Prognostic Impact of Pretreatment Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography SUVmax in Patients With Locally Advanced Cervical Cancer

Cima, S.; Perrone, Anna Myriam; Castellucci, Paolo; Macchia, G.; Buwenge, M.; Cammelli, S.; Cilla, Savino; Ferioli, Martina; Ferrandina, Gabriella; Galuppi, Andrea; Salizzoni, Eugenio; Rubino, Daniela; Fanti, Stefano; Iaco, Pierandrea De; Morganti, Alessio Giuseppe

doi:10.1097/igc.0000000000001207

Cited by 28 publications

(30 citation statements)

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“…Regarding 18 F-FDG-PET, pretreatment SUV max and MTV have been reported to be associated with tumor prognosis [ 30 , 31 ]. So MTV had a hazard ratio of 3.15 for disease-free survival [ 31 ], and SUV max of the primary tumor was the only identified prognostic factor in a multivariate analysis [ 30 ]. Furthermore, TLG was also associated with the overall survival in locally advanced cervical cancer [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Cervical Cancer: Associations between Metabolic Parameters and Whole Lesion Histogram Analysis Derived from Simultaneous ¹⁸F-FDG-PET/MRI

Meyer¹,

Purz

Sabri

2018

Contrast Media & Molecular Imaging

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Multimodal imaging has been increasingly used in oncology, especially in cervical cancer. By using a simultaneous positron emission (PET) and magnetic resonance imaging (MRI, PET/MRI) approach, PET and MRI can be obtained at the same time which minimizes motion artefacts and allows an exact imaging fusion, which is especially important in anatomically complex regions like the pelvis. The associations between functional parameters from MRI and 18F-FDG-PET reflecting different tumor aspects are complex with inconclusive results in cervical cancer. The present study correlates histogram analysis and 18F-FDG-PET parameters derived from simultaneous FDG-PET/MRI in cervical cancer. Overall, 18 female patients (age range: 32–79 years) with histopathologically confirmed squamous cell cervical carcinoma were retrospectively enrolled. All 18 patients underwent a whole-body simultaneous 18F-FDG-PET/MRI, including diffusion-weighted imaging (DWI) using b-values 0 and 1000 s/mm2. Apparent diffusion coefficient (ADC) histogram parameters included several percentiles, mean, min, max, mode, median, skewness, kurtosis, and entropy. Furthermore, mean and maximum standardized uptake values (SUVmean and SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were estimated. No statistically significant correlations were observed between SUVmax or SUVmean and ADC histogram parameters. TLG correlated inversely with p25 (r=−0.486, P=0.041), p75 (r=−0.490, P=0.039), p90 (r=−0.513, P=0.029), ADC median (r=−0.497, P=0.036), and ADC mode (r=−0.546, P=0.019). MTV also showed significant correlations with several ADC parameters: mean (r=−0.546, P=0.019), p10 (r=−0.473, P=0.047), p25 (r=−0.569, P=0.014), p75 (r=−0.576, P=0.012), p90 (r=−0.585, P=0.011), ADC median (r=−0.577, P=0.012), and ADC mode (r=−0.597, P=0.009). ADC histogram analysis and volume-based metabolic 18F-FDG-PET parameters are related to each other in cervical cancer.

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Section: Discussionmentioning

confidence: 99%

Cervical Cancer: Associations between Metabolic Parameters and Whole Lesion Histogram Analysis Derived from Simultaneous ¹⁸F-FDG-PET/MRI

Meyer¹,

Purz

Sabri

2018

Contrast Media & Molecular Imaging

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“…SUVmax primary cervical tumour is the most commonly used metabolic parameter in current routine practice and its prognostic benefit in the management of cervical cancers has been extensively described in the literature (17,(25)(26)(27)(28). The prognostic value of primary cervical tumour MTV and TLG has been also investigated in several studies (29)(30)(31)(32)(33).…”

Section: Discussionmentioning

confidence: 99%

¹⁸F-FDG PET/CT Identifies Predictors of Survival in Patients with Locally Advanced Cervical Carcinoma and Paraaortic Lymph Node Involvement to Allow Intensification of Treatment

et al. 2020

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Introduction: To use positron emission tomography coupled with computed tomography (18 FDG-PET/CT) to identify a high-risk subgroup requiring therapeutic intensification among patients with locally advanced cervical cancer (LACC) and para-aortic lymph node (PALN) involvement. Methods: In this retrospective multicentric study, patients with LACC and PALN involvement concurrently treated with chemoradiotherapy and extended-field radiotherapy (EFR) between 2006 and 2016 were included. A senior nuclear medicine specialist in PET for gynaecologic oncology reviewed all 18 FDG-PET/CT scans. Metabolic parameters including maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) were determined for the primary tumour, pelvic lymph nodes and PALN. Associations between these parameters and overall survival (OS) were assessed with Cox's proportional hazards model. Results: Sixty-eight patients were enrolled in the study. Three-year OS was 55.5% (95% CI [40.8-68.0]). When adjusted for age, stage and histology, pelvic lymph node TLG, PALN TLG and PALN SUVmax were significantly associated with OS (p<0.005). Conclusion: FDG-PET/CT was able to identify predictors of survival in the homogeneous subgroup of patients with LACC and PALN involvement, thus allowing therapeutic intensification to be proposed.

