Early posttreatment imaging is performed most commonly following a period of approximately 3 to 6 months after the completion of chemoradiation. Some centers also image during therapy for early response assessment and/or adaptive radiation planning [7]. The goals of early posttreatment imaging are multiple. First, imaging response after chemoradiation is a potent predictor of oncologic outcome, therefore providing crucial prognostic data [40-42]. Second, the degree of imaging response directly informs therapeutic decision-making, because persistent or progressive disease following chemoradiation requires salvage therapy [40]. For persistent pelvic disease, options include salvage radical surgery or less commonly reirradiation. Detection of new distant disease following initial treatment obviates curative surgery and may direct therapy toward chemotherapeutic and/or palliative options. Finally, the degree of response can influence the frequency of subsequent surveillance, with complete response enabling more conservative follow- up testing [42]. Following complete response, there is no formally established role for routine surveillance imaging in asymptomatic patients treated for vaginal cancer nor has a role been established for cervical cancer. Guidelines generally advocate for routine clinical examination for surveillance in asymptomatic patients, with imaging suggested in the setting of symptoms or abnormal physical examination findings [43]. CT Chest Although thoracic metastases are known to occur in vaginal cancer, no studies specifically address their incidence or the incremental value of chest CT in early posttreatment evaluation. Pulmonary metastases have been studied to a limited degree in cervical cancer, occurring in approximately 5% to 10% of patients at diagnosis [13,14].
Staging and Follow up of Primary Vaginal Cancer. Early posttreatment imaging is performed most commonly following a period of approximately 3 to 6 months after the completion of chemoradiation. Some centers also image during therapy for early response assessment and/or adaptive radiation planning [7]. The goals of early posttreatment imaging are multiple. First, imaging response after chemoradiation is a potent predictor of oncologic outcome, therefore providing crucial prognostic data [40-42]. Second, the degree of imaging response directly informs therapeutic decision-making, because persistent or progressive disease following chemoradiation requires salvage therapy [40]. For persistent pelvic disease, options include salvage radical surgery or less commonly reirradiation. Detection of new distant disease following initial treatment obviates curative surgery and may direct therapy toward chemotherapeutic and/or palliative options. Finally, the degree of response can influence the frequency of subsequent surveillance, with complete response enabling more conservative follow- up testing [42]. Following complete response, there is no formally established role for routine surveillance imaging in asymptomatic patients treated for vaginal cancer nor has a role been established for cervical cancer. Guidelines generally advocate for routine clinical examination for surveillance in asymptomatic patients, with imaging suggested in the setting of symptoms or abnormal physical examination findings [43]. CT Chest Although thoracic metastases are known to occur in vaginal cancer, no studies specifically address their incidence or the incremental value of chest CT in early posttreatment evaluation. Pulmonary metastases have been studied to a limited degree in cervical cancer, occurring in approximately 5% to 10% of patients at diagnosis [13,14].