Skip to main content
SpringerLink
Log in

Early response of patients undergoing concurrent chemoradiotherapy for cervical cancer: a comparison of PET/CT and MRI

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

To investigate the efficacy of positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) for early response evaluation of cervical cancer patients undergoing concurrent chemoradiotherapy (CCRT).

Methods

Fifty-two patients were prospectively enrolled in the study. The pathologic findings were squamous cell carcinoma in 47 patients and adenocarcinoma in 5 patients. All patients underwent PET/CT and MRI scans before, during and within 1 month after completion of CCRT. The percent change in tumor volume during and after CCRT based on PET/CT and MRI images was compared.

Results

There were significant differences (p < 0.001) between the initial tumor volume and tumor volume during and after CCRT as measured by both PET/CT and MRI. During CCRT, the percent volume reduction based on PET/CT images was significantly greater than the percent volume reduction calculated from MRI images (p = 0.024). However, after the completion of CCRT, no significant differences were found in volume reduction as calculated based on PET/CT versus MRI images (p = 0.289). The percent volume reduction of adenocarcinomas was significantly smaller than that of squamous cell carcinomas based on both PET/CT (p = 0.041) and MRI images (p < 0.001).

Conclusions

Significant decreases in tumor volume were observed during and after CCRT in patients with cervical cancer. Tumor volume reduction on PET/CT images was greater than that on MRI images during CCRT. We suggest that early PET/CT as well as MRI scans could be taken during CCRT to evaluate tumor response and allow personalized treatment of cervical cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hricak H, Gatsonis C, Coakley FV, Snyder B, Reinhold C, Schwartz LH, et al. Early invasive cervical cancer: CT and MR imaging in preoperative evaluation—ACRIN/GOG comparative study of diagnostic performance and interobserver variability. Radiology. 2007;245:491–8.

    Article  PubMed  Google Scholar 

  2. Showalter TN, Miller TR, Huettner P, Rader J, Grigsby PW. 18F-fluorodeoxyglucose-positron emission tomography and pathologic tumor size in early-stage invasive cervical cancer. Int J Gynecol Cancer. 2009;19:1412–4.

    Article  PubMed  Google Scholar 

  3. Grigsby PW. The role of FDG-PET/CT imaging after radiation therapy. Gynecol Oncol. 2007;107:S27–9.

    Article  PubMed  Google Scholar 

  4. Schwarz JK, Siegel BA, Dehdashti F, Grigsby PW. Association of posttherapy positron emission tomography with tumor response and survival in cervical carcinoma. JAMA. 2007;298:2289–95.

    Article  PubMed  CAS  Google Scholar 

  5. Lin LL, Yang Z, Mutic S, Miller TR, Grigsby PW. FDG-PET imaging for the assessment of physiologic volume response during radiotherapy in cervix cancer. Int J Radiat Oncol Biol Phys. 2006;65:177–81.

    Article  PubMed  Google Scholar 

  6. Nam H, Park W, Huh SJ, Bae DS, Kim BG, Lee JH, et al. The prognostic significance of tumor volume regression during radiotherapy and concurrent chemoradiotherapy for cervical cancer using MRI. Gynecol Oncol. 2007;107:320–5.

    Article  PubMed  Google Scholar 

  7. Ma DJ, Zhu JM, Grigsby PW. Tumor volume discrepancies between FDG-PET and MRI for cervical cancer. Radiother Oncol. 2011;98:139–42.

    Article  PubMed  Google Scholar 

  8. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.

    Article  PubMed  CAS  Google Scholar 

  9. Hardt N, van Nagell JR, Hanson M, Donaldson E, Yoneda J, Maruyama Y. Radiation-induced tumor regression as a prognostic factor in patients with invasive cervical cancer. Cancer. 1982;49:35–9.

    Article  PubMed  CAS  Google Scholar 

  10. Hong JH, Chen MS, Lin FJ, Tang SG. Prognostic assessment of tumor regression after external irradiation for cervical cancer. Int J Radiat Oncol Biol Phys. 1992;22:913–7.

    Article  PubMed  CAS  Google Scholar 

  11. Jacobs AJ, Faris C, Perez CA, Kao MS, Galakatos A, Camel HM. Short-term persistence of carcinoma of the uterine cervix after radiation. An indicator of long-term prognosis. Cancer. 1986;57:944–50.

