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Open Access Special Issue

Adjuvant radiotherapy of endometrial cancer: role of 18F-FDG-PET/CT in treatment modulation

  • Martina Ferioli1,2*,
  • Anna Myriam Perrone3,4
  • Paolo Castellucci5
  • Valeria Panni2
  • Anna Benini1,2
  • Gabriella Macchia6
  • Andrea Galuppi1
  • Milly Buwenge1,2
  • Elisa Lodi Rizzini1
  • Lidia Strigari7
  • Luca Tagliaferri8
  • Claudio Zamagni9
  • Pierandrea De Iaco3,4
  • Stefano Fanti5
  • Alessio Giuseppe Morganti1,2

1Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy

2Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, 40138 Bologna, Italy

3Oncologic Gynaecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy

4Department Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy

5Nuclear Medicine Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy

6Radiotherapy Unit, Gemelli Molise Hospital, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 86100 Campobasso, Italy

7Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy

8UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy

9Oncologia Medica Addarii, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy

DOI: 10.31083/j.ejgo4302028 Vol.43,Issue 2,April 2022 pp.219-226

Submitted: 31 October 2021 Accepted: 28 December 2021

Published: 15 April 2022

(This article belongs to the Special Issue Endometrial Cancer)

*Corresponding Author(s): Martina Ferioli E-mail:


Objective: Residual disease after surgery is related to an unfavorable prognosis in patients with endometrial cancer (EC). An early diagnosis and treatment of this condition could improve patients’ outcome. Aim of this study was to define the role of postoperative 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography (18F-FDG-PET/CT) in patients with high risk of residual disease after EC surgery. Methods: Patients operated for EC, with one or more risk factors, who underwent 18F-FDG-PET/CT before adjuvant treatment were included in this observational study. The primary endpoint was the rate of patients in whom 18F-FDG-PET/CT changed the treatment strategy and/or the radiotherapy (RT) planning. Results: Our analysis included 58 patients (median age: 67.5 years, range: 48.0–86.0) with the following risk factors: lymphadenectomy not performed (26 patients; 44.8%), inadequate lymphadenectomy (23 patients; 39.7%), and high risk of residual disease due to advanced stage (nine patients; 15.5%). Postoperative 18F-FDG-PET/CT imaging was positive in 18 patients (31%) in the following sites: pelvic extra-nodal disease (one patient), pelvic and/or paraaortic lymph nodes (12 patients), distant metastases (one patient), or combination of previous sites (four patients). Based on these results, the adjuvant therapeutic strategy was changed in five patients, three of whom were referred to chemotherapy alone due to distant metastases and two of whom were referred to nodal-directed treatment due to lymph node metastases (lymphadenectomy and pelvic chemoradiation plus boost, respectively). Furthermore, based on the 18F-FDG-PET/CT results, the RT plan was modified in 13 patients (addition of a boost on residual pelvic/abdominal disease in 12 and target modification in one, respectively). Therefore, based on postoperative 18F-FDG-PET/CT findings, the therapeutic strategy and the RT plan were changed in 5 patients (8.6%) and 13 patients (22.4%), respectively. Conclusion: In this analysis, the adjuvant treatment was modified after post-operative 18F-FDG-PET/CT in about one third of patients. Further studies are needed to better define the risk factors (or their combinations) correlated with higher probability of residual disease after radical hysterectomy-adnexectomy for EC.


Endometrial cancer; Postoperative treatment; 18F-FDG-PET/CT; Radiotherapy; Concurrent chemoradiation; Brachytherapy

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Martina Ferioli,Anna Myriam Perrone,Paolo Castellucci,Valeria Panni,Anna Benini,Gabriella Macchia,Andrea Galuppi,Milly Buwenge,Elisa Lodi Rizzini,Lidia Strigari,Luca Tagliaferri,Claudio Zamagni,Pierandrea De Iaco,Stefano Fanti,Alessio Giuseppe Morganti. Adjuvant radiotherapy of endometrial cancer: role of 18F-FDG-PET/CT in treatment modulation. European Journal of Gynaecological Oncology. 2022. 43(2);219-226.


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