18F-FDG PET/CT following chemoradiation of uterine cervix cancer provides powerful prognostic stratification independent of HPV status: a prospective cohort of 105 women with mature survival data

Siva, Shankar; Deb, Siddhartha; Young, Richard J.; Hicks, Rodney J.; Callahan, Jason; Bressel, Mathias; Mileshkin, Linda; Rischin, Danny; Bernshaw, David; Narayan, Kailash

doi:10.1007/s00259-015-3112-8

Cited by 21 publications

(19 citation statements)

References 33 publications

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“…Fluorodeoxyglucose-positron emission tomography (FDG-PET) has high potential for predicting response and metastasis after treatment [ 5 – 7 ]. Siva et al evaluated therapy response by PET-CT 3 months after treatment [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Positron emission tomography-magnetic resonance imaging (PET-MRI) for response assessment after radiation therapy of cervical carcinoma: a pilot study

et al. 2018

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BackgroundAdvanced stage cervical cancer is primarily treated by radiotherapy. Local tumor control is a prerequisite for cure. Imaging after treatment is controversial. Positron emission tomography (PET) combined with computer tomography (PET-CT) shows great promise for detecting metastases. On the other hand, magnetic resonance imaging (MRI) is superior in depicting anatomical details. The combination of PET-MRI could result in more accurate evaluation of cervical cancer treatment outcome. The aim of this pilot study is to share our initial experience with PET-MRI in the evaluation of treatment response in cervical cancer after radiation treatment.MethodsTen patients with cervical carcinoma (FIGO ≥IB2) were prospectively evaluated. Eleven weeks (median; range 8–15 weeks) after radiation therapy, treatment response was evaluated by PET-MRI. The PET, MRI, and combined PET-MRI images were evaluated for the presence of local residual tumor and metastasis. Diagnostic performance was assessed by area under the receiver operator characteristic (ROC) curve for evaluation of local residual tumor. The readers were blinded for outcome data. Local residual disease, metastasis, diagnostic confidence, and change of opinion were scored on a 5-point Likert scale. The reference standard consisted of pathology and/or follow-up according to the clinical guidelines.ResultsThree out of ten patients had local residual abnormalities suggestive for tumor residue after radiation treatment. The availability of both PET and MRI resulted in an increase in diagnostic confidence in 80–90% of all patients. Change of opinion was observed in 70% and change of policy in 50%, especially in the group with residual tumor. The diagnostic accuracy increased significantly for the radiologist if PET-MRI was combined (AUC .54 versus .83).ConclusionsPET-MRI shows promise for evaluation of treatment response after radiation for cervical cancer, especially increasing diagnostic confidence, while potentially increasing diagnostic performance.

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Section: Introductionmentioning

confidence: 99%

Positron emission tomography-magnetic resonance imaging (PET-MRI) for response assessment after radiation therapy of cervical carcinoma: a pilot study

et al. 2018

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“…Recent advances in imaging have improved the ability to characterize the full extent of local disease extension, pelvic/para aortic lymph node involvement, and the presence of distant metastasis in cervical cancer patients [ 11 ]. Functional information derived from PET/CT like the SUV max can also be prognostic [ 5 – 7 ]. Unfortunately this advance in PET/CT imaging is not readily available in developing countries such as Brazil.…”

Section: Discussionmentioning

confidence: 99%

“…One of the challenges of this approach is being able to identify patients at highest risk for poor outcomes following chemoradiation alone. Advances in functional imaging with Positron Emission Tomography (PET) and quantification of a standardized uptake value (SUV) can provide prognostic information that may be helpful in identifying women populations at higher risk of failure, thereby allowing for an enriched patient population that is more likely to benefit from escalated therapy [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Pre-treatment MRI minimum apparent diffusion coefficient value is a potential prognostic imaging biomarker in cervical cancer patients treated with definitive chemoradiation

