Skip to main content

PET-detected asymptomatic recurrence is associated with improved survival in recurrent cervical cancer



We aimed to examine utilization patterns of positron emission tomography scans (PET or PET/CT) beyond 6 months after cervical cancer treatment. We investigated survival outcomes of asymptomatic patients with PET-detected recurrence.


We performed a retrospective review of 283 patients with stage IA-IVA cervical cancer treated with primary chemoradiation. The 107 patients (37.8%) with recurrence were categorized as “asymptomatic PET-detected recurrence” (n = 23) or “standard detection” (n = 84) and we compared clinical characteristics and outcomes using multivariate logistic regression analysis.


Late post-treatment PET (≥ 6 months after treatment) was performed in 35.3% (n = 100). Indications for late post-treatment PET included restaging in setting of known recurrence (23.6%), follow up of prior ambiguous imaging findings (9.7%), and new symptoms or exam findings (6.7%). However, late post-treatment PET was most commonly performed outside of current imaging guidelines, in asymptomatic patients without suspicion for recurrence (60.0%), presumably for surveillance. The median time to recurrence was 12.1 months (IQR 7.3–26.6). 23 patients (21.5%) had recurrence detected late post-treatment PET while asymptomatic (n = 23/107). Patients with asymptomatic PET-detected recurrence had improved survival by 26.3 months compared to the standard detection cohort (50.3 vs 24.0 months, p = 0.0015). On multivariate analysis, predictors of survival after recurrence were presence of distant metastases at diagnosis (p = 0.010) and asymptomatic PET-detected recurrence (p = 0.039).


PET imaging in asymptomatic patients beyond 6 months after treatment may have clinical benefit and warrants further study. Detection of recurrence by PET in asymptomatic patients ≥ 6 months after chemoradiation was associated with prolonged survival by more than   2 years.

Graphic abstract

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    L. A. Torre, F. Islami, R. L. Siegel, E. M. Ward, and A. Jemal, “Global Cancer in Women: Burden and Trends,” Cancer Epidemiol. Prev. Biomark., vol. 26, no. 4, pp. 444–457, Apr. 2017,

    Article  Google Scholar 

  2. 2.

    R. Salani, N. Khanna, M. Frimer, R. E. Bristow, and L. Chen, “An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations,” Gynecol. Oncol., vol. 146, no. 1, pp. 3–10, Jul. 2017,

    Article  PubMed  Google Scholar 

  3. 3.

    M. Friedlander and M. Grogan, “Guidelines for the Treatment of Recurrent and Metastatic Cervical Cancer,” The Oncologist, vol. 7, no. 4, pp. 342–347, Aug. 2002.

    Article  Google Scholar 

  4. 4.

    C. L. Siegel et al., “ACR Appropriateness Criteria® Pretreatment Planning of Invasive Cancer of the Cervix,” J. Am. Coll. Radiol., vol. 9, no. 6, pp. 395–402, Jun. 2012,

    Article  PubMed  Google Scholar 

  5. 5.

    “Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology in: Journal of the National Comprehensive Cancer Network Volume 17 Issue 1 (2019).” (accessed Jun. 21, 2019).

  6. 6.

    P. W. Grigsby, “The prognostic value of PET and PET/CT in cervical cancer,” Cancer Imaging, vol. 8, no. 1, pp. 146–155, Jul. 2008,

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    W. C. Lin, Y. C. Hung, L. S. Yeh, C. H. Kao, R. F. Yen, and Y. Y. Shen, “Usefulness of (18)F-fluorodeoxyglucose positron emission tomography to detect para-aortic lymph nodal metastasis in advanced cervical cancer with negative computed tomography findings,” Gynecol. Oncol., vol. 89, no. 1, pp. 73–76, Apr. 2003.

    Article  Google Scholar 

  8. 8.

    L.-S. Yeh, Y.-C. Hung, Y.-Y. Shen, C.-H. Kao, C.-C. Lin, and C.-C. Lee, “Detecting para-aortic lymph nodal metastasis by positron emission tomography of 18F-fluorodeoxyglucose in advanced cervical cancer with negative magnetic resonance imaging findings,” Oncol. Rep., vol. 9, no. 6, pp. 1289–1292, Dec. 2002.

    PubMed  Google Scholar 

  9. 9.

    P. G. Rose, L. P. Adler, M. Rodriguez, P. F. Faulhaber, F. W. Abdul-Karim, and F. Miraldi, “Positron emission tomography for evaluating para-aortic nodal metastasis in locally advanced cervical cancer before surgical staging: a surgicopathologic study,” J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol., vol. 17, no. 1, pp. 41–45, Jan. 1999,

    CAS  Article  Google Scholar 

  10. 10.

    T. Belhocine et al., “Contribution of whole-body 18FDG PET imaging in the management of cervical cancer,” Gynecol. Oncol., vol. 87, no. 1, pp. 90–97, Oct. 2002.

    Article  Google Scholar 

  11. 11.

    M. Atri et al., “Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN6671/GOG0233 trial,” Gynecol. Oncol., vol. 142, no. 3, pp. 413–419, Sep. 2016,

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    L. J. Havrilesky, S. L. Kulasingam, D. B. Matchar, and E. R. Myers, “FDG-PET for management of cervical and ovarian cancer,” Gynecol. Oncol., vol. 97, no. 1, pp. 183–191, Apr. 2005,

    Article  PubMed  Google Scholar 

  13. 13.

    L. Elit, A. W. Fyles, T. K. Oliver, M. C. Devries-Aboud, and M. Fung-Kee-Fung, “Follow-up for women after treatment for cervical cancer,” Curr. Oncol., vol. 17, no. 3, pp. 65–69, 2010,

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    P. Zola et al., “Could follow-up different modalities play a role in asymptomatic cervical cancer relapses diagnosis? An Italian multicenter retrospective analysis,” Gynecol. Oncol., vol. 107, no. 1 Suppl 1, pp. S150-154, Oct. 2007,

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    G. J. S. Rustin et al., “Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC 55955): a randomised trial,” Lancet Lond. Engl., vol. 376, no. 9747, pp. 1155–1163, Oct. 2010,

    Article  Google Scholar 

  16. 16.

    D. G. Mitchell et al., “ACR appropriateness criteria staging and follow-up of ovarian cancer,” J. Am. Coll. Radiol. JACR, vol. 10, no. 11, pp. 822–827, Nov. 2013,

    Article  PubMed  Google Scholar 

  17. 17.

    “Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial - The Lancet.” (accessed May 27, 2019).

  18. 18.

    A. GADDUCCI, R. TANA, S. COSIO, and L. CIONINI, “Treatment options in recurrent cervical cancer (Review),” Oncol. Lett., vol. 1, no. 1, pp. 3–11, Jan. 2010,

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    “Five Things Physicians and Patients Should Question.” American Society of Clinical Oncology (ASCO), Oct. 29, 2013, [Online]. Available:

Download references

Author information



Corresponding author

Correspondence to Pamela N. Peters.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Peters, P.N., Pierson, W.E., Chen, Lm. et al. PET-detected asymptomatic recurrence is associated with improved survival in recurrent cervical cancer. Abdom Radiol 46, 341–350 (2021).

Download citation


  • Cervical cancer
  • PET
  • Surveillance
  • Chemoradiation
  • Asymptomatic recurrence