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01.12.2016 | Research | Ausgabe 1/2016 Open Access

Radiation Oncology 1/2016

[18F]FDG-PET/CT metabolic parameters as useful prognostic factors in cervical cancer patients treated with chemo-radiotherapy

Radiation Oncology > Ausgabe 1/2016
Fernanda G. Herrera, Thomas Breuneval, John O. Prior, Jean Bourhis, Mahmut Ozsahin
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

FGH: conception, design, acquisition of data, analysis and interpretation of data. Drafted the manuscript. Gave final approval to the version to be published. TB: acquisition of data and interpretation. JOP: conception, design, analysis and interpretation of data. JB: accountable for all aspects of the work. MO: accountable for all aspects of the work, gave final approval of the version to be published. All authors read and approved the final manuscript.



To compare the prognostic value of different anatomical and functional metabolic parameters determined using [18F]FDG-PET/CT with other clinical and pathological prognostic parameters in cervical cancer (CC).


Thirty-eight patients treated with standard curative doses of chemo-radiotherapy (CRT) underwent pre- and post-therapy [18F]FDG-PET/CT. [18F]FDG-PET/CT parameters including mean tumor standardized uptake values (SUV), metabolic tumor volume (MTV) and tumor glycolytic volume (TGV) were measured before the start of CRT. The post-treatment tumor metabolic response was evaluated. These parameters were compared to other clinical prognostic factors. Survival curves were estimated by using the Kaplan-Meier method. Cox regression analysis was performed to determine the independent contribution of each prognostic factor.


After 37 months of median follow-up (range, 12–106), overall survival (OS) was 71 % [95 % confidence interval (CI), 54–88], disease-free survival (DFS) 61 % [95 % CI, 44–78] and loco-regional control (LRC) 76 % [95 % CI, 62–90]. In univariate analyses the [18F]FDG-PET/CT parameters unfavorably influencing OS, DFS and LRC were pre-treatment TGV-cutoff ≥562 (37 vs. 76 %, p = 0.01; 33 vs. 70 %, p = 0.002; and 55 vs. 83 %, p = 0.005, respectively), mean pre-treatment tumor SUV cutoff ≥5 (57 vs. 86 %, p = 0.03; 36 vs. 88 %, p = 0.004; 65 vs. 88 %, p = 0.04, respectively) and a partial tumor metabolic response after treatment (9 vs. 29 %, p = 0.0008; 0 vs. 83 %, p < 0.0001; 22 vs. 96 %, p < 0.0001, respectively). After multivariate analyses a partial tumor metabolic response after treatment remained as an independent prognostic factor unfavorably influencing DFS and LRC (RR 1:7.7, p < 0.0001, and RR 1:22.6, p = 0.0003, respectively) while the pre-treatment TGV-cutoff ≥562 negatively influenced OS and DFS (RR 1:2, p = 0.03, and RR 1:2.75, p = 0.05).


Parameters capturing the pre-treatment glycolytic volume and metabolic activity of [18F]FDG–positive disease provide important prognostic information in patients with CC treated with CRT. The post-therapy [18F]FDG-PET/CT uptake (partial tumor metabolic response) is predictive of disease outcome.
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