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Prognostic Impact of Pretreatment Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography SUVmax in Patients With Locally Advanced Cervical Cancer
  1. Simona Cima, MD*,,
  2. Anna Myriam Perrone, MD,
  3. Paolo Castellucci, MD§,
  4. Gabriella Macchia, MD,
  5. Milly Buwenge,
  6. Silvia Cammelli, MD,
  7. Savino Cilla, Phys,
  8. Martina Ferioli, MD,
  9. Gabriella Ferrandina, MD#,
  10. Andrea Galuppi, MD,
  11. Eugenio Salizzoni, MD**,
  12. Daniela Rubino, MD,,
  13. Stefano Fanti, MD§,
  14. Pierandrea De Iaco, MD and
  15. Alessio Giuseppe Morganti, MD
  1. * Radiation Oncology Unit, Oncology Institute of Southern Switzerland, Bellinzona-Lugano, Switzerland;
  2. Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna,
  3. Gynecologic Oncology Unit, Azienda Ospedaliera Universitaria, and
  4. § Department of Nuclear Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna;
  5. Radiotherapy Unit and
  6. Medical Physic Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II,” Catholic University of Sacred Heart, Campobasso;
  7. # Department of Medicine and Health Sciences, University of Molise, Campobasso/Ginecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Roma;
  8. ** Radiology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, S. Orsola-Malpighi Hospital, Bologna; and
  9. †† Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
  1. Address correspondence and reprint requests to Simona Cima MD, Radiation Oncology Unit, Oncology Institute of Southern Switzerland, Ospedale Regionale Bellinzona e Valli, via Ospedale, 6500 Bellinzona CH, Switzerland. E-mail: simona.cima{at}, simonacima{at}


Objective The aim of this study was to investigate the impact of SUVmax fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) measured in the primary tumor, pelvic and para-aortic node with disease-free survival (DFS) and overall survival (OS) in patients with locally advanced cervical cancer.

Methods and Materials A total of 92 patients with histological diagnosis of locally advanced cervical cancer are treated with radiochemotherapy plus brachytherapy boost from January 2008 to April 2014 in our Institution. A pretreatment FDG-PET/CT for staging and radiotherapy planning was performed, and the value of SUVmax measured in primary tumor and positive nodes was related to DFS and OS.

Results Univariate analysis showed that DFS is related to FDG-PET/CT positive para-aortic nodes (P = 0.01), International Federation of Gynecology and Obstetrics (FIGO) stage of disease (P = 0.01), and primary tumor SUVmax (P = 0.02), and OS is related to positive para-aortic nodes (P = 0.01) and primary tumor SUVmax (P = 0.02).

In multivariate analysis, DFS is modified by FDG-PET/CT positive para-aortic lymph nodes, stage and high T SUVmax (P = 0.02; P = 0.003; P = 0.04), but the only worse prognostic factor of OS is the high SUVmax in the primary tumor (P = 0.01).

Conclusions We found that T SUVmax, stage, and para-aortic lymph node status assessed by FDG-PET were independent prognostic factors of DFS, whereas only T SUVmax correlated with OS.

  • Cervix cancer
  • 18F-FDG-PET/CT
  • Radiotherapy
  • Chemotherapy
  • Prognostic factor

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  • The authors declare no conflicts of interest.