Staging and Follow-up of Primary Vaginal Cancer CT of the abdomen and pelvis is not commonly performed in the absence of chest CT, given that the lungs are a potential site of distant disease that may newly arise in patients who have undergone definitive chemoradiation for disease that was initially locoregional [41]. Importantly, CT alone is inferior to FDG/PET-CT for evaluation of distant disease in the bones [25] and modestly inferior for nodal assessment [23,41]. The use of IV contrast is strongly encouraged when possible, because the improved tissue contrast likely benefits primary tumor evaluation, delineation of lymph nodes from adjacent vessels, and detection of hepatic metastases. No studies have specifically assessed the performance of CT of the abdomen and pelvis without IV contrast for posttreatment evaluation of primary vaginal cancer. FDG-PET/CT Skull Base to Mid-Thigh Although data in primary vaginal cancer patients are limited, studies substantiating its treatment response assessment role in cervical cancer are numerous. In one prospective study in cervical cancer patients treated with definitive chemoradiation, FDG-PET/CT responses classified as complete metabolic response (absence of abnormal uptake at prior sites of disease), partial metabolic response and progressive disease at a mean of 3 months after therapy correlated closely with prognosis, with 3 year progression-free survival of 78%, 33%, and 0%, respectively [40]. In another prospective study, 9% (5 of 55) of patients developed new distant disease at the time of a posttreatment FDG-PET/CT scan, underscoring the value of whole-body imaging rather than pelvic-only imaging at the time of response evaluation [41]. Accordingly, the NCCN guidelines for cervical cancer recommend whole- body FDG-PET/CT at 3 to 6 months after completion of definitive therapy for disease stages II to IV, because it directly informs prognosis, therapy, and intensity of surveillance [27].
Staging and Follow up of Primary Vaginal Cancer. Staging and Follow-up of Primary Vaginal Cancer CT of the abdomen and pelvis is not commonly performed in the absence of chest CT, given that the lungs are a potential site of distant disease that may newly arise in patients who have undergone definitive chemoradiation for disease that was initially locoregional [41]. Importantly, CT alone is inferior to FDG/PET-CT for evaluation of distant disease in the bones [25] and modestly inferior for nodal assessment [23,41]. The use of IV contrast is strongly encouraged when possible, because the improved tissue contrast likely benefits primary tumor evaluation, delineation of lymph nodes from adjacent vessels, and detection of hepatic metastases. No studies have specifically assessed the performance of CT of the abdomen and pelvis without IV contrast for posttreatment evaluation of primary vaginal cancer. FDG-PET/CT Skull Base to Mid-Thigh Although data in primary vaginal cancer patients are limited, studies substantiating its treatment response assessment role in cervical cancer are numerous. In one prospective study in cervical cancer patients treated with definitive chemoradiation, FDG-PET/CT responses classified as complete metabolic response (absence of abnormal uptake at prior sites of disease), partial metabolic response and progressive disease at a mean of 3 months after therapy correlated closely with prognosis, with 3 year progression-free survival of 78%, 33%, and 0%, respectively [40]. In another prospective study, 9% (5 of 55) of patients developed new distant disease at the time of a posttreatment FDG-PET/CT scan, underscoring the value of whole-body imaging rather than pelvic-only imaging at the time of response evaluation [41]. Accordingly, the NCCN guidelines for cervical cancer recommend whole- body FDG-PET/CT at 3 to 6 months after completion of definitive therapy for disease stages II to IV, because it directly informs prognosis, therapy, and intensity of surveillance [27].