title: Prognostic value of 18F-fluorodeoxyglucose uptake in pelvic lymph nodes in patients with cervical cancer treated with definitive chemoradiotherapy.
abstract: OBJECTIVE
  To evaluate the prognostic significance of the maximum standardized uptake (SUVmax) value for pelvic lymph nodes in patients with cervical cancer and its impact on treatment response, disease control, and survival.
  
  
  METHODS
  Ninety-three patients with pelvic or para-aortic metastasis detected by PET/CT and treated with definitive chemoradiotherapy were evaluated. The impact of pelvic lymph node SUVmax on prognostic factors and treatment outcomes was assessed.
  
  
  RESULTS
  The size and SUVmax of pelvic lymph nodes were significantly correlated (r=0.859; p<0.001). Patients with pelvic and para-aortic lymph node metastases had significantly higher SUVmax values for both primary tumor (23.4±9.2 vs. 18.5±7.3; p=0.01) and pelvic lymph nodes (11.4±4.6 vs. 7.4±3.8; p=0.001). Patients with pelvic lymph node SUVmax≥7.5 had significantly higher primary tumor SUVmax, larger pelvic lymph nodes, higher rates of para-aortic lymph node metastasis, and lower post-therapy complete response rates. Overall survival (OS) and disease-free survival (DFS) rates were significantly higher in patients with SUVmax<7.5 compared to patients with SUVmax≥7.5. In a multivariate analysis, pelvic lymph node SUVmax and post-therapy metabolic response were significant prognostic factors for both OS and DFS for all patients, but no significant prognostic factors were found in pelvic lymph node metastasis only.
  
  
  CONCLUSIONS
  Patients with highly FDG-avid pelvic lymph nodes have a higher risk of disease recurrence with worse survival. Identification of these patients may assist in the evaluation of the clinical benefits of additional treatments.
authors: Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey. Electronic address: hcemonal@hotmail.com.
authors: Cem
authors: C
authors: Onal
authors: Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey.
authors: Ozan C
authors: OC
authors: Guler
authors: Department of Nuclear Medicine, Baskent University Faculty of Medicine, Ankara, Turkey.
authors: Mehmet
authors: M
authors: Reyhan
authors: Department of Nuclear Medicine, Baskent University Faculty of Medicine, Ankara, Turkey.
authors: Ali Fuat
authors: AF
authors: Yapar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000378:metabolism*; D008875:Middle Aged; D064847:Multimodal Imaging; D010388:Pelvis; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000628:therapy*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Cervical cancer; Chemoradiotherapy; Lymph node metastasis; Positron emission tomography