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European Journal of Nuclear Medicine and Molecular Imaging

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14.08.2019 | Original Article

The role of ¹⁸F-FDG-PET/CT in predicting the histopathological response in locally advanced cervical carcinoma treated by chemo-radiotherapy followed by radical surgery: a prospective study

verfasst von: Vittoria Rufini, Angela Collarino, Maria Lucia Calcagni, Guido Maria Meduri, Valentina Fuoco, Tina Pasciuto, Antonia Carla Testa, Gabriella Ferrandina, Maria Antonietta Gambacorta, Maura Campitelli, Benedetta Gui, Gianfranco Zannoni, Riccardo Manfredi, Giovanni Scambia, Alessandro Giordano

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 5/2020

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Abstract

Purpose

This prospective study aimed to evaluate whether ¹⁸F-FDG-PET/CT performed before, during and after neoadjuvant chemo-radiotherapy (CRT) could predict histopathological response in patients with locally advanced cervical cancer (LACC) treated with CRT followed by radical surgery.

Methods

Between October 2010 and June 2014, 88 patients with LACC were enrolled. For each patient, three ¹⁸F-FDG-PET/CT scans (baseline, early and final) were acquired and evaluated by qualitative and quantitative analysis. Maximum standardized uptake value (SUV_max), SUV_mean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured as absolute values and their percentage variation (delta) (early vs. baseline and final vs. baseline). The role of ¹⁸F-FDG-PET/CT in predicting lymph node (LN) residual disease was evaluated by qualitative analysis only. Histopathology was the reference standard.

Results

At histopathology, 40 patients had complete response (CR, pR0), 48 had partial response (PR: 21 microscopic [pR1] and 27 macroscopic [pR2]). At baseline, SUV_max and SUV_mean were significantly higher in pR0 than in pR1–pR2 patients. At early evaluation, MTV and TLG were significantly higher in pR1–pR2 than in pR0 patients. At final evaluation, SUV_max, SUV_mean and TLG were significantly higher in pR1–pR2 than in pR0 patients. Delta SUV parameters and delta TLG were significantly lower in PR group both during and after CRT. Delta MTV was significantly lower in patients with PR in the early phase only. In receiver operating characteristic (ROC) curve analysis, baseline SUV_mean, early delta TLG, and final delta SUV_max better discriminated PR, providing 83.3%, 67.6% and 85% positive predictive value (PPV) and 60.3%, 90% and 70.8% negative predictive value (NPV), respectively. For LN assessment, high NPV was observed at early and final ¹⁸F-FDG-PET/CT (93.5% and 92.3%, respectively).

Conclusion

In LACC patients treated with CRT followed by surgery, early variations in metabolic parameters effectively discriminate histopathological PR of the primary tumor, suggesting the potential role of ¹⁸F-FDG-PET/CT in early personalized treatment. The high NPV of early and final PET/CT could enable “tailored surgery” by avoiding lymphadenectomy in selected patients.

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Titel: The role of 18F-FDG-PET/CT in predicting the histopathological response in locally advanced cervical carcinoma treated by chemo-radiotherapy followed by radical surgery: a prospective study
verfasst von: Vittoria Rufini
Angela Collarino
Maria Lucia Calcagni
Guido Maria Meduri
Valentina Fuoco
Tina Pasciuto
Antonia Carla Testa
Gabriella Ferrandina
Maria Antonietta Gambacorta
Maura Campitelli
Benedetta Gui
Gianfranco Zannoni
Riccardo Manfredi
Giovanni Scambia
Alessandro Giordano
Publikationsdatum: 14.08.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 5/2020
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-019-04436-y

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

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