HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Miller, T. R. Articles by Grigsby, P. W. Search for Related Content PubMed PubMed Citation Articles by Miller, T. R. Articles by Grigsby, P. W.

Improved Prognostic Value of ¹⁸F-FDG PET Using a Simple Visual Analysis of Tumor Characteristics in Patients with Cervical Cancer

¹ Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
² Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri

In patients with cervical cancer, it is important to estimate prognosis at the time of diagnosis. This study using PET with ¹⁸F-FDG was undertaken to determine whether a simple and fast visual analysis of characteristics of the primary tumor before initiation of treatment could achieve this goal. Methods: Forty-seven patients with cervical cancer who were to be treated by combined radiation therapy and chemotherapy were imaged before beginning treatment. They were then followed for up to 3 y for evidence of recurrence or death. Images of the chest, abdomen, and pelvis were obtained 40–90 min after administration of 370–555 MBq (10–15 mCi) ¹⁸F-FDG. Three observers then independently graded the primary tumor for size (0 = small, 1 = moderate, 2 = large), shape (0 = spherical, 1 = nonspherical), heterogeneity of uptake (0 = none, 1 = moderate, 2 = marked), and presence of lymph nodes (0 = none, 1 = pelvic, 2 = paraaortic, 3 = distant). The scores were summed to achieve a total score. A statistical calculation demonstrated that a score cutoff of 4 best separated patients with a good prognosis from patients with a bad prognosis. Kaplan-Meier analysis was used to compute progression-free survival and overall survival. Evaluation of lymph nodes alone was compared with the grading of tumor characteristics. Results: Observers 1 and 2 scored 26 patients as having a good prognosis and 21 as having a bad prognosis. Observer 3 scored 30 and 17, respectively, a statistically insignificant difference. Survival curves were almost identical for the 3 observers. For progression-free survival, approximately 12% of patients with a good score had disease recurrence whereas approximately 75% with a bad score had disease recurrence. For overall survival, approximately 10% (good) and 80% (bad) died. Evaluation of lymph nodes also separated the groups, but not as well as did visual analysis alone. The combination of the 2 was only slightly superior to visual assessment alone. Conclusion: A simple, rapid, and highly reproducible system is described for visual grading of characteristics of the primary tumor in patients with cervical cancer at the time of diagnosis. This approach separates patients with a poor prognosis from those who will do well, thus providing a new tool for accurate estimation of prognosis.

Key Words: PET • cervical cancer • ¹⁸F-FDG

This article has been cited by other articles:

				E. A. Kidd and P. W. Grigsby Intratumoral Metabolic Heterogeneity of Cervical Cancer Clin. Cancer Res., August 15, 2008; 14(16): 5236 - 5241. [Abstract] [Full Text] [PDF]

				S. M. Schuetze, L. H. Baker, R. S. Benjamin, and R. Canetta Selection of Response Criteria for Clinical Trials of Sarcoma Treatment Oncologist, April 1, 2008; 13(suppl_2): 32 - 40. [Abstract] [Full Text] [PDF]

				T. A.D. Smith, R. I. Sharma, A. M. Thompson, and F. E.M. Paulin Tumor 18F-FDG Incorporation Is Enhanced by Attenuation of P53 Function in Breast Cancer Cells In Vitro J. Nucl. Med., September 1, 2006; 47(9): 1525 - 1530. [Abstract] [Full Text] [PDF]

				J. Guo, K. Higashi, Y. Ueda, M. Oguchi, T. Takegami, H. Toga, T. Sakuma, H. Yokota, S. Katsuda, H. Tonami, et al. Microvessel Density: Correlation with 18F-FDG Uptake and Prognostic Impact in Lung Adenocarcinomas J. Nucl. Med., March 1, 2006; 47(3): 419 - 425. [Abstract] [Full Text] [PDF]

				L. Hooft, A. A. M. van der Veldt, P. J. van Diest, O. S. Hoekstra, J. Berkhof, G. J. J. Teule, and C. F. M. Molthoff [18F]Fluorodeoxyglucose Uptake in Recurrent Thyroid Cancer Is Related to Hexokinase I Expression in the Primary Tumor J. Clin. Endocrinol. Metab., January 1, 2005; 90(1): 328 - 334. [Abstract] [Full Text] [PDF]

				A. K. Buck, G. Glatting, and S. N. Reske Quantification of 18F-FDG Uptake in Non-Small Cell Lung Cancer: A Feasible Prognostic Marker? J. Nucl. Med., August 1, 2004; 45(8): 1274 - 1276. [Full Text] [PDF]

				J. Guo, K. Higashi, H. Yokota, Y. Nagao, Y. Ueda, Y. Kodama, M. Oguchi, S. Taki, H. Tonami, and I. Yamamoto In Vitro Proton Magnetic Resonance Spectroscopic Lactate and Choline Measurements, 18F-FDG Uptake, and Prognosis in Patients with Lung Adenocarcinoma J. Nucl. Med., August 1, 2004; 45(8): 1334 - 1339. [Abstract] [Full Text] [PDF]