title: Use of Metabolic Parameters as Prognostic Factors During Concomitant Chemoradiotherapy for Locally Advanced Cervical Cancer.
abstract: OBJECTIVE
  To investigate the use of metabolic parameters as early prognostic factors during concomitant chemoradiotherapy for locally advanced cervix carcinoma (LACC).
  
  
  METHODS
  Between February 2008 and January 2012, 34 consecutive patients treated for LACC (International Federation of Gynecology and Obstetrics Staging System stage IB2-IVA) were included in a retrospective study. Treatment was standard of care: total dose of 45 Gy in 1.8 Gy per fraction with concurrent cisplatin followed by brachytherapy. 18F-FDG PET-CT modalities were performed before treatment and per-treatment (at 40 Gy). The analyzed parameters were: maximum standardized uptake value (SUVmax), SUVmax variations of the primary tumor between the 2 investigations (DSUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Survival was assessed according to early metabolic changes during chemoradiotherapy.
  
  
  RESULTS
  Median follow-up was 16 months (range, 5.3 to 32.4 mo). Median SUVmax before treatment was 13.15 (5.9 to 31) and was 5.05 (0 to 12) per-treatment. Median DSUVmax was 63.97% (0% to 100%). Median MTV before treatment was 44.16 mL (3.392 to 252.768 mL) and was 5.44 mL (0 to 69.88 mL) per-treatment. Median TLG before treatment was 249.82 mL (13.40 to 1931.10 mL) and was 20.14 mL (0 to 349.99 mL) per-treatment. At 40 Gy, SUVmax≥6, DSUVmax≤40%, MTV≥5.6 mL, and TLG≥21.6 mL were significantly associated with overall survival and progression-free survival reduction. MTV predicted progression with a sensitivity of 80% and a specificity of 87.5% and TLG with a sensitivity of 80% and a specificity of 83.3%.
  
  
  CONCLUSIONS
  PET-CT imaging could be useful as an early prognostic factor during treatment for LACC. MTV and TLG seem to provide better prognostic information than SUVmax and DSUVmax.
authors.affiliation: Departments of *Radiation Oncology §Statistics, Institut de Cancérologie de l'Ouest, Angers †Nuclear Medicine, Centre Jean Bernard ‡Department of Radiation Oncology, Centre Jean Bernard-Clinique Victor Hugo, Le Mans, France.
authors.forename: Samar
authors.initials: S
authors.lastname: Krhili
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Muratet
authors.forename: Sophie
authors.initials: S
authors.lastname: Roche
authors.forename: Yoann
authors.initials: Y
authors.lastname: Pointreau
authors.forename: Sena
authors.initials: S
authors.lastname: Yossi
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Septans
authors.forename: Fabrice
authors.initials: F
authors.lastname: Denis
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D019540:Area Under Curve; D001918:Brachytherapy; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006019:Glycolysis; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002945:Cisplatin