title: A preliminary investigation into textural features of intratumoral metabolic heterogeneity in (18)F-FDG PET for overall survival prognosis in patients with bulky cervical cancer treated with definitive concurrent chemoradiotherapy.
abstract: We examined the role of intratumoral metabolic heterogeneity on (18)F-FDG PET during concurrent chemoradiotherapy (CCRT) in predicting survival outcomes for patients with cervical cancer. This prospective study consisted of 44 patients with bulky (≥ 4 cm) cervical cancer treated with CCRT. All patients underwent serial (18)F-FDG PET studies. Primary cervical tumor standardized uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) were measured in pretreatment and intra-treatment (2 weeks) PET scans. Regional textural features were analyzed using the grey level run length encoding method (GLRLM) and grey-level size zone matrix. Associations between PET parameters and overall survival (OS) were tested by Kaplan-Meier analysis and Cox regression model. In univariate analysis, pretreatment grey-level nonuniformity (GLNU) > 48 by GLRLM textural analysis and intra-treatment decline of run length nonuniformity < 55% and the decline of TLG (∆TLG) < 60% were associated with significantly worse OS. In multivariate analysis, only ∆TLG was significant (P = 0.009). Combining pretreatment with intra-treatment factors, we defined the patients with a initial GLNU > 48 and a ∆TLG ≤ 60% as the high-risk group and the other patients as the low-risk. The 5-year OS rate for the high-risk group was significantly worse than that for the low-risk group (42% vs. 81%, respectively, P = 0.001). The heterogeneity of intratumoral FDG distribution and the early temporal change in TLG may be an important predictor for OS in patients with bulky cervical cancer. This gives the opportunity to adjust individualized regimens early in the treatment course.
authors: Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan UniversityTaipei, Taiwan; Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital and Chang Gung UniversityTaoyuan, Taiwan.
authors: Kung-Chu
authors: KC
authors: Ho
authors: Department of Biomedical Engineering, National Cheng Kung University Tainan, Taiwan.
authors: Yu-Hua Dean
authors: YH
authors: Fang
authors: Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University Taipei, Taiwan.
authors: Hsiao-Wen
authors: HW
authors: Chung
authors: Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital and Chang Gung University Taoyuan, Taiwan.
authors: Tzu-Chen
authors: TC
authors: Yen
authors: Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital and Chang Gung University Taoyuan, Taiwan.
authors: Tsung-Ying
authors: TY
authors: Ho
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University Taoyuan, Taiwan.
authors: Hung-Hsueh
authors: HH
authors: Chou
authors: Department of Radiation Oncology, Chang Gung Memorial HospitalTaoyuan, Taiwan; Radiation Biology Research Center, Institute for Radiological Research, Chang Gung UniversityTaoyuan, Taiwan.
authors: Ji-Hong
authors: JH
authors: Hong
authors: Department of Radiation Oncology, Chang Gung Memorial Hospital Taoyuan, Taiwan.
authors: Yi-Ting
authors: YT
authors: Huang
authors: Department of Radiation Oncology, Chang Gung Memorial HospitalTaoyuan, Taiwan; Radiation Biology Research Center, Institute for Radiological Research, Chang Gung UniversityTaoyuan, Taiwan.
authors: Chun-Chieh
authors: CC
authors: Wang
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University Taoyuan, Taiwan.
authors: Chyong-Huey
authors: CH
authors: Lai
keywords: 18F-FDG PET; Cervical cancer; chemoradiotherapy; texture analysis