Weighted quantification of ¹⁸F-FDG tumor metabolism activity using fuzzy-thresholding to predict post-treatment tumor...

Cervical cancer is one of the most common cancer to affect women worldwide. Despite the efficiency of radiotherapy treatment, some patients present post-treatment tumor recurrence which increases the risk of death. Early outcome prediction could help oncologists to adapt the treatment. Several studies suggest that quantification of tumor activity using (18)FFDG PET imaging could be used to predict post-treatment tumor recurrence. In this paper we study the predictive value of weighted quantification of tumor metabolism extracted by fuzzy-thresholding for tumor recurrence of locally advanced cervical cancer. Fifty-three patients with locally advanced cervical cancer treated by chemo-radiotherapy were considered in our study. For each patient, a coregistered (18)F-FDG PET/CT scan was acquired before the treatment and was segmented using different hard and fuzzy segmentations methods. The tumor activity was extracted through the total lesion glycolysis and through a weighted analog of the total lesion glycolysis using the probability maps provided by the fuzzy segmentations. Outcomes prediction was performed using the area under the receiver operating characteristic curve (AUC) and the Harrell's C-index. Results suggest that weighted quantification of tumor activity seems to be strongly informative and could be used to predict post-treatment tumor recurrence in cervical cancer.