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Prediction of treatment response in patients with locally advanced cervical cancer using midtreatment PET/MRI during concurrent chemoradiotherapy

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Abstract

Purpose

We aimed to find metabolic, functional or morphological characteristics of the tumor predicting failure to achieve complete metabolic remission (CMR) by the midtreatment PET/MRI (positron emission tomography/magnetic resonance imaging) in cervical cancer patients.

Methods

We evaluated 66 patients treated between August 2015 and November 2019 who underwent pretreatment staging, subsequent midtreatment evaluation, and definitive restaging 3 months after completing the whole treatment, all using PET/MRI. The pretreatment parameters (pre-SUVmax, pre-SUVmean, pre-MTV, pre-MTV‑S, pre-TLG, pre-TLG‑S [SUV: standard uptake value, MTV: metabolic tumor volume, TLG: total lesion glycolysis]), and the midtreatment parameters at week 5 during chemoradiotherapy (mid-SUVmax, mid-SUVmean, mid-MTV, mid-MTV‑S, mid-TLG and mid-TLG-S) were recorded. The value of ADC (apparent diffusion coefficient) was also measured. Furthermore, we recorded absolute and relative changes in all parameters—∆ and ∆%. We divided the whole group of patients into “responders” (CMR) and “non-responders” (non-CMR), and compared them on the basis of the parameters from pre-PET/MRI and mid-PET/MRI.

Results

A statistically significant difference in the evaluated parameters between responders and non-responders was found for the following parameters: mid-MTV, mid-TLG, mid-TLG‑S, mid-MTV‑S, mid-tumor size, and ∆%SUVmax. According to the ROC (receiver operating characteristic) analysis, mid-MTV‑S showed the best albeit moderate discrimination ability for the prediction of non-CMR. Significant mutual correlations of all variables, in particular between mid-MTV‑S and mid-TLG‑S and between mid-MTV and mid-TLG, were found (all p < 0.05).

Conclusion

Our study confirmed that when using the midtreatment PET/MRI we are able to identify metabolic parameters having the discrimination ability for the prediction of non-CMR. In particular mid-MTV‑S, mid-MTV, mid-tumor size, mid-TLG‑S, mid-TLG and ∆%SUVmax.

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Funding

This study was supported by UNCE/MED/006 Charles University—Center of Clinical and Experimental Liver Surgery, and from the European Regional Development Fund Project “Application of Modern Technologies in Medicine and Industry” (No. CZ.02.1.01/0.0/0.0/17_048/0007280)

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Authors and Affiliations

  1. Department of Oncology and Radiotherapy, Charles University in Prague, Faculty of Medicine and University Hospital in Pilsen, alej Svobody 80, 30460, Pilsen, Czech Republic

    Radovan Vojtíšek MD, PhD, Petra Kovářová MD, Emília Sukovská MD &  Jindřich Fínek MD, PhD, MHA

  2. Department of Imaging Methods, Charles University in Prague, Faculty of Medicine and University Hospital in Pilsen, alej Svobody 80, 30460, Pilsen, Czech Republic

    Jan Baxa MD, PhD, Amira Almortaza MD, Radek Tupý MD, MSc., PhD &  Jiří Ferda MD, PhD

  3. Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alej Svobody 76, 32300, Pilsen, Czech Republic

    Petr Hošek MSc., PhD

Authors
  1. Radovan Vojtíšek MD, PhD
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  2. Jan Baxa MD, PhD
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  5. Petr Hošek MSc., PhD
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  6. Emília Sukovská MD
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  8. Jiří Ferda MD, PhD
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  9. Jindřich Fínek MD, PhD, MHA
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Corresponding author

Correspondence to Radovan Vojtíšek MD, PhD.

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Conflict of interest

R. Vojtíšek, J. Baxa, P. Kovářová, A. Almortaza, P. Hošek, E. Sukovská, R. Tupý, J. Ferda and J. Fínek declare that they have no competing interests.

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This is an observational study. The local ethics committee confirmed that no ethical approval is required.

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Vojtíšek, R., Baxa, J., Kovářová, P. et al. Prediction of treatment response in patients with locally advanced cervical cancer using midtreatment PET/MRI during concurrent chemoradiotherapy. Strahlenther Onkol 197, 494–504 (2021). https://doi.org/10.1007/s00066-020-01740-7

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