Increased bone marrow SUVmax on 18F-FDG PET is associated with higher pelvic treatment failure in patients with cervical cancer treated by chemoradiotherapy and brachytherapy

Abstract

The aim of this study was to evaluate if bone marrow (BM) SUVmax measured on pre-treatment 18F-FDG PET/CT predicts the clinical outcome of locally advanced cervical cancer (LACC). We recruited retrospectively patients with LACC who underwent staging 18F-FDG PET/CT and had baseline blood tests, then treated by chemoradiation therapy (CRT), followed by image-guided adaptive brachytherapy (IGABT). BM SUVmax was calculated and correlated to inflammatory blood markers. Tumor size and pelvic lymph node involvement were evaluated on baseline MRI. Prognostic value of SUV uptake and blood markers regarding overall survival (OS), pelvic and extra-pelvic recurrence-free survival (PRFS and EPRFS respectively) was assessed using Cox models with adjusted p-values. 116 patients with FIGO stage Ib-IVa cervical cancer, treated between 2005 and 2014, were analyzed. The median follow-up was 75.5 months. BM SUVmax was significantly correlated to tumor SUVmax. In multivariate analysis, PRFS was significantly poorer in patients with high BM SUVmax (>2.8) and neutrophilia (p < .05). Tumor size (>5 vs ≤5 cm) could predict PRFS, EPRFS and OS (p < .05). In our cohort, FIGO stage (I-II vs III-IV), pelvic lymph node involvement and tumor SUVmax (>12 vs ≤12) were not prognostic for OS or pelvic and extra-pelvic relapses. Patients with LACC and high BM SUVmax on 18F-FDG PET have worse PFRS following CRT plus IGABT. These results can be potentially explained by the pro-inflammatory role of the tumor microenvironment and G-CSF expressed by tumor cells. These data support the role of PET as a potential indicator of disease aggressiveness beyond tumor staging.

Prognostic significance of bone marrow FDG uptake in patients with gynecological cancer

“…In the area of gynecological cancer, 2 previous studies have investigated the prognostic significance of BM FDG-uptake 23 , 24 : both studies included patients with cervical cancer and their conclusions were similar to ours, but performed no mechanistic investigations. For ovarian and endometrial cancer, our study is the first investigate the prognostic significance of BM FDG uptake.…”

“…The reason for this, as well as whether this finding is universal, remains unknown. However, previous investigations have suggested that pretreatment neutrophilia as well as the greater tumor G-CSF expression are more frequently observed in advanced-stage disease than in early-stage disease in endometrial or ovarian cancer patients [22][23][24][25] . These results may indicate that the amount of tumor-derived G-CSF is greater in advanced-stage disease than in early-stage disease.…”

Prognostic Value of Bone Marrow Metabolism on Pretreatment 18F-FDG PET/CT in Patients with Metastatic Melanoma Treated with Anti-PD-1 Therapy

“…Metabolic tumor volume (MTV) and glucose metabolism of normal tissues associated with immunity on 18 F-FDG PET/CT before and during immune checkpoint inhibitor (ICI) therapy have been explored as predictors of therapeutic efficacy (1)(2)(3)(4). The link between 18 F-FDG uptake by immunemediating tissues, such as the bone marrow (BM) and spleen, and poor cancer outcomes is hypothesized to be explained by generalized (5,6).…”

Association of the Metabolic Score Using Baseline FDG-PET/CT and dNLR with Immunotherapy Outcomes in Advanced NSCLC Patients Treated with First-Line Pembrolizumab

“…Beyond the PD-L1 expression, easily measurable and accessible biomarkers for the prediction of outcomes are needed. Initial investigations, including a complete blood count and a 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET), provide both diagnostic and staging information [ 9 , 10 , 11 ], but could also be predictive or prognostic [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. On the basis of these two tests, certain parameters are beneficial and meaningful, particularly the derived neutrophils to lymphocytes ratio (dNLR) and the total metabolic tumor volume (TMTV) on FDG-PET [ 19 ].…”