ArticlePhysics and imaging in radiation oncology2025
The prognostic value of baseline 18FDG - Positron Emission Tomography - Computed Tomography in cervical cancer patients treated with definitive chemoradiotherapy - External multicentre validation model.
Article in Physics and imaging in radiation oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and purpose: 18F-Fluorodeoxyglucose-Positron Emission Tomography - Computed Tomography (18FDG-PET-CT) is commonly used for baseline clinical staging in cervical cancer. In this study, we assessed the prognostic value of standardised PET-CT parameters for the overall survival (OS) of patients treated with definitive chemoradiotherapy (CRT), or radiotherapy (RT) with subsequent brachytherapy (BT). Material and methods: This study included consecutive cervical cancer patients treated with definitive CRT or RT and BT, between 2011 and 2017, at a single tertiary institution. Each patient had a 18-FDG-PET-CT scan before treatment. Patients from three institutions with equal inclusion criteria were included in external validation group. The metabolic parameters of the primary tumour: standardized uptake value (SUV) derivatives, metabolic tumour volume (MTV) and total lesion glycolysis (TLG), were evaluated using the semi-automated method. Statistical analysis was conducted using the Kaplan-Meier method, log-rank tests, Cox regression models, and the Akaike Information Criterion (AIC). Results: The study group included 198 patients treated with RT (100 %) concurrent with Cisplatin-based CT (91.4 %), and subsequent BT (99 %). The majority of patients were diagnosed with squamous cell carcinoma (96.5 %) and International Federation of Gynaecology and Obstetrics (FIGO) stage III disease (84.3 %). The OS was significantly higher in patients with TLG30 below the median value (78.8 % vs. 58.9 %; p < 0.01). TLG30 remained as the only independent prognostic factor (hazard ratio 1.32,95 % confidence interval:1.12-1.56, p < 0.01). In the external validation model neither of analysed PET parameters were significant. Conclusions: A high TLG30 was associated with worse OS in primary cohort. However, external validation model did not confirm the clinical utility of the cervical tumour's metabolic parameters.
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