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Utility of 18F-FDG PET/CT in patients with advanced squamous cell carcinoma of the uterine cervix receiving concurrent chemoradiotherapy: a parallel study of a prospective randomized trial

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Abstract

Purpose

The aim of this prospective study was to assess the usefulness of 18F-FDG PET/CT performed before and during treatment for predicting treatment failure in patients with advanced squamous cell carcinoma of the uterine cervix treated with concurrent chemoradiotherapy (CCRT).

Methods

Patients with cervical squamous cell carcinoma, International Federation of Gynecology and Obstetrics stage III/IVA or positive pelvic or paraaortic lymph node (LN) metastasis without other distant metastasis on PET/CT entering a randomized trial of CCRT (AGOG 09-001) were eligible. PET/CT scans were performed at baseline, during week 3 of CCRT and 2 − 3 months after CCRT. PET/CT parameters were correlated with sites of failure and overall survival (OS). The resulting predictors developed from the study cohort were validated on two independent datasets using area under the curve values, sensitivities and specificities.

Results

With a median follow-up of 54 months for survivors, 20 (36 %) of the 55 eligible patients were proven to have treatment failure. Sites of failure were local in five, regional in 11, and distant in 11. Four predictors for local failure, three for regional failure, and four for distant failures were identified. After validation with two independent cohorts of 31 and 105 patients, we consider the following as clinically useful predictors: pretreatment metabolic tumour volume (MTV) and during-treatment cervical tumour MTV for local failure; during-treatment SUVnode (maximum standardized uptake value of LNs) for regional and distant failure, and during-treatment MTV for distant failure. During-treatment SUVnode (P = .001) and cervical tumour MTVratio (P = .004) were independent significant predictors of OS by stepwise Cox regression.

Conclusion

PET/CT imaging before and during treatment is useful for predicting failure sites and OS, making tailored therapeutic modifications feasible with potential outcome improvement during primary therapy.

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Author notes

    Authors and Affiliations

    1. Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5, Fu-Shin St., Gueishan Township, Taoyuan County, 33305, Taiwan

      Feng-Yuan Liu, Yu-Chen Chang & Tzu-Chen Yen

    2. Gynecologic Cancer Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

      Feng-Yuan Liu, Chyong-Huey Lai, Chun-Chieh Wang, Gigin Lin, Ji-Hong Hong, Angel Chao, Hung-Hsueh Chou, Yu-Chen Chang & Tzu-Chen Yen

    3. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

      Chyong-Huey Lai, Angel Chao & Hung-Hsueh Chou

    4. Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

      Lan-Yan Yang & Wei-Yang Chang

    5. Data Management and Biostatistical Core, Asian Gynecologic Oncology Group, Taoyuan, Taiwan

      Lan-Yan Yang & Chee-Jen Chang

    6. Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

      Chun-Chieh Wang & Ji-Hong Hong

    7. Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

      Gigin Lin

    8. Research Center of Clinical Informatics and Medical Statistics, Chang Gung University, Taoyuan, Taiwan

      Chee-Jen Chang

    9. Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

      Shu-Hua Huang

    10. Department of Nuclear Medicine, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan

      Yu-Erh Huang

    11. Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

      Nan-Jing Peng

    12. Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan

      Yu-Chen Chang

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    1. Feng-Yuan Liu
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    2. Chyong-Huey Lai
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    15. Tzu-Chen Yen
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    Corresponding author

    Correspondence to Tzu-Chen Yen.

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    Funding

    This study was funded by Chang Gung Memorial Hospital-Linkou (CMRPG381141 and CMRPG381142) and the Ministry of Health and Welfare-Taiwan (DOH101-TD-B-111-005, DOH102-TD-B-111-005, and DOHW103-TDU-B-212-113003).

    Conflicts of interest

    None.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

    Informed consent

    Informed consent was obtained from all individual participants included in the study.

    Additional information

    Feng-Yuan Liu, Chyong-Huey Lai and Lan-Yan Yang contributed equally to this work.

    A related abstract (OP460) has been previously published in the EANM’15 abstract book from the 28th Annual EANM Congress of the European Association of Nuclear Medicine (Eur J Nucl Med Mol Imaging. 2015;42:S191).

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    Cite this article

    Liu, FY., Lai, CH., Yang, LY. et al. Utility of 18F-FDG PET/CT in patients with advanced squamous cell carcinoma of the uterine cervix receiving concurrent chemoradiotherapy: a parallel study of a prospective randomized trial. Eur J Nucl Med Mol Imaging 43, 1812–1823 (2016). https://doi.org/10.1007/s00259-016-3384-7

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    • DOI: https://doi.org/10.1007/s00259-016-3384-7

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