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“…18 F-FDG-PET/CT, instead, is more sensitive in detecting lymph node metastases (pelvic, paraaortic, inguinal and supraclavicular) and peritoneum, mesentery, gastrointestinal tract, pleura and mediastinal involvement [26]. Therefore, both exams are useful in the treatment choice (surgery or CCRT), and in RT planning [27,28]. However, evidence on the evaluation of response to CCRT are weak, although this assessment has a crucial role to decide subsequent treatments [29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Predictive Role of MRI and 18F FDG PET Response to Concurrent Chemoradiation in T2b Cervical Cancer on Clinical Outcome: A Retrospective Single Center Study

Perrone

Dondi

Coe

et al. 2020

Cancers

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Tumor response in locally advanced cervical cancer (LACC) is generally evaluated with MRI and PET, but this strategy is not supported by the literature. Therefore, we compared the diagnostic performance of these two techniques in the response evaluation to concurrent chemoradiotherapy (CCRT) in LACC. Patients with cervical cancer (CC) stage T2b treated with CCRT and submitted to MRI and PET/CT before and after treatment were enrolled in the study. All clinical, pathological, therapeutic, radiologic and follow-up data were collected and examined. The radiological response was analyzed and compared to the follow-up data. Data of 40 patients with LACC were analyzed. Agreement between MRI and PET/CT in the evaluation response to therapy was observed in 31/40 (77.5%) of cases. The agreement between MRI, PET/CT and follow-up data showed a Cohen kappa coefficient of 0.59 (95% CI = 0.267–0.913) and of 0.84 (95% CI = 0.636–1.00), respectively. Considering the evaluation of primary tumor response, PET/CT was correct in 97.5% of cases, and MRI in 92.5% of cases; no false negative cases were observed. These results suggest the use of PET/CT as a unique diagnostic imaging tool after CCRT, to correctly assess residual and progression disease.

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Prognostic Impact of Pretreatment Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography SUVmax in Patients With Locally Advanced Cervical Cancer

Abstract: We found that T SUVmax, stage, and para-aortic lymph node status assessed by FDG-PET were independent prognostic factors of DFS, whereas only T SUVmax correlated with OS.

Cited by 28 publications

References 9 publications

Cervical Cancer: Associations between Metabolic Parameters and Whole Lesion Histogram Analysis Derived from Simultaneous ¹⁸F-FDG-PET/MRI

Cervical Cancer: Associations between Metabolic Parameters and Whole Lesion Histogram Analysis Derived from Simultaneous ¹⁸F-FDG-PET/MRI

¹⁸F-FDG PET/CT Identifies Predictors of Survival in Patients with Locally Advanced Cervical Carcinoma and Paraaortic Lymph Node Involvement to Allow Intensification of Treatment

Predictive Role of MRI and 18F FDG PET Response to Concurrent Chemoradiation in T2b Cervical Cancer on Clinical Outcome: A Retrospective Single Center Study

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Prognostic Impact of Pretreatment Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography SUVmax in Patients With Locally Advanced Cervical Cancer

Abstract: We found that T SUVmax, stage, and para-aortic lymph node status assessed by FDG-PET were independent prognostic factors of DFS, whereas only T SUVmax correlated with OS.

Cited by 28 publications

References 9 publications

Cervical Cancer: Associations between Metabolic Parameters and Whole Lesion Histogram Analysis Derived from Simultaneous 18F-FDG-PET/MRI

Cervical Cancer: Associations between Metabolic Parameters and Whole Lesion Histogram Analysis Derived from Simultaneous 18F-FDG-PET/MRI

18F-FDG PET/CT Identifies Predictors of Survival in Patients with Locally Advanced Cervical Carcinoma and Paraaortic Lymph Node Involvement to Allow Intensification of Treatment

Predictive Role of MRI and 18F FDG PET Response to Concurrent Chemoradiation in T2b Cervical Cancer on Clinical Outcome: A Retrospective Single Center Study

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Cervical Cancer: Associations between Metabolic Parameters and Whole Lesion Histogram Analysis Derived from Simultaneous ¹⁸F-FDG-PET/MRI

Cervical Cancer: Associations between Metabolic Parameters and Whole Lesion Histogram Analysis Derived from Simultaneous ¹⁸F-FDG-PET/MRI

¹⁸F-FDG PET/CT Identifies Predictors of Survival in Patients with Locally Advanced Cervical Carcinoma and Paraaortic Lymph Node Involvement to Allow Intensification of Treatment