F-18 fluorodeoxyglucose uptake in primary cervical cancer as an indicator of prognosis after radiation therapy
Introduction
Positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) is now routinely used for the staging and restaging of a variety of malignancies, including non-small cell lung carcinoma, esophageal carcinoma, colorectal carcinoma, head and neck carcinoma, lymphoma, and melanoma [1]. Several reports from our institution and others have demonstrated the efficacy of FDG-PET in both pretreatment and posttreatment evaluation of patients with cervical cancer [2], [3], [4], [5], [6], [7], [8]. At our institution, pretreatment FDG-PET is performed routinely in all patients with carcinoma of the uterine cervix.
Recent clinical studies in patients with head and neck, lung, breast, and esophageal cancers have demonstrated that high pretreatment FDG uptake in the primary tumor is predictive of an inferior outcome [9], [10]. The relationship between FDG uptake in primary cervical cancer and outcome has not been examined. In the present study, we retrospectively assessed, in a blinded manner, the FDG uptake within the primary tumor using the semiquantitative standardized uptake value (SUV) method in patients who underwent FDG-PET for cervical cancer at Washington University in St. Louis. The objective of this study was to determine whether FDG uptake within the primary tumor, as measured by the SUV, can predict disease-free or overall survival in patients with cervical cancer undergoing definitive radiotherapy with or without chemotherapy.
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Patients
The study population consisted of 96 consecutive patients with carcinoma of the cervix who was referred for treatment to the Department of Radiation Oncology at Washington University between 1999 and 2003 and who underwent FDG-PET as part of their initial clinical evaluation. The study group included patients with FIGO stage Ib1 through IVb disease. The Human Studies Committee at Washington University approved this retrospective study, and the requirement for consent was waived. All patients
Results
Patient characteristics including initial FIGO stage, histology of disease, age, and treatment are included in Table 1. The median follow-up of all surviving patients was 42.5 months (range 4 to 70 months). Of the 96 patients in the study cohort, 34 (35%) developed a pelvic or distant failure. Of these, 9 developed a pelvic failure (9%), 16 developed distant metastasis (17%), and 9 developed both pelvic and distant failure (9%). At last follow-up, 68 patients were alive (8 with disease), and 29
Discussion
The utility of pretreatment FDG-PET in evaluating extent of disease in patients with newly diagnosed carcinoma of the cervix has been established by our group as well as others [2], [3], [7], [8], [15]. In a study by Grigsby et al. [3], FDG-PET detected abnormal lymph nodes more often than CT, and the presence of para-aortic lymph node FDG uptake correlated most significantly with disease-free survival. FDG-PET capitalizes on the increased glucose metabolism observed in malignant tumors. The
Acknowledgment
This project was supported in part by Grant Number R01 CA85797 from the National Institutes of Health. This work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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