Utility of 2-[18F]Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in assessing treatment...

Cervical cancer is the fourth most common malignancy globally. As many cases are locally advanced, early prediction of local recurrence, which often occurs within 2 years of chemoradiotherapy (CCRT), is crucial. The National Comprehensive Cancer Network Guidelines recommend post-treatment 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT) for response assessment, but this is not standard in Japan. We aimed to investigate the utility of 18F-FDG-PET/CT in assessing primary tumor response after CCRT for cervical cancer. Seventy-three patients with cervical cancer who received curative CCRT and underwent pre- and post-treatment magnetic resonance imaging and 18F-FDG-PET/CT were analyzed. We collected PET metrics (maximum standardized uptake value [SUVmax], metabolic tumor volume [MTV], total lesion glycolysis [TLG]) and classified the response. Receiver operating characteristic (ROC) curve analysis was performed on the post-treatment PET data. Univariate analysis was performed to determine the prognostic factors for local control. ROC curve analysis yielded high negative predictive values for local recurrence of post-treatment MTV, SUVmax and TLG. Univariate analysis showed significant differences in local control for post-treatment MTV, SUVmax, TLG and PET Response Criteria in Solid Tumors, but not for Response Evaluation Criteria in Solid Tumors (RECIST). Functional assessment using 18F-FDG-PET/CT after CCRT for cervical cancer is useful for complementing conventional morphological evaluation and improving the accuracy of response assessment.