The relationship between pre-treatment 18F-FDG PET/CT metabolic data and treatment response in patients with cervix uteri cancer.

Abstract

To determine the risk group of patients with locally advanced squamous cell carcinoma of the uterine cervix that will resist to treatment before concomitant chemoradiotherapy and who will develop metastasis via fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) metabolic data. Fifty two patients with carcinoma of the uterine cervix who were treated in our clinic between 2015-2018 were evaluated. The presence of human papilloma virus (HPV) from the first paraffin blocks diagnosed in all patients has been tested withreal time polymerase chain reaction (PCR). All patients received brachytherapy after concomittant chemotherapy with external radiotherapy. The first 18F-FDG PET/CT and magnetic resonance images (MRI) images obtained for pretreatment staging and MRI after external radiotherapy were retrospectively reviewed. The patients who resisted concomittant chemoradiotherapy were tried and determined with pre-treatment 18F-FDG PET/CT metabolic data. The follow-up period of our patients with an average age of 53 years (42.5-60.75) was 53.5 months (42.5-60.75). Radiotherapy with a total median dose of 85 EqD2 (84-86) was delivered to all patients. The heterogeneity factor(HF) was found to be statistically significantly lower in patients in whom complete response was obtained after external radiotherapy in MRI (P=0.049). Any statistically significant difference was not found between groups of patients who did, and did not develop metastases as for primary tumor standardized uptake value (SUVmax, SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values. In patients without metastasis, heterogeneity factor (HF) was found to be statistically significantly lower than those who developed metastasis (P=0.026). It is possible to predict poor prognostic patients with the help of HF, although we could not predict the resistant patients to treatment of primary tumor.