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

• Published in: European journal of nuclear medicine and molecular imaging 2020-05, Vol.47 (5), p.1228-1238
• Main Authors: Rufini, Vittoria, Collarino, Angela, Calcagni, Maria Lucia, Meduri, Guido Maria, Fuoco, Valentina, Pasciuto, Tina, Testa, Antonia Carla, Ferrandina, Gabriella, Gambacorta, Maria Antonietta, Campitelli, Maura, Gui, Benedetta, Zannoni, Gianfranco, Manfredi, Riccardo, Scambia, Giovanni, Giordano, Alessandro
• Format: Article
• Language: English
• Subjects: Cancer; Cardiology; Cervical cancer; Cervical carcinoma; Computed tomography; Evaluation; Fluorine isotopes; Glycolysis; Histopathology; Imaging; Lymph nodes; Medicine; Medicine & Public Health; Metabolism; Nuclear Medicine; Oncology; Oncology – Genitourinary; Original Article; Orthopedics; Parameters; Patients; Positron emission; Positron emission tomography; Precision medicine; Qualitative analysis; Quantitative analysis; Radiation therapy; Radiology; Surgery; Tomography; Tumors
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-019-04436-y

Purpose This prospective study aimed to evaluate whether 18 F-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 18 F-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 18 F-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 18 F-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 18 F-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.