    Article  PubMed  CAS  Google Scholar 

  12. Mayr NA, Magnotta VA, Ehrhardt JC, Wheeler JA, Sorosky JI, Wen BC, et al. Usefulness of tumor volumetry by magnetic resonance imaging in assessing response to radiation therapy in carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys. 1996;35:915–24.

    Article  PubMed  CAS  Google Scholar 

  13. Schwarz JK, Lin LL, Siegel BA, Miller TR, Grigsby PW. 18-F-fluorodeoxyglucose-positron emission tomography evaluation of early metabolic response during radiation therapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2008;72:1502–7.

    Article  PubMed  Google Scholar 

  14. Kong FM, Frey KA, Quint LE, Ten Haken RK, Hayman JA, Kessler M, et al. A pilot study of [18F]fluorodeoxyglucose positron emission tomography scans during and after radiation-based therapy in patients with non-small-cell lung cancer. J Clin Oncol. 2007;36:3116–23.

    Article  Google Scholar 

  15. Wieder HA, Brücher BL, Zimmermann F, Becker K, Lordick F, Beer A, et al. Time course of tumor metabolic activity during chemoradiotherapy of esophageal squamous cell carcinoma and response to treatment. J Clin Oncol. 2004;22:900–8.

    Article  PubMed  CAS  Google Scholar 

  16. Hautzel H, Müller-Gärtner HW. Early changes in fluorine-18-FDG uptake during radiotherapy. J Nucl Med. 1997;38:1384–6.

    PubMed  CAS  Google Scholar 

  17. Hatano K, Sekiya Y, Araki H, Sakai M, Togawa T, Narita Y, et al. Evaluation of the therapeutic effect of radiotherapy on cervical cancer using magnetic resonance imaging. Int J Radiat Oncol Biol Phys. 1999;45:639–44.

    Article  PubMed  CAS  Google Scholar 

  18. Devic S, Tomic N, Faria S, Menard S, Lisbona R, Lehnert S. Defining radiotherapy target volumes using 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography: still a Pandora’s box? Int J Radiat Oncol Biol Phys. 2010;78:1555–62.

    Article  PubMed  Google Scholar 

  19. Miller T, Grigsby P. Measurement of tumor volume by PET to evaluate prognosis in patients with advanced cervical cancer treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2002;53:353–9.

    Article  PubMed  Google Scholar 

  20. Paulino AC, Koshy M, Howell R, Schuster D, Davis LW. Comparison of CT- and FDG-PET-defined gross tumor volume in intensity-modulated radiotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2005;61:1385–92.

    Article  PubMed  Google Scholar 

  21. Gien LT, Beauchemin MC, Thomas G. Adenocarcinoma: a unique cervical cancer. Gynecol Oncol. 2010;116:140–6.

    Article  PubMed  CAS  Google Scholar 

  22. Bjurberg M, Kjellén E, Ohlsson T, Bendahl PO, Brun E. Prediction of patient outcome with 2-deoxy-2-[18F]fluoro-d-glucose-positron emission tomography early during radiotherapy for locally advanced cervical cancer. Int J Gynecol Cancer. 2009;19:1600–5.

    Article  PubMed  Google Scholar 

  23. Kidd EA, Thomas M, Siegel BA, Dehdashti F, Grigsby PW. Changes in cervical cancer FDG uptake during chemoradiation and association with response. Int J Radiat Oncol Biol Phys. 2012 (Epub ahead of print).

Download references

Conflict of interest

The authors have no conflicts of interest in connection with this work.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea

    Jeong Eun Lee

  2. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul, 135-710, Korea

    Seung Jae Huh, Heerim Nam & Sang Gyu Ju

Authors
  1. Jeong Eun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seung Jae Huh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heerim Nam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sang Gyu Ju
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seung Jae Huh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, J.E., Huh, S.J., Nam, H. et al. Early response of patients undergoing concurrent chemoradiotherapy for cervical cancer: a comparison of PET/CT and MRI. Ann Nucl Med 27, 37–45 (2013). https://doi.org/10.1007/s12149-012-0659-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-012-0659-3

Keywords

Search

Navigation