Article Text

Download PDFPDF
Prognostic Value of Pretreatment 18F-fluorodeoxyglucose Uptake in Patients With Cervical Cancer Treated With Definitive Chemoradiotherapy
  1. Cem Onal, MD*,
  2. Mehmet Reyhan, MD,
  3. Cem Parlak, MD*,
  4. Ozan Cem Guler, MD* and
  5. Ezgi Oymak, MD
  1. *Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey;
  2. Department of Nuclear Medicine, Baskent University Faculty of Medicine, Ankara, Turkey; and
  3. Department of Radiation Oncology, Sakarya University Faculty of Medicine, Sakarya, Turkey.
  1. Address correspondence and reprint requests to Cem Onal, MD, Baskent University Faculty of Medicine, Adana Research and Treatment Centre, Department of Radiation Oncology, 01120 Adana, Turkey. E-mail:


Objective We analyzed the correlation of 18F-fluorodeoxyglucose (FDG) uptake into primary tumors using the maximum standardized uptake value (SUVmax) and clinicopathological factors of disease. The impact of the pretreatment SUVmax of the primary tumor on survival was investigated.

Materials and Methods The records of 149 patients with biopsy-proven cervical cancer treated with definitive chemoradiotherapy (ChRT) were reviewed. All patients underwent pretreatment FDG positron emission tomography with computed tomography, and posttherapy FDG positron emission tomography with computed tomography was performed within a median interval of 4.2 months (range, 3.0–11.2 months) after the completion of chemoradiotherapy.

Results The mean SUVmax in patients with lymph node metastasis was significantly higher than that in patients without metastasis (19.7 ± 8.2 vs 16.4 ± 8.2, respectively; P = 0.01). A significant difference existed between tumor size (<4 vs ≥4 cm) and the primary tumor SUVmax (14.7 ± 6.6 vs 18.7 ± 8.5, respectively; P = 0.02). The primary tumor pretreatment SUVmax for patients with complete remission was significantly lower than that of patients with partial response or progressive disease (15.6 ± 5.7 vs 28.0 ± 9.9, respectively; P < 0.001). The relationship between primary tumor FDG uptake and survival was evaluated by the cutoff value determined by receiver operating characteristic curve analysis. The area under the curve was 0.901 (P < 0.001; 95% confidence interval, 0.848–0.954), and 15.6 was determined as the SUVmax cutoff value. The 4-year actuarial overall survival (OS) and disease-free survival for SUVmax of less than 15.6 compared with SUVmax of 15.6 or greater were 85% vs 34% (P < 0.001) and 80% vs 29%, respectively (P < 0.001). In multivariate analysis, age, SUVmax of 15.6 or greater, and lymph node metastasis were independent prognostic factors of OS, and International Federation of Gynecology and Obstetrics stage IIB or higher, SUVmax of 15.6 or greater, and lymph node metastasis were significant factors for disease-free survival.

Conclusion The primary tumor pretreatment SUVmax is correlated with increased tumor size and lymph node involvement at diagnosis, how well the primary tumor responds to treatment, the likelihood of disease recurrence, and OS.

  • Cervical cancer
  • Radiotherapy
  • Positron emission tomography
  • Metabolic response

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • The authors declare no conflicts of interest.