Prognostic value of total lesion glycolysis measured by 18F-FDG PET/CT in patients with locally advanced cervical cancer

Liu

et al. 2020

Preprint

Abstract Purpose The purpose of the present study was to evaluate the role of the pre-treatment metabolic parameters of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) in patients with locally advanced cervical cancer (LACC) treated with definitive concurrent chemoradiotherapy (CCRT) or radiotherapy. Methods Patients with LACC who underwent pre-treatment 18F-FDG PET/CT examination and definitive CCRT or radiotherapy between February 2010 and December 2015 in our institute were enrolled. For each patient, the maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) of the primary tumour were measured. The survival outcomes were calculated with the Kaplan-Meier method. Cox proportional hazards models were used for univariate and multivariate analyses. Results A total of 125 patients were finally included in this study. The median follow-up duration was 62 months (range, 4-114 months). The 5-year overall survival (OS), disease-free survival (DFS), local control (LC) and distant metastasis-free survival (DMFS) rates were 83.6%, 75.1%, 92.3% and 79.9%, respectively. Univariate analysis indicated that MTV ≥ 18.3 cm3 showed worse OS and DMFS; however, no significant differences were identified for OS and DMFS in multivariate analyses. TLG ≥ 113.4 implied worse DFS and DMFS. In multivariate analysis, TLG ≥ 113.4 was an independent predictive factor for OS, DFS and DMFS. SUVmax and SUVmean had no significant influence on OS, DFS, LC or DMFS in either univariate or multivariate analysis. Conclusion Pre-treatment TLG ≥ 113.4 was associated with a high incidence of disease recurrence and poor OS in patients with LACC.

Section: Discussionsupporting

confidence: 79%

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

Liu

et al. 2020

Preprint

“…Kidd et al found that SUVmax of the primary tumor also has other prognostic value, having a correlation with histology and differentiation[11]. Other quantitative data obtained from PET/CT have been shown to be helpful, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) [12, 13]. Zhang et al compared the gross tumor volume (GTV) as assessed by CT, MRI, and PET/CT to pathologic volume in 10 patients with stages I-II cervical cancer, and found that PET/CT GTV determined under 40% SUVmax had the best correlation with pathology volume [14].…”

Section: Stagingmentioning

confidence: 99%

[18F]-2-Fluoro-2-Deoxy-D-glucose–PET Assessment of Cervical Cancer

et al. 2018

“…Most of those prognostic factors are derived from inherent characteristics of the tumor including tumor size, FIGO stage and lymph node involvement. [1][2][3] Additionally, various tumor metabolic parameters derived from 18F-FDG PET, including maximum standardized uptake value (SUVmax), 4 metabolic tumor volume (MTV), 5 total lesion glycolysis (TLG) 6 and more recently, radiomic features, 7 have been shown to be accurate and sensitive prognostic biomarkers. Some treatment features, such as the volume of the high-risk clinical target volume (HR-CTV) or the dose received by 90% of the HR-CTV, 8 have also demonstrated potential in predicting local control.…”

Section: Introductionmentioning

confidence: 99%

Increased bone marrow SUVmax on 18F-FDG PET is associated with higher pelvic treatment failure in patients with cervical cancer treated by chemoradiotherapy and brachytherapy

et al. 2019

The aim of this study was to evaluate if bone marrow (BM) SUVmax measured on pre-treatment 18F-FDG PET/CT predicts the clinical outcome of locally advanced cervical cancer (LACC). We recruited retrospectively patients with LACC who underwent staging 18F-FDG PET/CT and had baseline blood tests, then treated by chemoradiation therapy (CRT), followed by image-guided adaptive brachytherapy (IGABT). BM SUVmax was calculated and correlated to inflammatory blood markers. Tumor size and pelvic lymph node involvement were evaluated on baseline MRI. Prognostic value of SUV uptake and blood markers regarding overall survival (OS), pelvic and extra-pelvic recurrence-free survival (PRFS and EPRFS respectively) was assessed using Cox models with adjusted p-values. 116 patients with FIGO stage Ib-IVa cervical cancer, treated between 2005 and 2014, were analyzed. The median follow-up was 75.5 months. BM SUVmax was significantly correlated to tumor SUVmax. In multivariate analysis, PRFS was significantly poorer in patients with high BM SUVmax (>2.8) and neutrophilia (p < .05). Tumor size (>5 vs ≤5 cm) could predict PRFS, EPRFS and OS (p < .05). In our cohort, FIGO stage (I-II vs III-IV), pelvic lymph node involvement and tumor SUVmax (>12 vs ≤12) were not prognostic for OS or pelvic and extra-pelvic relapses. Patients with LACC and high BM SUVmax on 18F-FDG PET have worse PFRS following CRT plus IGABT. These results can be potentially explained by the pro-inflammatory role of the tumor microenvironment and G-CSF expressed by tumor cells. These data support the role of PET as a potential indicator of disease aggressiveness beyond tumor staging.