title: Metabolic response of lymph nodes immediately after RT is related with survival outcome of patients with pelvic node-positive cervical cancer using consecutive [18F]fluorodeoxyglucose-positron emission tomography/computed tomography.
abstract: OBJECTIVE
  To evaluate the metabolic response of uterine cervix and pelvic lymph nodes (LNs) using consecutive 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) immediately after RT and to correlate survival outcome with the metabolic response.
  
  
  METHODS
  We retrospectively reviewed 48 patients with cervical cancer who had positive pelvic LNs by preradiation therapy (pre-RT) PET/CT. All patients underwent PET/CT scans immediately after RT (inter-RT PET/CT) after median 63 Gy to the gross LNs. The metabolic response of the LNs was assessed quantitatively and semiquantitatively by measurement of the maximal standardized uptake value (SUVmax).
  
  
  RESULTS
  Classifying the metabolic response of all nodal lesions, 37 patients (77%) had LNs with complete metabolic response on the inter-RT PET/CT (LNCMRi), and 11 patients had a non-LNCMRi, including 4 patients with progressive metabolic disease. The overall 3-year survival rates were 83% for the patients with LNCMRi and 73% for the non-LNCMRi group (P=.038). The disease-free survival for patients with LNCMRi were significantly better than that for the non-LNCMRi group (71% vs 18%, respectively, P<.001). The 3-year distant metastasis-free survival rates were 79% for the patients with LNCMRi and 27% for the non-LNCMRi group (P<.001). There were no statistically significant differences in overall survival (76% vs 86%, respectively, P=.954) and disease-free survival rates (58% vs 61%, respectively, P=.818) between the CMR of primary cervical tumor and the non-CMR groups.
  
  
  CONCLUSIONS
  The results showed a significant correlation between survival outcome and the interim metabolic response of pelvic LNs. CMR of nodal lesion on inter-RT PET/CT had excellent overall survival, disease-free survival and distant metastasis-free survival rates. This suggested that PET/CT immediately after RT can be a useful tool for the evaluation of the interim response of the LNs and identify a subset of patients with a high risk of recurrence and poor survival in patients with cervical cancer with initial positive LNs.
authors: Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea.
authors: Mee Sun
authors: MS
authors: Yoon
authors: Sung-Ja
authors: SJ
authors: Ahn
authors: Byung-Sik
authors: BS
authors: Nah
authors: Woong-Ki
authors: WK
authors: Chung
authors: Ho-Chun
authors: HC
authors: Song
authors: Su Woong
authors: SW
authors: Yoo
authors: Ju-Young
authors: JY
authors: Song
authors: Jae-Uk
authors: JU
authors: Jeong
authors: Taek-Keun
authors: TK
authors: Nam
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000378:metabolism / Q000528:radiation effects; D059248:Chemoradiotherapy / Q000379:methods; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000528:radiation effects*; D015182:Lymphatic Irradiation; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D010388:Pelvis; D049268:Positron-Emission Tomography; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D011838:Radiation-Sensitizing Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002945:Cisplatin