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  • Prognostic significance of delayed complete metabolic response on PET/CT after primary chemoradiation treatment of cervical cancer

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Original research
Prognostic significance of delayed complete metabolic response on PET/CT after primary chemoradiation treatment of cervical cancer
  1. Nadav Michaan1,
  2. Atalia Wenkert2,
  3. Einat Even-Sapir3,
  4. Kosta Kerzhner3,
  5. Tatiana Rabin4,
  6. Tamar Safra5,
  7. Shira Peleg-Hasson5,
  8. Yoav Baruch1,
  9. Yael Raz1,
  10. Dan Grisaru1 and
  11. Ido Laskov1
  1. 1 Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  2. 2 Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  3. 3 Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  4. 4 Department of Radiation Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  5. 5 Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  1. Correspondence to Dr Nadav Michaan, Department of Gynecologic oncology, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel; nadavmi{at}gmail.com

Abstract

Objective To investigate the prognostic significance of near-complete metabolic response on initial follow-up PET/CT after primary chemoradiation treatment of cervical cancer.

Methods Survival data were retrospectively compared between patients who had complete metabolic response on first follow-up PET/CT, 3 months after chemoradiation (group 1) with those who had near-complete metabolic response on first PET/CT and later showed complete metabolic response at subsequent PET/CT, 6 months or more after treatment (group 2).

Results Of the 108 patients included in the final analysis, 74 (68.5%) showed complete metabolic response on initial PET/CT, 3 months after treatment, and 34 patients (31.5%) showed complete metabolic response on subsequent PET/CT, 6 months after treatment. Tumor characteristics were comparable between groups. Group 1 had higher percent of stage 1 (12% vs 0%) and lower percent of stage 4 disease (3% vs 14%) than those of group 2. Group 2 patients had significantly fewer cases of recurrences and deaths than group 1 patients (6% vs 26%, p=0.018; 0% vs 20%, p=0.003, respectively), with comparable 3-year survival rates (group 1, 90% vs group 2, 100%, p=0.31). Twelve patients had progressive disease on first follow-up PET/CT; these patients had significantly worse overall survival compared with all other patients (log-rank test, p<0.001). Younger age and delayed complete metabolic response were associated with lower chance of recurrence and death on univariate analysis. On multivariate analysis, delayed complete metabolic response remained significantly associated with no recurrence HR=0.14 (95% CI 0.25 to 0.84), p=0.031.

Conclusions Survival outcome of patients with cervical cancer who show residual 18F-fluorodeoxyglucose uptake on initial PET/CT after treatment, but reach complete metabolic response on follow-up PET/CT, is not inferior compared with survival of patients who show complete metabolic response on initial PET/CT 3 months after treatment. Watchful waiting with follow-up PET/CT seems a safe option for these patients.

  • Cervical Cancer
  • Genital Neoplasms, Female
  • Radiation Oncology

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/ijgc-2023-004703

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors NM: main author, conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, validation, writing-original draft, writing-review and editing, guarantor. AW: data curation, formal analysis, investigation, methodology. EE-S: conceptualization, data curation, methodology, writing-review and editing. KK: data curation, formal analysis, investigation, methodology,writing-review and editing. TR: conceptualization, data curation, supervision, validation, writing-review and editing. TS: conceptualization, data curation, supervision, validation, writing-review and editing. SP-H: conceptualization, data curation, supervision, validation, writing-review and editing. YB: conceptualization, data curation, writing-review and editing. YR: conceptualization, data curation, investigation, methodology, writing-review and editing. DG: conceptualization, methodology, project administration, supervision, writing-original draft, writing-review and editing. IL: conceptualization, formal analysis, investigation, methodology, writing-review and editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.