Physics and imaging in radiation oncology · 2025
The prognostic value of baseline 18FDG - Positron Emission Tomography - Computed Tomography in cervical cancer patients treated with definitive chemoradiotherapy - External multicentre validation model.
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Staniewska Emilia, Stankiewicz Magdalena, Burchardt Ewa, Grudzien Karolina, Raczek-Zwierzycka Katarzyna, Rembak-Szynkiewicz Justyna, Sobczak Matylda, d'Amico Andrea, Borys Damian, Gorczewska Izabela, Krysiak Kamil, Rydzinski Martin, Stando Rafal, Spalek Mateusz, Nowicka Zuzanna, Tarnawski Rafal, Miszczyk Marcin
Аннотация
BACKGROUND AND PURPOSE: 18F-Fluorodeoxyglucose-Positron Emission Tomography - Computed Tomography (18FDG-PET-CT) is commonly used for baseline clinical staging in cervical cancer. In this study, we assessed the prognostic value of standardised PET-CT parameters for the overall survival (OS) of patients treated with definitive chemoradiotherapy (CRT), or radiotherapy (RT) with subsequent brachytherapy (BT).
MATERIAL AND METHODS: This study included consecutive cervical cancer patients treated with definitive CRT or RT and BT, between 2011 and 2017, at a single tertiary institution. Each patient had a 18-FDG-PET-CT scan before treatment. Patients from three institutions with equal inclusion criteria were included in external validation group. The metabolic parameters of the primary tumour: standardized uptake value (SUV) derivatives, metabolic tumour volume (MTV) and total lesion glycolysis (TLG), were evaluated using the semi-automated method. Statistical analysis was conducted using the Kaplan-Meier method, log-rank tests, Cox regression models, and the Akaike Information Criterion (AIC).
RESULTS: The study group included 198 patients treated with RT (100 %) concurrent with Cisplatin-based CT (91.4 %), and subsequent BT (99 %). The majority of patients were diagnosed with squamous cell carcinoma (96.5 %) and International Federation of Gynaecology and Obstetrics (FIGO) stage III disease (84.3 %). The OS was significantly higher in patients with TLG30 below the median value (78.8 % vs. 58.9 %; p < 0.01). TLG30 remained as the only independent prognostic factor (hazard ratio 1.32,95 % confidence interval:1.12-1.56, p < 0.01). In the external validation model neither of analysed PET parameters were significant.
CONCLUSIONS: A high TLG30 was associated with worse OS in primary cohort. However, external validation model did not confirm the clinical utility of the cervical tumour's metabolic parameters.
MATERIAL AND METHODS: This study included consecutive cervical cancer patients treated with definitive CRT or RT and BT, between 2011 and 2017, at a single tertiary institution. Each patient had a 18-FDG-PET-CT scan before treatment. Patients from three institutions with equal inclusion criteria were included in external validation group. The metabolic parameters of the primary tumour: standardized uptake value (SUV) derivatives, metabolic tumour volume (MTV) and total lesion glycolysis (TLG), were evaluated using the semi-automated method. Statistical analysis was conducted using the Kaplan-Meier method, log-rank tests, Cox regression models, and the Akaike Information Criterion (AIC).
RESULTS: The study group included 198 patients treated with RT (100 %) concurrent with Cisplatin-based CT (91.4 %), and subsequent BT (99 %). The majority of patients were diagnosed with squamous cell carcinoma (96.5 %) and International Federation of Gynaecology and Obstetrics (FIGO) stage III disease (84.3 %). The OS was significantly higher in patients with TLG30 below the median value (78.8 % vs. 58.9 %; p < 0.01). TLG30 remained as the only independent prognostic factor (hazard ratio 1.32,95 % confidence interval:1.12-1.56, p < 0.01). In the external validation model neither of analysed PET parameters were significant.
CONCLUSIONS: A high TLG30 was associated with worse OS in primary cohort. However, external validation model did not confirm the clinical utility of the cervical tumour's metabolic parameters.