze the role of follow-up in patients treated for endometrial cancer and to provide some compelling issues that may contribute to improve daily practice while waiting for evidence-based guidelines. METHODS/MATERIALS A literature search has been conducted in MEDLINE database using key words "endometrial neoplasms" and "follow up". RESULTS Endometrial cancer represents the most common gynecologic malignancy after breast cancer. The overall recurrence rate is 13% and correlates with prognostic factors of the primary tumor. The anatomic sites of endometrial cancer relapse are mostly equivalently distributed between local (pelvic) and distant (abdominal and chest). Most endometrial cancer recurrences are symptomatic, even if vaginal vault relapses represent a particular setting of a more frequently asymptomatic disease. Most of endometrial cancer recurrences occur within 3 years since diagnosis of primary tumor. Long-term surveillance programs are mainly addressed to the early detection of recurrence, the rationale of follow-up being that an earlier diagnosis of relapse correlates with lower morbidity and mortality rates. Adjunctive objectives of routine follow-up are identification of treatment complications and detection of possible second tumors associated with endometrial cancer. CONCLUSIONS No rationale (examination sensitivity/sensibility, cost-effectiveness, or patient's survival benefit) is available today for any particular follow-up protocol; follow-up procedures should probably be tailored according to different prognostic factors; only physical examination, including pelvic-rectal examination, showed some utility in detecting recurrence. In this uncertain setting, follow-up interval should be defined with the consideration of the patient's will.
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Affiliation(s)
- Enrico Sartori
- Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy
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Haynes-Outlaw ED, Grigsby PW. The Role of FDG-PET/CT in Cervical Cancer: Diagnosis, Staging, Radiation Treatment Planning and Follow-Up. PET Clin 2010; 5:435-46. [DOI: 10.1016/j.cpet.2010.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gadducci A, Fuso L, Cosio S, Landoni F, Maggino T, Perotto S, Sartori E, Testa A, Galletto L, Zola P. Are Surveillance Procedures of Clinical Benefit for Patients Treated for Ovarian Cancer?: A Retrospective Italian Multicentric Study. Int J Gynecol Cancer 2009; 19:367-74. [DOI: 10.1111/igc.0b013e3181a1cc02] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of this retrospective investigation was to assess the pattern of failures of 412 patients with recurrent ovarian cancer followed up with different surveillance protocols.Time to recurrence was less than 6 months in 98 women (23.8%), 6 to 12 months in 102 women (24.7%), and more than 12 months in 212 women (51.5%). Symptoms at relapse were referred by 81 women (19.7%). Among the 331 asymptomatic patients, the surveillance procedure that raised the suspect of recurrent disease was clinical examination in 49 (14.8%), imaging technique in 90 (27.2%), serum CA 125 in 77 (23.3%), and both serum CA 125 and imaging technique in 115 (34.7%). At univariate analysis, survival from initial diagnosis was related to stage (P = 0.004), residual disease after initial surgery (P < 0.0001), time to recurrence (P < 0.0001), site of relapse (P = 0.04), and treatment at recurrence (P < 0.0001), and survival after recurrence was related to stage (P = 0.01), residual disease (P < 0.0001), time to recurrence (P < 0.0001), and treatment at recurrence (P < 0.0001). Conversely, symptoms at recurrence had no prognostic relevance. Cox proportional hazards model showed that residual disease and time to recurrence were the only independent prognostic variables for both survival from initial diagnosis (P < 0.0001) and survival after recurrence (P < 0.0001). In conclusion, there was no survival difference between asymptomatic and symptomatic patients at the time of relapse, and therefore, the diagnostic anticipation allowed by a scheduled follow-up protocol did not seem to improve the clinical outcome of patients who ultimately developed recurrent disease.
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Brooks RA, Rader JS, Dehdashti F, Mutch DG, Powell MA, Thaker PH, Siegel BA, Grigsby PW. Surveillance FDG-PET detection of asymptomatic recurrences in patients with cervical cancer. Gynecol Oncol 2008; 112:104-9. [PMID: 18929403 DOI: 10.1016/j.ygyno.2008.08.028] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 08/26/2008] [Accepted: 08/27/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate survival after detection of recurrent cervical cancer by FDG-PET in symptomatic versus asymptomatic patients. METHODS This is a prospective registry study of 103 patients treated with definitive chemoradiation for advanced cervical cancer who demonstrated no abnormal FDG uptake (a complete metabolic response, CMR) on their 3-month posttherapy FDG-PET. Their median age was 48 years (range 26-84). The clinical stages were Ib in 38, IIa in 1, IIb in 39, and IIIb in 25. All patients underwent subsequent surveillance FDG-PET. Patients were grouped according to symptom status at the time of the surveillance FDG-PET. Recurrence sites and survival data were analyzed. RESULTS The median time from the 3-month posttherapy FDG-PET to the first surveillance FDG-PET was 13 months. 25 patients (25/103; 24%) were symptomatic at the time of surveillance FDG-PET and 21 of these had FDG-PET findings indicative of recurrence. 78 patients (78/103; 76%) were asymptomatic and 9 of these had tumor recurrence detected by PET. All recurrences were confirmed by biopsy or radiologic progression. The recurrences in the 21 symptomatic patients were loco regional in 4 and distant in 17. The 9 asymptomatic patients had isolated loco regional disease in 8 and distant disease in 1. All patients received treatment for recurrence. The three-year cause-specific survival for symptomatic recurrences was 19% versus 59% for asymptomatic recurrences (p=0.09). CONCLUSIONS Surveillance FDG-PET can detect asymptomatic recurrent disease that is potentially amenable to salvage therapy. Prospective investigation of surveillance PET is warranted.
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Affiliation(s)
- Rebecca A Brooks
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine, St Louis, MO 63110, USA
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