Use of Baseline 18F-FDG PET/CT to Identify Initial Sub-Volumes Associated With Local Failure After Concomitant Chemoradiotherapy in Locally Advanced Cervical Cancer

Abstract

Introduction: Locally advanced cervical cancer (CC) patients treated by chemoradiotherapy (CRT) have a significant local recurrence rate. The objective of this work was to assess the overlap between the initial high-uptake sub-volume (V1) on baseline 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scans and the metabolic relapse (V2) sites after CRT in locally advanced CC. Methods: PET/CT performed before treatment and at relapse in 21 patients diagnosed with LACC and treated with CRT were retrospectively analyzed. CT images at the time of recurrence were registered to baseline CT using the 3D Slicer TM Expert Automated Registration module. The corresponding PET images were then registered using the corresponding transform. The fuzzy locally adaptive Bayesian (FLAB) algorithm was implemented using 3 classes (one for the background and the other two for tumor) in PET1 to simultaneously define an overall tumor volume and the sub-volume V1. In PET2, FLAB was implemented using 2 classes (one for background, one for tumor), in order to define V2. Four indices were used to determine the overlap between V1 and V2 (Dice coefficients, overlap fraction, X = (V1nV2)/V1 and Y = (V1nV2)/V2). Results: The mean (±standard deviation) follow-up was 26 ± 11 months. The measured overlaps between V1 and V2 were moderate to good according to the four metrics,

Markers of Prognosis for Early Stage Cervical Cancer Patients (Stage IB1, IB2) Undergoing Surgical Treatment

“…F-FDG PET/CT, a functional imaging technique, provides quantified metabolic information (the mean and maximum standardized uptake values (SUV mean and SUV max ), metabolic tumor volume (MTV) and total lesion glycolysis (TLG))and has a well-established role in the management of patients with cervical cancer (12)(13)(14). Many studies have shown that hematological parameters such as hemoglobin (Hb), coagulation indexes [D-dimer, fibrinogen (Fg)], tumor marker for squamous cell carcinoma [squamous cell carcinoma antigen (SCCA)], and novel systemic inflammation response index (SIRI) are potential prognostic marker of malignant tumors (15)(16)(17)(18)(19).…”

Impact of suboptimal dosimetric coverage of pretherapeutic 18F-FDG PET/CT hotspots on outcome in patients with locally advanced cervical cancer treated with chemoradiotherapy followed by brachytherapy

“…Pre-treatment high 18F-FDG uptake areas on PET/CT denoted as ''hotspots" have been identified as preferential sites of local relapse after chemoradiotherapy (CRT) in many tumor subtypes including non-small cell lung cancer [13], rectal cancer [14], head and neck cancer [15] and esophageal cancer [16]. We previously found that there is a good correlation between the site of recurrent disease and the more active intratumoral region on the baseline PET/CT in locally advanced CC [17].…”

Artificial intelligence in tumor subregion analysis based on medical imaging: A review

“…Lucia et al 165 developed a framework to evaluate the overlap between the initial high‐uptake sub‐volume () on baseline ‐FDG PET/CT images and the metabolic relapse () after chemoradiotherapy in locally advanced cervical cancer. CT images of recurrence were registered with baseline CT using the 3D Slicer Expert Automated Registration module 176 to obtain the deformation fields by optimizing the Mattes mutual information metric, 177 and the corresponding PET images were registered using the corresponding deformation fields.…”