PET for predicting chemoradiotherapy survival in cervical cancer: the search continues
Objective
Cervical c ancer is still a global health concern. The push for personalized care has been the mainstay and the use of noninvasive approaches to stratify patients is a corollary of this management strategy. 18 F-fluorodeoxyglucose PET/computed tomography is frequently used for cervical c ancer staging. Identifying predictive factors PET-based imaging scores could mean increased benefit for these patients, at no increased cost.
Methods
An observational study was conducted with stage IIB–IIIB cervical cancer patients receiving erlotinib concomitantly to standard therapy. Survival analyses employed Kaplan–Meier and Cox proportional hazards models, waterfall, and heatmap plots to investigate survival associations. Maximum and average PET measures were obtained before and 3 months after treatment.
Results
Thirty patients were enrolled in this phase I/II study. IIB Staging was significantly associated with longer survival when compared with IIIB. Simultaneous lower 2SD algorithm mean standard uptake value (SUV 2SD ) (<4.1) and greater BMI reduction (< −0.17 kg/m 2 ), or lower PERCIST SUV (SUV per ) (<7.6) and greater BMI reduction, predicted worse overall and progression-free survival ( P < 0.05). Unifying pretreatment maximum SUV (SUV max ), SUV per , and SUV 2SD demonstrated a trend toward significant overall survival stratification ( P = 0.057). In the heatmap analysis, there was a lack of high percentile pretreatment tumor-to-liver ratio, SUV max , SUV per , and SUV 2SD features in patients with worse endpoints. The waterfall plots suggested pretreatment lesion volume may predict volume reduction.
Conclusion
SUV 2SD and SUV per , paired with BMI variation, were associated with survival prediction. PET might play an important role in individualizing patients before treatment decisions for optimal management of locally advanced disease.