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Metabolic parameters of [18F]FDG PET-CT before and after radiotherapy may predict survival and recurrence in cervical cancer

Markus, Maria LU ; Sartor, Hanna LU ; Bjurberg, Maria LU and Trägårdh, Elin LU (2023) In Acta Oncologica 62(2). p.180-188
Abstract

Background: Cervical cancer is the fourth most common female malignancy. [18F]-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET-CT) is routinely performed in patients with locally advanced cervical cancer for staging and treatment response evaluation. With this retrospective, observational cohort study, we wanted to investigate the prognostic value of the maximum standardised uptake value (SUVmax) and the volumetric parameters of metabolic tumour volume (MTV) and total lesion glycolysis (TLG) before and after treatment in women with cervical cancer, with overall survival (OS) and recurrence as outcome measures. Methods: Women with cervical cancer referred for curative radiotherapy and who... (More)

Background: Cervical cancer is the fourth most common female malignancy. [18F]-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET-CT) is routinely performed in patients with locally advanced cervical cancer for staging and treatment response evaluation. With this retrospective, observational cohort study, we wanted to investigate the prognostic value of the maximum standardised uptake value (SUVmax) and the volumetric parameters of metabolic tumour volume (MTV) and total lesion glycolysis (TLG) before and after treatment in women with cervical cancer, with overall survival (OS) and recurrence as outcome measures. Methods: Women with cervical cancer referred for curative radiotherapy and who underwent two PET-CT scans (before treatment and approximately 7 months post-treatment) were included. SUVmax, MTV and TLG were measured at baseline and post-treatment on the primary tumour, pelvic and distant lymph node metastases, distant organ metastases, and on total tumour burden. The PET parameters were associated with OS by Cox regression and recurrence by multivariable logistic regression. Kaplan-Meier curves and C-index were used to visualise the prognostic potential of the different measures. Results: A total of 133 patients were included. At the primary tumour level and on total tumour burden, age- and clinical-stage adjusted analyses showed a significant association between PET parameters and OS and recurrence when measured post-treatment. At baseline (pre-treatment), MTV and TLG were associated with OS and recurrence, whereas SUVmax was not. C-index from adjusted Cox models on total tumour burden showed higher values for the post-treatment PET compared to baseline. Kaplan-Meier curves demonstrated a greater prognostic potential for MTV and TLG compared to SUVmax, both at baseline and post-treatment. Conclusions: The FDG PET-CT-derived parameters SUVmax, MTV, and TLG measured post-treatment can predict OS and recurrence in cervical cancer. Parameters measured before treatment had overall lower prognostic potential, and only MTV and TLG showed significant association to OS and recurrence.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cervical cancer, FDG PET-CT, positron emission tomography, prognostic value
in
Acta Oncologica
volume
62
issue
2
pages
180 - 188
publisher
Taylor & Francis
external identifiers
  • scopus:85148641341
  • pmid:36815676
ISSN
0284-186X
DOI
10.1080/0284186X.2023.2181100
language
English
LU publication?
yes
id
ed3daa67-9d5c-46d4-a814-86d004c4ce6d
date added to LUP
2023-03-13 12:45:34
date last changed
2024-06-14 00:32:11
@article{ed3daa67-9d5c-46d4-a814-86d004c4ce6d,
  abstract     = {{<p>Background: Cervical cancer is the fourth most common female malignancy. [<sup>18</sup>F]-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET-CT) is routinely performed in patients with locally advanced cervical cancer for staging and treatment response evaluation. With this retrospective, observational cohort study, we wanted to investigate the prognostic value of the maximum standardised uptake value (SUVmax) and the volumetric parameters of metabolic tumour volume (MTV) and total lesion glycolysis (TLG) before and after treatment in women with cervical cancer, with overall survival (OS) and recurrence as outcome measures. Methods: Women with cervical cancer referred for curative radiotherapy and who underwent two PET-CT scans (before treatment and approximately 7 months post-treatment) were included. SUVmax, MTV and TLG were measured at baseline and post-treatment on the primary tumour, pelvic and distant lymph node metastases, distant organ metastases, and on total tumour burden. The PET parameters were associated with OS by Cox regression and recurrence by multivariable logistic regression. Kaplan-Meier curves and C-index were used to visualise the prognostic potential of the different measures. Results: A total of 133 patients were included. At the primary tumour level and on total tumour burden, age- and clinical-stage adjusted analyses showed a significant association between PET parameters and OS and recurrence when measured post-treatment. At baseline (pre-treatment), MTV and TLG were associated with OS and recurrence, whereas SUVmax was not. C-index from adjusted Cox models on total tumour burden showed higher values for the post-treatment PET compared to baseline. Kaplan-Meier curves demonstrated a greater prognostic potential for MTV and TLG compared to SUVmax, both at baseline and post-treatment. Conclusions: The FDG PET-CT-derived parameters SUVmax, MTV, and TLG measured post-treatment can predict OS and recurrence in cervical cancer. Parameters measured before treatment had overall lower prognostic potential, and only MTV and TLG showed significant association to OS and recurrence.</p>}},
  author       = {{Markus, Maria and Sartor, Hanna and Bjurberg, Maria and Trägårdh, Elin}},
  issn         = {{0284-186X}},
  keywords     = {{cervical cancer; FDG PET-CT; positron emission tomography; prognostic value}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{180--188}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Oncologica}},
  title        = {{Metabolic parameters of [<sup>18</sup>F]FDG PET-CT before and after radiotherapy may predict survival and recurrence in cervical cancer}},
  url          = {{http://dx.doi.org/10.1080/0284186X.2023.2181100}},
  doi          = {{10.1080/0284186X.2023.2181100}},
  volume       = {{62}},
  year         = {{2023}},
}