Association of Posttherapy Positron Emission Tomography With Tumor Response and Survival in Cervical Carcinoma

Schwarz, Julie K. MD, PhD
Siegel, Barry A. MD
Dehdashti, Farrokh MD
Grigsby, Perry W. MD, MS

Departments of Radiation Oncology (Drs Schwarz and Grigsby) and Obstetrics and Gynecology (Dr Grigsby), Division of Nuclear Medicine, Mallinckrodt Institute of Radiology (Drs Siegel, Dehdashti, and Grigsby), and the Alvin J. Siteman Cancer Center (Drs Siegel, Dehdashti, and Grigsby), Washington University School of Medicine, St Louis, Missouri.

Corresponding Author: Perry W. Grigsby, MD, MS, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4921 Parkview Pl, Box 8224, St Louis, MO 63110 ([email protected]).

Author Contributions: Dr Grigsby had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Schwarz, Siegel, Grigsby.

Acquisition of data: Dehdashti, Grigsby.

Analysis and interpretation of data: Schwarz, Siegel, Grigsby.

Drafting of the manuscript: Schwarz, Siegel.

Critical revision of the manuscript for important intellectual content: Schwarz, Siegel, Dehdashti, Grigsby.

Statistical analysis: Schwarz, Grigsby.

Financial Disclosures: Dr Siegel reported stock ownership, being a medical advisory board member, and receiving lecture honoraria from Radiology Corporation of America, which is a provider of mobile PET services; being a consultant to Tyco Healthcare/Mallinckrodt Inc; receiving lecture honoraria from Siemens Canada Ltd; and receiving lecture honoraria from PETNET Solutions. No other authors reported financial disclosures.

JAMA: The Journal of the American Medical Association 298(19):p 2289-2295, November 21, 2007.

Context

Retrospective studies have demonstrated that the use of positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) in the posttherapy evaluation of patients with cervical carcinoma is predictive of survival outcome.

Objective

To validate the association between the metabolic response on the 3-month posttherapy FDG-PET and long-term survival outcome.

Design, Setting, and Patients

A prospective cohort study designed to validate our previous finding that the results of a 3-month posttherapy FDG-PET are predictive of long-term clinical outcome. A total of 92 women were treated with external irradiation, brachytherapy, and concurrent chemotherapy from January 2003 through September 2006. Posttherapy whole-body FDG-PET was performed 2 to 4 months (mean, 3 months) after completion of therapy.

Main Outcome Measures

The primary outcome end points were metabolic response, progression-free survival, and cause-specific survival.

Results

Posttherapy FDG-PET showed a complete metabolic response in 65 patients (70%), a partial metabolic response in 15 (16%), and progressive disease in 12 (13%). Their 3-year progression-free survival rates were 78%, 33%, and 0%, respectively (P < .001). Multivariate analysis demonstrated that the hazard ratio (HR) for risk of recurrence based on the posttherapy metabolic response showing progressive disease was 32.57 (95% confidence interval [CI], 10.22–103.82). A partial metabolic response had an HR of 6.30 (95% CI, 2.73–14.56). These were more predictive of survival outcome than the pretreatment lymph node status (HR, 3.54; 95% CI, 1.54–8.09).

Conclusion

In this single-site study population of women with cervical cancer, 3-month posttherapy FDG uptake, as detected by whole-body PET, was predictive of survival.