| Objective: To research the clinical value of 18F-2-Fluro-D-deoxy-glucose positron emission tomography/computed tomography(18F-FDG PET/CT)for cervical cancer,including diagnose,treatment plan and prognosis.Methods: From January 2014 to June 2015,84 cases cervical cancer were selected for study.47 cases,who were preliminary diagnosis as cervical cancer,were selected.37 cases,who treated by operation?chemoradiotherapy or postoperative chemoradiotherapy,were selected as suspicious subjects.47 cases did chest x-ray and abdominal CT scan before treatment.They did PET/CT examination and radiotherapy positioning at the same time.The doctor calculated the size of cervical tumor in PET/CT and CT,maximum standard uptake value(SUVmax)of cervical tumor in PET/CT,recorded lymph nodes by PET/CT reporting system.The PET /CT images were transmitted to the planning system.The gross tumor volume(GTV),clinical target volume(CTV),planning target volume(PTV)were contoured.Radiotherapy plans were guided by PET/CT,CT to planning target volume and received the minimum amount,the maximum amount,the average amount of bowel,bladder,rectum and the dose-volume histogram(DVH).To research the recently clinical effect on cervical cancer and the recent adverse impact,the 47 cases of diagnosed cancer patients were randomly divided into two groups,PET/CT-guided planned group of 24 people,CT-guided planned group of 23 people.All plans were designed using 7 field coplanar and 6MV X photon.The prescribed dose of PTV was 46.8Gy,1.8Gy per fraction,5 fractions per week.And 95% of the planning target volume received the prescribed dose.Three or four weeks later,high dose rate brachytherapy of 24Gy~30Gy to point A were followed,once a week with 6Gy~7Gy/fraction and 4-5 times.Each patient received concurrent oxaliplatin 130mg/m2*d1 and tegafur 800~1000mg/d*d1-d5 per four weeks.37 cases,who with cervical cancer after therapy underwent whole body PET/CT?CT and serological tests examination,were suspected recurrence.The SCCAg elevated at the same time(>1.5ng/ml).The diagnostic criteria was pathological findings and clinical follow-up results.All of patients were followed-up for 6-24 months.Results: For detection of primary tumors,the diagnostic rate of PET/CT was 97.9% as compared with 76.6% of abdominal CT scan(?2=6.8,P=0.025).PET/CT also diagnosed with uterine body involvement,but CT scan didn't.There was a linear correlation of cervical tumor size and its SUVmax(r=0.8,P P=0.000).There was no a linear correlation of clinical stage and its SUVmax(r=0.5,P =0.149).32 places were found with lymph nodes by PET/CT,PET/CT found a lymph node metastasis of the left clavicle,5 abdominal aortic lymph nodes,26 iliac vessels lymph nodes.23 places were found with lymph nodes by CT,CT found 2 abdominal aortic lymph nodes,21 iliac vessels lymph nodes.CT diagnosed a metastatic pelvic iliac vessels lymph node,PET/CT was normal.PET/CT compared with CT diagnosis more metastatic lymph node.Radiotherapy planning adjusted according to PET/CT results.The left clavicle lymph node was disappeared after 1 year follow-up.3 cases of aortic lymph node metastasis in patients which given extended field radiotherapy were disappeared after 1 year follow-up.6 cases iliac vessels lymph nodes increased 10Gy-15 Gy radiotherapy dose radiotherapy,were disappear after three months follow.CT diagnosis a iliac vessels lymph node metastasis,but PET / CT examination in patients with normal,regional lymph nodes increased 12 Gy radiation dose,but the 6-month follow the lymph node increased.47 cases were received PET-guided target of gross tumor volume(GTV),all of them revised the target.46 cases diminished the volume of GTV.The GTV-PET mean volume was significantly smaller compared with GTV-CT(t=8.7,P=0.000).No statistically significant difference was observed between two plans,bowel,there is statistically significant difference was observed between two plans,bladder and rectum.The PET/CT treatment group obtained Complete response(CR)and complete response(PR)17 patients,CT in the treatment of 15 patients with CR and PR,the recently efficiency was no significant difference(70.8% and 65.2%,?2=0.2,P=0.680).The incidence of acute genitourinary toxicity was 20.8% in PET/CT,which was 21.7% in CT(?2=0.0 P=0.940),the rate of acute gastrointestinal toxicity was 37.5% in PET/CT and 39.1% in CT(?2=0.0 P=0.908).37 cases showed squamous cell carcinoma antigen(SCCAg)unusually.They all did PET/CT and whole body CT.PET / CT and CT in the diagnosis of recurrence or metastasis rate was 91.9% and 62.2%(?2=5.4,P=0.021).Conclusions:PET/CT has important clinical value in diagnosis,finding lymph nodes of cervical cancer,making radiotherapy planning.Compared with CT-guided radiotherapy planning,PET/CT-guided radiotherapy planning of cervical tumor target delineation of more accurate.Two groups are similar to the short-term effect,its long-term effect need further follow-up.PET/CT can detects early the recurrence and metastasis joint with SCCAg. |
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