PET/CT Response Criteria (European Organization for Research and Treatment of Cancer) Predict Survival Better Than Response Evaluation Criteria in Solid Tumors in Locally Advanced Cervical Cancer Treated With Chemoradiation.
OBJECTIVE
To investigate whether the ratio of SUVs measured with F-FDG PET/CT between pretreatment and posttreatment has prognostic value in patients with locally advanced cervical cancer treated with primary chemoradiation therapy.


METHODS
Cases of locally advanced cervical cancer (International Federation of Gynecology and Obstetrics stages IB1 to IVA) treated with a nonsurgical curative modality (172 cases including chemoradiation or radiation therapy) were reviewed. F-FDG PET/CT parameters, including SUVmax and SUVmean, were evaluated by F-FDG PET/CT performed prior to treatment and 6 weeks after the end of treatment. Metabolic response was evaluated according to the European Organization for Research and Treatment of Cancer guidelines and was compared with radiologic response measured according to the Response Evaluation Criteria In Solid Tumours (RECIST).


RESULTS
In total, 142 patients receiving chemoradiation showed radiologic responses (median 56% decrease in maximal diameter), whereas 160 and 146 patients showed metabolic responses measured with SUVmax and SUVmean, respectively (73% decrease in SUVmax; 48% decrease in SUVmean). Radiologic response and metabolic response were significantly correlated for SUVmax and SUVmean (P = 0.0009; P = 0.0457, respectively). Kaplan-Meier analysis revealed significant differences in overall survival and progression-free survival between the responder and nonresponder groups, based on the European Organization for Research and Treatment of Cancer criteria (both P < 0.001), whereas no significant difference was found when using RECIST criteria (P = 0.058, P = 0.088, respectively).


CONCLUSIONS
F-FDG PET/CT parameters are good prognostic markers for the response of cervical cancer patients to concurrent chemoradiation therapy, as compared with the RECIST criteria.
From the *Women's Cancer Clinic, Department of Obstetrics Gynecology, Institute of Women's Life Medical Science, and †Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea.
Jung Won
JW
Yoon
Sunghoon
S
Kim
Sang Wun
SW
Kim
Young Tae
YT
Kim
Won Jun
WJ
Kang
Eun Ji
EJ
Nam
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000379:methods; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D064847:Multimodal Imaging; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000378:metabolism; D012044:Regression Analysis; D066066:Response Evaluation Criteria in Solid Tumors; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000628:therapy*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18