Evaluation of the Frequency and Patterns of Cervical Cancer Recurrence After Treatment Using ^18F-FDG PET-CT: A...

Cervical cancer recurrence remains a major clinical challenge, particularly in patients with advanced disease or high-risk pathological features. This study aimed to evaluate the frequency and distribution of recurrence and metastases in posttreatment cervical cancer patients using ^18F-FDG PET/CT, with additional analysis by histological subtype and primary treatment modality.

This retrospective cross-sectional study included 120 posttreatment cervical cancer patients who underwent ^18F-FDG PET/CT at the Institute of Nuclear Medicine and Oncology, Lahore, Pakistan, between July 2024 and January 2025. Patient demographics, tumor histology, and PET-CT findings were recorded. Recurrence was classified as local, lymphatic, visceral, or skeletal. Data were analyzed using SPSS (v26.0). The Chi-square test compared recurrence patterns between histological subtypes. A p-value ≤ 0.05 was considered significant.

The overall recurrence rate was 65.0% (n = 78). Local recurrence occurred in 33.3%, and lymph node metastases were most frequent in the chest (40.8%), followed by abdominal (25.0%), pelvic (21.7%), and neck (10.8%) nodes. Visceral metastases involved the lungs (17.5%) and liver (14.2%), while skeletal metastases were uncommon (8.3%). Squamous cell carcinoma (73.3%) was the predominant subtype, but adenocarcinoma carried a significantly higher relative risk of recurrence (p = 0.041). Treatment modality influenced outcomes, with the lowest recurrence after surgery alone (44.0%) and higher recurrence after chemoradiation (70.6%) or combined therapy (70.4%).

This study demonstrates that ^18F-FDG PET-CT is a valuable imaging modality for detecting recurrence and metastases in posttreatment cervical cancer patients. The recurrence rate was high, with adenocarcinoma showing a greater risk compared to squamous cell carcinoma. PET-CT effectively identified both local and distant disease, with chest and abdominal nodes, lungs, and liver being the most frequent metastatic sites, while skeletal involvement was rare. Recurrence was also significantly associated with treatment modality, being lowest after surgery and higher among patients treated with chemoradiation or combined therapy.