Cancer Res Treat.  2021 Jul;53(3):803-812. 10.4143/crt.2020.1251.

Early Metabolic Response Assessed Using ¹⁸F-FDG-PET/CT for Image-Guided Intracavitary Brachytherapy Can Better Predict Treatment Outcomes in Patients with Cervical Cancer

• Kim N
• Park W
• Cho WK
• Bae DS
• Kim BG
• Lee JW
• Kim TJ
• Choi CH
• Lee YY
• Cho YS

• KMID: 2518404
• DOI: http://doi.org/10.4143/crt.2020.1251

Abstract

Purpose
This study aimed to identify the prognostic value of early metabolic response assessed using ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) during radiation therapy (RT) for cervical cancer.
Materials and Methods
We identified 116 patients treated with definitive RT, including FDG-PET/CT–guided intracavitary brachytherapy, between 2009 and 2018. We calculated parameters including maximum (SUV_max) and mean standardized uptake values (SUV_mean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for baseline FDG-PET/CT (PET_base) and image-guided brachytherapy planning FDG-PET/CT (PET_IGBT). Multivariable analyses of disease-free survival (DFS) and overall survival (OS) were performed.
Results
We observed a time-dependent decrease in PET parameters between PET_base and PET_IGBT; ΔSUV_max, ΔSUV_mean, ΔMTV, and ΔTLG were 65%, 61%, 78%, and 93%, respectively. With a median follow-up of 59.5 months, the 5-year DFS and OS rates were 66% and 79%, respectively. Multivariable analysis demonstrated that ΔSUV_max ≥ 50% was associated with favorable DFS (hazard ratio [HR], 2.56; 95% confidence interval [CI], 1.14 to 5.77) and OS (HR, 5.14; 95% CI, 1.55 to 17.01). Patients with ΔSUV_max ≥ 50% (n=87) showed better DFS and OS than those with ΔSUV_max < 50% (n=29) (DFS, 76% vs. 35%, p < 0.001; OS, 90% vs. 41%, p < 0.001, respectively). Adenocarcinoma was frequently observed in ΔSUV_max < 50% compared to ΔSUV_max ≥ 50% (27.6% vs. 10.3%, p=0.003). In addition, models incorporating metabolic parameters showed improved accuracy for predicting DFS (p=0.012) and OS (p=0.004) than models with clinicopathologic factors.
Conclusion
Changes in metabolic parameters, especially those in SUV_max by > 50%, can help improve survival outcome predictions for patients with cervical cancer treated with definitive RT.

Keyword

Uterine cervical neoplasms; Fluorodeoxyglucose F18; Radiotherapy; Image-guided brachytherapy

Figure

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  Fig. 1 Metabolic parameters of the primary tumor in PETbase and PETIGBT: SUVmax (A), SUVmean (B), MTV (C), and TLG (D). FDG-PET/CT, 18F-fluorodeoxyglucose positron emission tomography/computed tomography; MTV, metabolic tumor volume; PETbase, baseline FDG-PET/CT; PETIGBT, image-guided brachytherapy planning FDG-PET/CT; SUVmax, maximum standardized uptake value; SUVmean, mean standardized uptake value; TLG, total lesion glycolysis.

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  Fig. 2 Kaplan-Meier curves of disease-free survival (DFS) and overall survival (OS) outcomes for all patients.

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  Fig. 3 Clinical outcomes according to the reduction in maximum standardized uptake value (SUVmax): disease-free survival (A) and overall survival (B).

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  Fig. 4 Metabolic parameters of primary tumor in PETbase and PETIGBT according to ΔSUVmax of 50%: SUVmax (A), SUVmean (B), MTV (C), and TLG (D). FDG-PET/CT, 18F-fluorodeoxyglucose positron emission tomography/computed tomography; MTV, metabolic tumor volume; PETbase, baseline FDG-PET/CT; PETIGBT, image-guided brachytherapy planning FDG-PET/CT; SUVmax, maximum standardized uptake value; SUVmean, mean standardized uptake value; TLG, total lesion glycolysis.

Reference

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