Metabolic response on post-therapy FDG-PET predicts patterns of failure after radiotherapy for cervical cancer.
OBJECTIVE
To determine the patterns of failure in patients with cervical cancer treated with definitive radiotherapy and evaluated for metabolic response with early posttherapy (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET).


METHODS
The records of 238 patients with cervical cancer were reviewed. All patients were treated with a combination of external radiotherapy and intracavitary brachytherapy. Two hundred and nineteen patients (92%) received concurrent chemotherapy. All patients underwent pretreatment FDG-PET, and posttherapy FDG-PET was performed within 8-16 weeks of the completion of radiotherapy. Posttherapy FDG-PET results were categorized as complete metabolic response (CMR), partial metabolic response (PMR), and progressive disease (PD). Failure patterns were categorized as none, isolated local failure (central pelvis ± pelvic lymph nodes), distant failure, or combined local plus distant failure.


RESULTS
Of the 91 patients (38%) who had a recurrence, 22 had isolated local failures, and 69 had distant failures (49 distant failures and 20 combined local plus distant failures). Of the 173 patients with a CMR, 40 (23%) experienced treatment failure. All 25 patients with PD experienced treatment failure, which was distant in 24 patients (96%). Among the 40 patients with PMR, no failure has been observed for 14 patients (35%). Of the 26 failures within the PMR group, 15 (58%) were limited to the pelvis. Differences in the patterns of failure between the three groups (CMR, PMR, PD) were statistically significant (chi-square test; p < 0.0001).


CONCLUSIONS
The majority of failures after definitive radiotherapy for cervical cancer include distant failures, even in the setting of concurrent chemotherapy. PMR within the cervix or lymph nodes is more commonly associated with isolated local recurrence.
Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA. jschwarz@radonc.wustl.edu
Julie K
JK
Schwarz
Barry A
BA
Siegel
Farrokh
F
Dehdashti
Perry W
PW
Grigsby
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism / Q000532:radiotherapy; D018262:Adenocarcinoma, Clear Cell / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism / Q000532:radiotherapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018196:Carcinoma, Adenosquamous / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism / Q000532:radiotherapy; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism / Q000532:radiotherapy; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000378:metabolism; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics*; D011879:Radiotherapy Dosage; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism* / Q000532:radiotherapy*; D014599:Uterus / Q000000981:diagnostic imaging / Q000378:metabolism; D055815:Young Adult
D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002945:Cisplatin