title: Prospective evaluation of qualitative and quantitative ¹⁸F-FDG PET-CT parameters for predicting survival in recurrent carcinoma of the cervix.
abstract: OBJECTIVE
  The aim of this study was to evaluate the prognostic significance of qualitative and quantitative F-fluorodeoxyglucose (F-FDG) PET-computed tomography (PET-CT) parameters in patients with recurrent cervical carcinoma.
  
  
  METHODS
  Twenty-six patients (age: 44 ± 10.1 years) with histologically proven recurrent carcinoma of the cervix (squamous, 21; adenocarcinoma, five) were prospectively enrolled and they underwent F-FDG PET-CT before salvage therapy. The qualitative parameters included for analysis were vaginal involvement, regional nodal metastasis, and distant metastasis on PET-CT. The quantitative PET-CT parameters included were standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Cutoff values were determined using receiver operating characteristic curve analysis. A Kaplan-Meier analysis was carried out to compare survival among groups. Impact of PET-CT parameters on progression-free survival (PFS) and overall survival (OS) was evaluated using Cox proportional hazard regression.
  
  
  RESULTS
  On PET-CT, vaginal involvement was seen in 16 patients, regional nodal metastasis in 12 patients, and distant metastasis (node and lung) in 11 patients. The mean SUVmax was 6.8 ± 4, MTV was 8.2 ± 12.8 ml, and TLG was 49.6 ± 108.4 ml. On multivariate analysis, SUVmax of up to 4.9 [hazard ratio (HR): 0.026, confidence interval (CI): 0.002-0.268, P=0.002] and distant metastasis (HR: 18.88, CI: 2.14-166.24, P=0.008) were independent predictors of PFS. On multivariate analysis, SUVmax greater than 9 (HR: 19.25, CI: 2.15-172.17, P=0.008) and distant metastasis (HR: 33.88, CI: 2.17-526.61, P=0.012) were also independent predictors of OS. MTV, TLG, and regional node involvement evaluated using PET-CT were found to be significant on univariate analysis but not on multivariate analysis.
  
  
  CONCLUSIONS
  SUVmax and the presence of distant metastasis on F-FDG PET-CT are independent predictors of PFS and OS in patients with recurrent cervical carcinoma.
authors.affiliation: Departments of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sagar
authors.initials: S
authors.lastname: Maharjan
authors.forename: Punit
authors.initials: P
authors.lastname: Sharma
authors.forename: Chetan D
authors.initials: CD
authors.lastname: Patel
authors.forename: Daya N
authors.initials: DN
authors.lastname: Sharma
authors.forename: Varun S
authors.initials: VS
authors.lastname: Dhull
authors.forename: Sunesh K
authors.initials: SK
authors.lastname: Jain
authors.forename: Sanjay
authors.initials: S
authors.lastname: Thulkar
authors.forename: Arun
authors.initials: A
authors.lastname: Malhotra
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging*
chemical_list: D019788:Fluorodeoxyglucose F18