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Changes on Midchemoradiation Therapy Fluorodeoxyglucose Positron Emission Tomography for Cervical Cancer Are Associated with Prognosis.

Publication ,  Journal Article
Carpenter, DJ; Jacobs, CD; Wong, TZ; Craciunescu, O; Chino, JP
Published in: Int J Radiat Oncol Biol Phys
October 1, 2019

PURPOSE: To assess whether radiographic and metabolic changes on midchemoradiation therapy (CRT) fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) for cervical cancer predict outcome. METHODS AND MATERIALS: Women with International Federation of Gynecology and Obstetrics stage IB1-IVB cervical cancer treated with concurrent cisplatin-based CRT and brachytherapy were enrolled on a single-institution prospective clinical trial; FDG-PET/CT was obtained before CRT and at 30 to 36 Gy. Max and mean standard uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) for the primary tumor and clinically involved lymph nodes from the pre-CRT and intra-CRT FDG-PET/CT were recorded. Clinical endpoints analyzed include overall survival (OS), disease-free survival (DFS), and rates of cervical recurrence (CR), nodal recurrence (NR), and distant metastasis (DM). FDG-PET/CT variables and other prognostic factors associated with clinical endpoints were identified via univariate Cox proportional hazards modeling and competing risk analysis. RESULTS: Thirty women were enrolled from 2012 to 2016. After a median follow-up of 24 months, 2-year rates of OS, DFS, DM, NR, and CR were 68% (95% confidence interval [CI], 51%-85%), 44% (95% CI, 26%-63%), 42% (95% CI, 23%-59%), 14% (95% CI, 4%-30%), and 10% (95% CI, 2%-24%), respectively. Intra-PET metrics and TLG across all PET scans were most consistently associated with OS, DFS, DM, and NR on univariate analysis. Intra-CRT TLG was associated with OS (hazard ratio [HR] 1.35; 95% CI, 1.15-1.55; P = .001), DFS (HR 1.19; 95% CI, 1.04-1.34; P = .018), and NR (HR 1.25; 95% CI, 1.10-1.40; P = .002). No absolute or relative changes between parameters of baseline and mid-CRT FDG-PET/CT were associated with disease outcomes on univariate analysis, with the exception of relative change in mean standard uptake values and CR (P = .004). CONCLUSIONS: In this group of patients with high-risk cervical cancer treated with CRT and brachytherapy, TLG and metabolic tumor volume on intra-CRT FDG-PET/CT was associated with OS. These metrics may provide an early signal for selective treatment intensification with either dose escalation or adjuvant chemotherapy.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

October 1, 2019

Volume

105

Issue

2

Start / End Page

356 / 366

Location

United States

Related Subject Headings

  • Young Adult
  • Uterine Cervical Neoplasms
  • Treatment Outcome
  • Radiotherapy, Intensity-Modulated
  • Radiotherapy Dosage
  • Radiopharmaceuticals
  • Radiation-Sensitizing Agents
  • Prospective Studies
  • Proportional Hazards Models
  • Prognosis
 

Citation

APA
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ICMJE
MLA
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Carpenter, D. J., Jacobs, C. D., Wong, T. Z., Craciunescu, O., & Chino, J. P. (2019). Changes on Midchemoradiation Therapy Fluorodeoxyglucose Positron Emission Tomography for Cervical Cancer Are Associated with Prognosis. Int J Radiat Oncol Biol Phys, 105(2), 356–366. https://doi.org/10.1016/j.ijrobp.2019.06.2506
Carpenter, David J., Corbin D. Jacobs, Terence Z. Wong, Oana Craciunescu, and Junzo P. Chino. “Changes on Midchemoradiation Therapy Fluorodeoxyglucose Positron Emission Tomography for Cervical Cancer Are Associated with Prognosis.Int J Radiat Oncol Biol Phys 105, no. 2 (October 1, 2019): 356–66. https://doi.org/10.1016/j.ijrobp.2019.06.2506.
Carpenter DJ, Jacobs CD, Wong TZ, Craciunescu O, Chino JP. Changes on Midchemoradiation Therapy Fluorodeoxyglucose Positron Emission Tomography for Cervical Cancer Are Associated with Prognosis. Int J Radiat Oncol Biol Phys. 2019 Oct 1;105(2):356–66.
Carpenter, David J., et al. “Changes on Midchemoradiation Therapy Fluorodeoxyglucose Positron Emission Tomography for Cervical Cancer Are Associated with Prognosis.Int J Radiat Oncol Biol Phys, vol. 105, no. 2, Oct. 2019, pp. 356–66. Pubmed, doi:10.1016/j.ijrobp.2019.06.2506.
Carpenter DJ, Jacobs CD, Wong TZ, Craciunescu O, Chino JP. Changes on Midchemoradiation Therapy Fluorodeoxyglucose Positron Emission Tomography for Cervical Cancer Are Associated with Prognosis. Int J Radiat Oncol Biol Phys. 2019 Oct 1;105(2):356–366.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

October 1, 2019

Volume

105

Issue

2

Start / End Page

356 / 366

Location

United States

Related Subject Headings

  • Young Adult
  • Uterine Cervical Neoplasms
  • Treatment Outcome
  • Radiotherapy, Intensity-Modulated
  • Radiotherapy Dosage
  • Radiopharmaceuticals
  • Radiation-Sensitizing Agents
  • Prospective Studies
  • Proportional Hazards Models
  • Prognosis