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18F-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography Standard Uptake Value Ratio as an Indicator of Cervical Cancer Chemoradiation Therapeutic Response
  1. Charles Kunos, MD, PhD*,
  2. Tomas Radivoyevitch, PhD,
  3. Fadi W. Abdul-Karim, MD and
  4. Peter Faulhaber, MD§
  1. *Departments of Radiation Oncology,
  2. Departments of Epidemiology and Biostatistics,
  3. Departments of Anatomic Pathology, and
  4. §Departments of Radiology, CASE Comprehensive Cancer Center, University Hospitals of Cleveland and Case Western Reserve University School of Medicine, Cleveland, OH.
  1. Address correspondence and reprint requests to Charles Kunos, MD, PhD, Department of Radiation Oncology, University Hospitals of Cleveland, 11100 Euclid Ave, LTR 6068, Cleveland, OH 44106-5000. E-mail: charles.kunos{at}


Hypothesis: A ratio of 3 months of posttherapy to pretherapy 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography (18F-FDG PET/CT) standard uptake values (SUVs) predicts progression-free survival after chemoradiation in patients with stages IB2 to IVA cervical cancer.

Methods: This retrospective review included 51 patients who received treatments of daily pelvic radiation and once-weekly cisplatin chemotherapy followed by brachytherapy. Posttherapy confirmatory surgical or cytologic pathology was done a median of 7 days after 3-month 18F-FDG PET/CT.

Results: All 51 patients receiving chemoradiation achieved at least a partial metabolic response (ie, >25% decrease in 18F-FDG PET/CT SUV) in the expected region of the cervix. A ratio of less than 0.33 for posttherapy to pretherapy 18F-FDG PET/CT SUVs of the expected area of the cervix was associated with a 35% improvement in 6-month progression-free survival.

Conclusions: In patients with cervical cancer, the 3-month posttherapy 18F-FDG PET/CT value is an indicator of therapeutic response to chemoradiation and needs further validation in clinical trials.

  • Cervical cancer
  • Chemoradiation response

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  • This study was supported in part by a grant (P30 CA43703) to the CASE Comprehensive Cancer Center, University Hospitals Case Medical Center (Cleveland, OH).

  • Each author certifies that he has no commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his institution has approved this retrospective investigation and that all investigations were conducted in conformity with ethical principles of research. The corresponding author certifies that all authors provided substantial conceptual or analytic contributions during manuscript preparation and thus satisfactorily qualify for authorship under the "Uniform Requirements." All authors grant approval for publication.