Originally published as JCO Early Release 10.1200/JCO.2005.06.965 on September 12 2005

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Prediction of Response to Neoadjuvant Chemotherapy by Sequential F-18-Fluorodeoxyglucose Positron Emission Tomography in Patients With Advanced-Stage Ovarian Cancer

From the Department of Nuclear Medicine, Pathology and Gynecology Technische Universität München, Munich, Germany; Division of Nuclear Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA; Department of Medical and Molecular Pharmacology, University of California, Los Angeles, CA; Department of Pathology, University of Freiburg, Freiburg; Department of Obstetrics and Gynecology, University of Bonn, Bonn, Germany

Address reprint requests to Norbert Avril, MD, Department of Nuclear Medicine, Barts and The London School of Medicine, Queen Mary University of London, West Smithfield (QE II), London, EC1A 7BE, United Kingdom; e-mail: n.e.avril{at}qmul.ac.uk

PURPOSE: The aim of this study was to evaluate sequential F-18-fluorodeoxyglucose positron emission tomography (FDG-PET) to predict patient outcome after the first and third cycle of neoadjuvant chemotherapy in advanced-stage (International Federation of Gynecology and Obstetrics stages IIIC and IV) ovarian cancer.

PATIENTS AND METHODS: Thirty-three patients received three cycles of carboplatin-based chemotherapy, followed by cytoreductive surgery. Quantitative FDG-PET of the abdomen and pelvis was acquired before treatment and after the first and third cycle of chemotherapy. Changes in tumoral FDG uptake, expressed as standardized uptake values (SUV), were compared with clinical and histopathologic response; overall survival served as a reference.

RESULTS: A significant correlation was observed between FDG-PET metabolic response after the first (P = .008) and third (P = .005) cycle of chemotherapy and overall survival. By using a threshold for decrease in SUV from baseline of 20% after the first cycle, median overall survival was 38.3 months in metabolic responders compared with 23.1 months in metabolic nonresponders. At a threshold of 55% decrease in SUV after the third cycle median overall survival was 38.9 months in metabolic responders compared with 19.7 months in nonresponders. There was no correlation between clinical response criteria (P = .7) or CA125 response criteria (P = .5) and overall survival. There was only a weak correlation (P = .09) between histopathologic response criteria and overall survival.

CONCLUSION: Sequential FDG-PET predicted patient outcome as early as after the first cycle of neoadjuvant chemotherapy and was more accurate than clinical or histopathologic response criteria including changes in tumor marker CA125. FDG-PET appears to be a promising tool for early prediction of response to chemotherapy.

Supported by the Department of Nuclear Medicine, Pathology and Gynecology of the Technische Universität München, Munich, Germany.

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

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