Prognostic value of posttreatment 18F-FDG PET/CT and predictors of metabolic response to therapy in patients with locally advanced cervical cancer treated with concomitant chemoradiation therapy: an analysis of intensity- and volume-based PET parameters

Abstract

PurposeTo investigate the prognostic value of posttreatment 18F-FDG PET/CT in patients with locally advanced cervical cancer (LACC) treated with concomitant chemoradiation therapy (CCRT). The secondary aim was to assess the possible role of intensity-based and volume-based PET parameters including SUVmax, SUVmean, MTV and TLG, and clinical parameters including age, pathology, FIGO stage and nodal involvement as factors predicting response to treatment.MethodsThis retrospective study included 82 patients affected by LACC treated with CCRT. All patients underwent 18F-FDG PET/CT both before and after treatment. The posttreatment PET/CT scans were used to classify patients as complete metabolic responders (CMR) or non-complete metabolic responders (N-CMR) according to the EORTC criteria. Kaplan-Meier analysis was used to evaluate differences in overall survival (OS) between the CMR and N-CMR groups. Student’s t test, Pearson’s chi-squared test and logistic regression were used to investigate the possible value of PET and clinical parameters as predictors of metabolic response to therapy.ResultsKaplan­Meier analysis showed a highly significant difference in OS between the CMR and N-CMR groups (log-rank test p < 0.0001). Significant independent predictors of response to therapy were MTV (p = 0.019, odds ratio = 1.015, 95% CI = 1.002–1.028, Nagelkerke R2 = 0.110), TLG (p = 0.045, odds ratio = 1.001, 95% CI = 1.000–1.002, Nagelkerke R2 = 0.081) and nodal involvement (p = 0.088, odds ratio = 2.361, 95% CI = 0.879–6.343, Nagelkerke R2 = 0.051).Conclusion18F-FDG PET/CT-based response assessment using the EORTC criteria reliably predicts OS in LACC patients treated with CCRT. In our cohort of patients, pretreatment MTV and TLG and nodal involvement were predictors of response to therapy. MTV was the best predictor of response. However, its additional risk value seems to be low (MTV odds ratio = 1.015).

The role of the metabolic parameters of pre-treatment 18F-FDG PET/CT in patients with locally advanced cervical cancer

“…Similarly, Carpenter et al indicated that TLG measured by 18 F-FDG PET/CT was associated with OS in patients with high-risk cervical cancer treated with chemoradiotherapy and brachytherapy [18]. Lima et al also preliminary suggested that although its p value seems to be below the critical value, pre-treatment TLG was a signi cant independent predictor of response to therapy [17]. However, the sample sizes of these studies were less than 100 cases.…”

“…The baseline SUVmean can effectively predict the histopathological partial response of the primary tumour in LACC patients treated with CRT followed by surgery, suggesting the potential role of 18 F-FDG PET/CT in personalized treatment [16]. Pre-treatment MTV and TLG are predictors of response to therapy and are associated with OS in cervical cancer patients treated with CRT [17,18]. On the other hand, there are some dissenting views.…”

Predictive Role of MRI and 18F FDG PET Response to Concurrent Chemoradiation in T2b Cervical Cancer on Clinical Outcome: A Retrospective Single Center Study

“…Therefore, both exams are useful in the treatment choice (surgery or CCRT), and in RT planning [27,28]. However, evidence on the evaluation of response to CCRT are weak, although this assessment has a crucial role to decide subsequent treatments [29][30][31][32]. To detect residual disease, both clinical and radiological competences are needed.…”

Results of a Phase I-II Study on Laser Therapy for Vaginal Side Effects after Radiotherapy for Cancer of Uterine Cervix or Endometrium

“…Radiotherapy (RT) represents a cornerstone in the treatment of gynecological tumors and, in cases of advanced cervical cancers, it is the only available therapy with curative intent [1][2][3][4][5][6]. However, some side effects affecting sexual function are well known.…”