[18F]FDG-PET/CT metabolic parameters as useful prognostic factors in cervical cancer patients treated with chemo-radiotherapy. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Herrera, Fernanda; Breuneval, Thomas; Prior, John; Bourhis, Jean; Ozsahin, Mahmut
• Is Part Of: Radiation oncology. Volume 11:Issue 1(2016)
• Page Start: 1
• Page End: 11
• Publication Date: 2016-12
• Subjects: [18F]FDG-PET/CT -- Cervical cancer -- Chemo-radiotherapy -- Tumor glycolytic volume -- Standard uptake value; Cancer -- Radiotherapy -- Periodicals; 616.9940642
• DOI: 10.1186/s13014-016-0614-x
• Languages: English
• ISSNs: 1748-717X

Abstract

Abstract Background To compare the prognostic value of different anatomical and functional metabolic parameters determined using [18 F]FDG-PET/CT with other clinical and pathological prognostic parameters in cervical cancer (CC). Methods Thirty-eight patients treated with standard curative doses of chemo-radiotherapy (CRT) underwent pre- and post-therapy [18 F]FDG-PET/CT. [18 F]FDG-PET/CT parameters including mean tumor standardized uptake values (SUV), metabolic tumor volume (MTV) and tumor glycolytic volume (TGV) were measured before the start of CRT. The post-treatment tumor metabolic response was evaluated. These parameters were compared to other clinical prognostic factors. Survival curves were estimated by using the Kaplan-Meier method. Cox regression analysis was performed to determine the independent contribution of each prognostic factor. Results After 37 months of median follow-up (range, 12–106), overall survival (OS) was 71 % [95 % confidence interval (CI), 54–88], disease-free survival (DFS) 61 % [95 % CI, 44–78] and loco-regional control (LRC) 76 % [95 % CI, 62–90]. In univariate analyses the [18 F]FDG-PET/CT parameters unfavorably influencing OS, DFS and LRC were pre-treatment TGV-cutoff ≥562 (37 vs. 76 %, p = 0.01; 33 vs. 70 %, p = 0.002; and 55 vs. 83 %, p = 0.005, respectively), mean pre-treatment tumor SUV cutoff ≥5 (57 vs. 86 %, p = 0.03; 36 vs. 88 %, p = 0.004; 65 vs. 88 %, p = 0.04, respectively) and a partial tumor metabolic response after treatment (9 vs. 29 %, p = 0.0008; 0 vs. 83 %, p < 0.0001; 22 vs. 96 %, p < 0.0001, respectively). After multivariate analyses a partial tumor metabolic response after treatment remained as an independent prognostic factor unfavorably influencing DFS and LRC (RR 1:7.7, p < 0.0001, and RR 1:22.6, p = 0.0003, respectively) while the pre-treatment TGV-cutoff ≥562 negatively influenced OS and DFS (RR 1:2, p = 0.03, and RR 1:2.75, p = 0.05). Conclusions Parameters capturing the pre-treatment glycolytic volume and metabolic activity of [18 F]FDG–positive disease provide important prognostic information in patients with CC treated with CRT. The post-therapy [18 F]FDG-PET/CT uptake (partial tumor metabolic response) is predictive of disease outcome.