Prediction of treatment response in patients with locally advanced cervical cancer using midtreatment PET/MRI during concurrent chemoradiotherapy

• Published in: Strahlentherapie und Onkologie Vol. 197; no. 6; pp. 494 - 504
• Main Authors: Vojtíšek, Radovan, Baxa, Jan, Kovářová, Petra, Almortaza, Amira, Hošek, Petr, Sukovská, Emília, Tupý, Radek, Ferda, Jiří, Fínek, Jindřich
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2021; Springer Nature B.V
• Subjects: Adult; Aged; Antineoplastic Agents, Alkylating - therapeutic use; Area Under Curve; Brachytherapy; Cancer; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - metabolism; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Cervical cancer; Chemoradiotherapy; Chemotherapy; Cisplatin - therapeutic use; Diffusion coefficient; Discrimination; Emission analysis; Evaluation; Female; Glycolysis; Humans; Image Processing, Computer-Assisted; Lymphatic Irradiation; Lymphatic Metastasis; Magnetic Resonance Imaging; Medicine; Medicine & Public Health; Metabolism; Middle Aged; Multimodal Imaging; Neoplasm Staging - methods; Oncology; Original Article; Parameter identification; Positron emission; Positron-Emission Tomography; Prognosis; Radiation therapy; Radiotherapy; Radiotherapy, Intensity-Modulated; ROC Curve; Tomography; Treatment Outcome; Tumor Burden; Tumors; Uterine Cervical Neoplasms - diagnostic imaging; Uterine Cervical Neoplasms - metabolism; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - therapy; Treatment response; Uterovaginal brachytherapy; Magnetic resonance imaging; Positron emission tomography; Cervical cancer
• ISSN: 0179-7158; 1439-099X
• DOI: 10.1007/s00066-020-01740-7

Purpose We aimed to find metabolic, functional or morphological characteristics of the tumor predicting failure to achieve complete metabolic remission (CMR) by the midtreatment PET/MRI (positron emission tomography/magnetic resonance imaging) in cervical cancer patients. Methods We evaluated 66 patients treated between August 2015 and November 2019 who underwent pretreatment staging, subsequent midtreatment evaluation, and definitive restaging 3 months after completing the whole treatment, all using PET/MRI. The pretreatment parameters (pre-SUVmax, pre-SUVmean, pre-MTV, pre-MTV‑S, pre-TLG, pre-TLG‑S [SUV: standard uptake value, MTV: metabolic tumor volume, TLG: total lesion glycolysis]), and the midtreatment parameters at week 5 during chemoradiotherapy (mid-SUVmax, mid-SUVmean, mid-MTV, mid-MTV‑S, mid-TLG and mid-TLG-S) were recorded. The value of ADC (apparent diffusion coefficient) was also measured. Furthermore, we recorded absolute and relative changes in all parameters—∆ and ∆%. We divided the whole group of patients into “responders” (CMR) and “non-responders” (non-CMR), and compared them on the basis of the parameters from pre-PET/MRI and mid-PET/MRI. Results A statistically significant difference in the evaluated parameters between responders and non-responders was found for the following parameters: mid-MTV, mid-TLG, mid-TLG‑S, mid-MTV‑S, mid-tumor size, and ∆%SUVmax. According to the ROC (receiver operating characteristic) analysis, mid-MTV‑S showed the best albeit moderate discrimination ability for the prediction of non-CMR. Significant mutual correlations of all variables, in particular between mid-MTV‑S and mid-TLG‑S and between mid-MTV and mid-TLG, were found (all p  < 0.05). Conclusion Our study confirmed that when using the midtreatment PET/MRI we are able to identify metabolic parameters having the discrimination ability for the prediction of non-CMR. In particular mid-MTV‑S, mid-MTV, mid-tumor size, mid-TLG‑S, mid-TLG and ∆%SUVmax.