Objective
The aim of the study was to assess the impact of clinical and metabolic parameters derived from 18F-FDG PET/CT (positron emission tomography–computed tomography) in patients with locally advanced cervical cancer (LACC) on prognosis.
Methods
Patients with LACC of stage IB2-IVA treated by primary radiochemotherapy followed by brachytherapy were enrolled in this retrospective study. Indexes derived from standardized uptake value (SUV), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and textural features of the primary tumor were measured for each patient. Overall survival (OS) and recurrence-free survival (RFS) rates were calculated according to Kaplan–Meier and survival curves were compared using the log-rank test. Uni- and multivariate analyses were performed using the Cox regression model.
Results
A total of 116 patients were included. Median follow-up was 58 months (range: 1–129). A total of 36 (31%) patients died. Five-year OS and RFS rates were 69 and 60%, respectively. Univariate analyses indicated that FIGO stage, the presence of hydronephrosis, high CYFRA 21.1 levels, and textural features had a significant impact on OS and RFS. MTV as well as SCC-Ag concentration were also significantly associated with OS. On multivariate analysis, the presence of hydronephrosis, CYFRA 21.1, and sphericity were independent prognostics factors for OS and RFS. Also, SCC-Ag level, MTV, and GLZLM (gray-level zone length matrix) ZLNU (zone length non-uniformity) were significantly associated with OS.
Conclusion
Classical prognostic factors and tumor heterogeneity on pretreatment PET/CT were significantly associated with prognosis in patients with LACC.
and WG cases was 12 and 18, respectively. The mean target coverage and normal tissue dose for HG and WG plans are summarized in Table 1. No differences were observed in the CTV V100 between HG and WG plans (p Z 0.35), but HG plans had significantly increased target D 90 and V150 than WG plans (p<0.0001). In addition, HG plans had significantly reduced dose to the normal tissues compared to WG plans (p<0.0001). Conclusion: HG plans provide statistically significant dose reduction to the normal tissues and dose escalation to the target while achieving the same target coverage compared as WG plans. Clinical follow-up with this approach is necessary to determine the potential clinical impact of HG treatment.
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