F-18 fluorodeoxyglucose uptake in primary cervical cancer as an indicator of prognosis after radiation therapy

doi:10.1016/j.ygyno.2005.10.005

Gynecologic Oncology

Volume 101, Issue 1, April 2006, Pages 147-151

https://doi.org/10.1016/j.ygyno.2005.10.005 Get rights and content

Abstract

Purpose.

We evaluated the prognostic significance of tumor metabolic activity on pretreatment positron emission tomography using the glucose analog F-18 fluorodeoxyglucose (FDG-PET) in patients with carcinoma of the cervix undergoing radiotherapy with or without concurrent chemotherapy.

Methods.

We studied 96 consecutive patients who underwent FDG-PET prior to initiation of radiotherapy with or without concurrent chemotherapy for carcinoma of the cervix. Pretreatment FDG uptake of the primary tumor was assessed with the semiquantitative standardized uptake value (SUV) and correlated with disease-free and overall survival. Survival was estimated by the Kaplan–Meier method. Univariate and multivariate analyses were performed with the logistic likelihood ratio test and the Cox proportional hazards model, respectively.

Results.

Five-year disease-free survivals in patients with maximal SUV < 10.2 and ≥ 10.2 were 71% and 52% (P = 0.0289) respectively, while overall survivals were 72% and 69% (P = 0.4), respectively. On multivariate analysis, lymph node metastasis on FDG-PET was found to be predictive of disease-free survival (P < 0.0001). Both the SUV for FDG and FIGO Stage I disease were found to be marginally predictive of disease-free survival (P = 0.055 and P = 0.058, respectively).

Conclusions.

FDG uptake within primary cervical cancer, as measured by SUV, is predictive of disease-free survival in patients undergoing radiotherapy for cervical cancer. High FDG uptake may be useful in identifying patients who may require more aggressive initial 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.

Section snippets

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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F-18 fluorodeoxyglucose uptake in primary cervical cancer as an indicator of prognosis after radiation therapy

Abstract

Purpose.

Methods.

Results.

Conclusions.

Introduction

Section snippets

Patients

Results

Discussion

Acknowledgment

Clin. Pos. Imag.

Mol. Imag. Biol.

Int. J. Radiat. Oncol. Biol. Phys.

Gynecol. Oncol.

Gynecol. Oncol.

Blood

Gynecol. Oncol.

Clinical applications of PET in oncology

Radiology

Lymph node staging by positron emission tomography in patients with carcinoma of the cervix

J. Clin. Oncol.

Posttherapy [18F] fluorodeoxyglucose positron emission tomography in carcinoma of the cervix: response and outcome

J. Clin. Oncol.

Positron emission tomography for evaluating para-aortic nodal metastasis in locally advanced cervical cancer before surgical staging: a surgicopathologic study

J. Clin. Oncol.

Improved prognostic value of 18F-FDG PET using a simple visual analysis of tumor characteristics in patients with cervical cancer

J. Nucl. Med.

Standardized uptake value of 2-[18F] Fluoro-2-deoxy-d-glucose in predicting outcome in head and neck carcinomas treated by radiotherapy with or without chemotherapy

J. Clin. Oncol.

Posttherapy [¹⁸F] fluorodeoxyglucose positron emission tomography in carcinoma of the cervix: response and outcome

Standardized uptake value of 2-[¹⁸F] Fluoro-2-deoxy-d-glucose in predicting outcome in head and neck carcinomas treated by radiotherapy with or without chemotherapy