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Posttherapy [¹⁸F] Fluorodeoxyglucose Positron Emission Tomography in Carcinoma of the Cervix: Response and Outcome

From the Department of Radiation Oncology and Division of Nuclear Medicine, Mallinckrodt Institute of Radiology; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology; and Alvin J. Siteman Cancer Center Cancer Center; Washington University School of Medicine, St Louis, MO.

Address reprint requests to Perry W. Grigsby, MD, Department of Radiation Oncology, Box 8224, Washington University School of Medicine, 4921 Parkview Pl, Lower Level, St Louis, MO 63110; e-mail: pgrigsby{at}wustl.edu

PURPOSE: The aim of this study was to evaluate response to therapy using posttherapy molecular imaging with [¹⁸F] fluorodeoxyglucose (FDG), and to compare the response with patient outcome.

PATIENTS AND METHODS: This was a retrospective medical record review of 152 patients with carcinoma of the cervix. All patients underwent a pre- and posttreatment whole-body positron emission tomography (PET) imaging scan with FDG. Patients were treated with external irradiation and intracavitary brachytherapy, and most received concurrent weekly cisplatin. Posttherapy whole-body FDG-PET was performed 1 to 12 months (mean, 3 months) after completion of treatment.

RESULTS: The posttherapy PET did not show any abnormal FDG uptake in 114 patients, and their 5-year cause-specific survival estimate was 80%. There was persistent (in the irradiated region) abnormal FDG uptake in the cervix or lymph nodes in 20 patients. Their 5-year cause-specific survival estimate was 32%. New anatomic sites (in unirradiated regions) of abnormal FDG uptake were present in 18 patients, and none were alive at 5 years. A Cox proportional hazards model of survival outcome indicated that any abnormal posttherapy FDG uptake (persistent or new) was the most significant prognostic factor for developing metastatic disease and death from cervical cancer when compared with pretreatment- and treatment-related prognostic factors (P < .0001).

CONCLUSION: Posttherapy abnormal FDG uptake (persistent or new) as detected by whole-body PET measures tumor response and might be predictive of tumor recurrence and death from cervical cancer. Prospective validation of these results is warranted.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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