¹⁸F-FDG PET/CT Identifies Predictors of Survival in Patients with Locally Advanced Cervical Carcinoma and Paraaortic Lymph Node Involvement to Allow Intensification of Treatment

Abstract

Introduction: To use positron emission tomography coupled with computed tomography (18 FDG-PET/CT) to identify a high-risk subgroup requiring therapeutic intensification among patients with locally advanced cervical cancer (LACC) and para-aortic lymph node (PALN) involvement. Methods: In this retrospective multicentric study, patients with LACC and PALN involvement concurrently treated with chemoradiotherapy and extended-field radiotherapy (EFR) between 2006 and 2016 were included. A senior nuclear medicine specialist in PET for gynaecologic oncology reviewed all 18 FDG-PET/CT scans. Metabolic parameters including maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) were determined for the primary tumour, pelvic lymph nodes and PALN. Associations between these parameters and overall survival (OS) were assessed with Cox's proportional hazards model. Results: Sixty-eight patients were enrolled in the study. Three-year OS was 55.5% (95% CI [40.8-68.0]). When adjusted for age, stage and histology, pelvic lymph node TLG, PALN TLG and PALN SUVmax were significantly associated with OS (p<0.005). Conclusion: FDG-PET/CT was able to identify predictors of survival in the homogeneous subgroup of patients with LACC and PALN involvement, thus allowing therapeutic intensification to be proposed.

Prognostic Implications of Metabolism Related Gene Signature in Cutaneous Melanoma

“…In the 1920s, Otto Warburg observed that proliferating ascites tumor cells preferentially performed glycolysis, even in oxygenrich circumstances (6). This seminal finding has been observed in a wide variety of cancers and currently has been exploited clinically using 18F-deoxyglucose positron emission tomography (7). Mechanically, in proliferating tumor cells, glycolysis, instead of pure mitochondrial metabolism, could provide essential intermediates for biosynthetic pathways, such as lipid or nucleotide synthesis (8).…”

The value of metabolic parameters and textural analysis in predicting prognosis in locally advanced cervical cancer treated with chemoradiotherapy

“…Positron emission tomography-computed tomography (PET/CT) with 18 F-fluorodeoxyglucose ( 18 F-FDG) is used in staging, treatment planning, and response assessment in locally advanced cervical cancer (LACC) [3,12,13]. 18 F-FDG PET/CT also has a prognostic value and has been used to study recurrence and survival outcome [14][15][16][17]. Metabolic parameters based on the standardized uptake value (SUV), like the highest SUV (SUVmax) of the lesion, and the metabolic tumor volume (MTV) as well as total lesion glycolysis (TLG) have been studied previously.…”

Diagnostic Accuracy of 18F-FDG-PET/CT and MRI in Predicting the Tumor Response in Locally Advanced Cervical Carcinoma Treated by Chemoradiotherapy: A Meta-Analysis

“…About 40% of these patients show locally advanced cervical carcinoma (LACC) at initial diagnosis [ 2 ]. The standard treatment for LACC is specific cisplatin-based radiotherapy chemotherapy (CRT) [ 3 ]. However, usually, in 33% of cases, the tumor recurs about 2 years after CRT, and the overall 5-year survival is approximately 70% [ 3 ].…”

“…The standard treatment for LACC is specific cisplatin-based radiotherapy chemotherapy (CRT) [ 3 ]. However, usually, in 33% of cases, the tumor recurs about 2 years after CRT, and the overall 5-year survival is approximately 70% [ 3 ]. Lymph node status, response to treatment, and clinical stage are the main predictors of recurrence.…”