Potential prognostic role of the 18F-FDG PET/CT metabolic response in locally advanced cervical cancer after definitive chemoradiotherapy: a narrative review

Purpose: In locally advanced cervical cancer (LACC), chemoradiotherapy (CRT) represents the standard of care. The aim of this narrative review is to investigate the prognostic role of metabolic response of 18F-FDG PET-CT after CRT in LACC patients. Methods: We reviewed the literature according to the PRISMA guidelines to identify studies up to December 2023. The literature search was performed on PubMed and Scopus, using the following combination of medical subject headings (MeSH) and keywords “Uterine Cervical Neoplasms”, “18F-FDG PET-CT”, “locally advanced cervical cancer”, “chemoradiotherapy”. Studies assessing metabolic response after CRT in LACC were included. All abstracts and full-text articles were screened independently by four authors. Discrepancies were resolved through discussion with a third party. Results: After the literature research, 9 studies fulfilled the inclusion criteria and were included in this review. Metabolic response after radical CRT treatment was significantly related to better clinical outcomes and to lower local relapse. Incomplete metabolic response could be considered a predictive factor for distant metastasis and cancer related deaths. Conclusion: Current data highlight the potential role of metabolic response of 18F-FDG PET-CT after CRT to predict survival outcomes. LACC patients are likely to benefit from this imaging technique in the follow up management. Patients with incomplete metabolic response could be addressed to further additional therapeutic strategies.