et al. 2016

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BackgroundDiffusion Weighted (DW) Magnetic Resonance Imaging (MRI) has been studed in several cancers including cervical cancer. This study was designed to investigate the association of DW-MRI parameters with baseline clinical features and clinical outcomes (local regional control (LRC), disease free survival (DFS) and disease specific survival (DSS)) in cervical cancer patients treated with definitive chemoradiation.Methods This was a retrospective study approved by an institutional review board that included 66 women with cervical cancer treated with definitive chemoradiation who underwent pre-treatment MRI at our institution between 2012 and 2013. A region of interest (ROI) was manually drawn by one of three radiologists with experience in pelvic imaging on a single axial CT slice encompassing the widest diameter of the cervical tumor while excluding areas of necrosis. The following apparent diffusion coefficient (ADC) values (×10−3 mm2/s) were extracted for each ROI: Minimum - ADCmin, Maximum - ADCmax, Mean - ADCmean, and Standard Deviation of the ADC - ADCdev. Receiver operating characteristic (ROC) curves were built to choose the most accurate cut off value for each ADC value. Correlation between imaging metrics and baseline clinical features were evaluated using the Mann Whitney test. Confirmatory multi-variate Cox modeling was used to test associations with LRC (adjusted by gross tumor volume – GTV), DFS and DSS (both adjusted by FIGO stage). Kaplan Meyer curves were built for DFS and DSS. A p-value < 0.05 was considered significant.Women median age was 52 years (range 23–90). 67 % had FIGO stage I-II disease while 33 % had FIGO stage III-IV disease. Eighty-two percent had squamous cell cancer. Eighty-eight percent received concurrent cisplatin chemotherapy with radiation. Median EQD2 of external beam and brachytherapy was 82.2 Gy (range 74–84).ResultsWomen with disease staged III-IV (FIGO) had significantly higher mean ADCmax values compared with those with stage I-II (1.806 (0.4) vs 1.485 (0.4), p = 0.01). Patients with imaging defined positive nodes also had significantly higher mean (±SD) ADCmax values compared with lymph node negative patients (1.995 (0.3) vs 1.551 (0.5), p = 0.03).With a median follow-up of 32 months (range 5–43) 11 patients (17 %) have developed recurrent disease and 8 (12 %) have died because of cervical cancer. ROC curves based on DSS showed optimal cutoffs for ADCmin (0.488 × 10−3), ADCmean (0.827 × 10−3), ADCmax (1.838 × 10−3) and ADCdev (0.148 × 10−3). ADCmin higher than the cutoff was significantly associated with worse DFS (HR = 3.632–95 % CI: 1.094–12.054; p = 0.035) and DSS (HR = 4.401–95 % CI: 1.048–18.483; p = 0.043).ConclusionPre-treatment ADCmax measured in the primary tumor may be associated with FIGO stage and lymph node status. Pre-treatment ADCmin may be a prognostic factor associated with disease-free survival and disease-specific survival in cervical cancer patients treated with definitive chemoradiation. Prospective validation of these findings is currently ong...

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“…The potential of PET/CT in evaluation of lymph nodes inside and outside of pelvis is recognized but PET/CT has also been described as an useful tool in 3D-based adaptative brachytherapy, an interesting concept of brachytherapy [19], debated during the last decade, that allows improving dose tumor coverage, without significantly increase dose to organ constraints, namely bladder and rectum, in an optimized and personalized treatment. Furthermore the evaluation of treatment response, with metabolic imaging, immediately after radio chemotherapy, has been demonstrated as capable of predicting outcome, making relevant PET/CT evaluation at this time of the course of malignant cervical disease [20].…”

Section: Clinical Case Of Evaluation For Brachytherapy (Post-rtx)mentioning

confidence: 99%

Normalized Uptake Fraction: An Alternative for Metabolic Quantification

Alves

Silva

Botelho

2016

JCPCR

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Introduction: Functional imaging with 18F-FDG PET/CT has become a valuable tool in Oncology. Standardized uptake value represents a semi-quantitative approach in PET in order to have an easy way to evaluate tissues metabolic rate. Despite the recommendations for its inclusion in clinical reports, its calculation is affected by multiple variables making difficult to compare exams from different labs or to use it in radiotherapy planning. Our goal was the development of an alternative methodology of quantification that despite remaining semiquantitative is less operator's dependent. Material and methods:We studied 32 women with cervical cancer in stage IIB, IIIA and IIIB that were scanned with 18 F-FDG PET/CT previously to treatment. Additionally, one woman had an evaluation post treatment, and another one was also evaluated 25 months after treatment terminus. Images were included in Velocity AI ® and the results of an independent and blind evaluation by two experts including the contouring of gross tumor volume were compared. Images were also included in MEVISLAB ® platform, an image processing and visualization software, and we obtained parametric images of the distribution of, what we called, normalized uptake fraction (FCN). Visualization of the FCN images was lower bounded by taking into account the activity of quadriceps muscle. Representative clinical cases were selected to describe our image results. Results and conclusion:We obtained an independent visualization method, allowing a new approach in quantification of metabolic imaging. There is evidence that, through visual navigation in CT-mode but mainly in PET/CT-mode after application of FCN, we were allowed to analyze quantification images of PET/CT, from different patients and different equipment's, without the controversial ROI or VOI definition and measurement of respective SUV. For radiotherapy planning the proposed method seems to improve the determination of biological target volume (BTV).

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18F-FDG PET/CT following chemoradiation of uterine cervix cancer provides powerful prognostic stratification independent of HPV status: a prospective cohort of 105 women with mature survival data

Abstract: At 5 years CMR remains a powerful factor predicting survival after initial and salvage therapy. Metabolic response was not associated with HPV infection risk. Further studies are required to establish the association with HPV infection risk and survival after chemoradiation.

Cited by 21 publications

References 33 publications

Positron emission tomography-magnetic resonance imaging (PET-MRI) for response assessment after radiation therapy of cervical carcinoma: a pilot study

Positron emission tomography-magnetic resonance imaging (PET-MRI) for response assessment after radiation therapy of cervical carcinoma: a pilot study

Pre-treatment MRI minimum apparent diffusion coefficient value is a potential prognostic imaging biomarker in cervical cancer patients treated with definitive chemoradiation

Normalized Uptake Fraction: An Alternative for Metabolic Quantification

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