Association of posttherapy positron emission tomography with tumor response and survival in cervical carcinoma.
BACKGROUND
Retrospective studies have demonstrated that the use of positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) in the posttherapy evaluation of patients with cervical carcinoma is predictive of survival outcome.


OBJECTIVE
To validate the association between the metabolic response on the 3-month posttherapy FDG-PET and long-term survival outcome.


METHODS
A prospective cohort study designed to validate our previous finding that the results of a 3-month posttherapy FDG-PET are predictive of long-term clinical outcome. A total of 92 women were treated with external irradiation, brachytherapy, and concurrent chemotherapy from January 2003 through September 2006. Posttherapy whole-body FDG-PET was performed 2 to 4 months (mean, 3 months) after completion of therapy.


METHODS
The primary outcome end points were metabolic response, progression-free survival, and cause-specific survival.


RESULTS
Posttherapy FDG-PET showed a complete metabolic response in 65 patients (70%), a partial metabolic response in 15 (16%), and progressive disease in 12 (13%). Their 3-year progression-free survival rates were 78%, 33%, and 0%, respectively (P < .001). Multivariate analysis demonstrated that the hazard ratio (HR) for risk of recurrence based on the posttherapy metabolic response showing progressive disease was 32.57 (95% confidence interval [CI], 10.22-103.82). A partial metabolic response had an HR of 6.30 (95% CI, 2.73-14.56). These were more predictive of survival outcome than the pretreatment lymph node status (HR, 3.54; 95% CI, 1.54-8.09).


CONCLUSIONS
In this single-site study population of women with cervical cancer, 3-month posttherapy FDG uptake, as detected by whole-body PET, was predictive of survival.
Schwarz
Julie K
JK
Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Siegel
Barry A
BA
Dehdashti
Farrokh
F
Grigsby
Perry W
PW
D000328:Adult; D015331:Cohort Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D016879:Salvage Therapy; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18