Prognostic value of18 F-fluorodeoxyglucose uptake in pelvic lymph nodes in patients with cervical cancer treated with definitive chemoradiotherapy

• Published in: Gynecologic oncology Vol. 137; no. 1; pp. 40 - 46
• Main Authors: Onal, Cem, Guler, Ozan C, Reyhan, Mehmet, Yapar, Ali Fuat
• Format: Journal Article
• Language: English
• Published: 2015
• Subjects: Hematology, Oncology and Palliative Medicine; Obstetrics and Gynecology; Lymph node metastasis; Chemoradiotherapy; Positron emission tomography; Cervical cancer
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2015.01.542

Abstract Purpose To evaluate the prognostic significance of the maximum standardized uptake (SUVmax ) value for pelvic lymph nodes in patients with cervical cancer and its impact on treatment response, disease control, and survival. Methods Ninety-three patients with pelvic or para-aortic metastasis detected by PET/CT and treated with definitive chemoradiotherapy were evaluated. The impact of pelvic lymph node SUVmax on prognostic factors and treatment outcomes was assessed. Results The size and SUVmax of pelvic lymph nodes were significantly correlated ( r = 0.859; p < 0.001). Patients with pelvic and para-aortic lymph node metastases had significantly higher SUVmax values for both primary tumor (23.4 ± 9.2 vs. 18.5 ± 7.3; p = 0.01) and pelvic lymph nodes (11.4 ± 4.6 vs. 7.4 ± 3.8; p = 0.001). Patients with pelvic lymph node SUVmax ≥ 7.5 had significantly higher primary tumor SUVmax , larger pelvic lymph nodes, higher rates of para-aortic lymph node metastasis, and lower post-therapy complete response rates. Overall survival (OS) and disease-free survival (DFS) rates were significantly higher in patients with SUVmax < 7.5 compared to patients with SUVmax ≥ 7.5. In a multivariate analysis, pelvic lymph node SUVmax and post-therapy metabolic response were significant prognostic factors for both OS and DFS for all patients, but no significant prognostic factors were found in pelvic lymph node metastasis only. Conclusions Patients with highly FDG-avid pelvic lymph nodes have a higher risk of disease recurrence with worse survival. Identification of these patients may assist in the evaluation of the clinical benefits of additional treatments.