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Published in: Annals of Nuclear Medicine 1/2013

01-01-2013 | Original Article

Early response of patients undergoing concurrent chemoradiotherapy for cervical cancer: a comparison of PET/CT and MRI

Authors: Jeong Eun Lee, Seung Jae Huh, Heerim Nam, Sang Gyu Ju

Published in: Annals of Nuclear Medicine | Issue 1/2013

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Abstract

Objective

To investigate the efficacy of positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) for early response evaluation of cervical cancer patients undergoing concurrent chemoradiotherapy (CCRT).

Methods

Fifty-two patients were prospectively enrolled in the study. The pathologic findings were squamous cell carcinoma in 47 patients and adenocarcinoma in 5 patients. All patients underwent PET/CT and MRI scans before, during and within 1 month after completion of CCRT. The percent change in tumor volume during and after CCRT based on PET/CT and MRI images was compared.

Results

There were significant differences (p < 0.001) between the initial tumor volume and tumor volume during and after CCRT as measured by both PET/CT and MRI. During CCRT, the percent volume reduction based on PET/CT images was significantly greater than the percent volume reduction calculated from MRI images (p = 0.024). However, after the completion of CCRT, no significant differences were found in volume reduction as calculated based on PET/CT versus MRI images (p = 0.289). The percent volume reduction of adenocarcinomas was significantly smaller than that of squamous cell carcinomas based on both PET/CT (p = 0.041) and MRI images (p < 0.001).

Conclusions

Significant decreases in tumor volume were observed during and after CCRT in patients with cervical cancer. Tumor volume reduction on PET/CT images was greater than that on MRI images during CCRT. We suggest that early PET/CT as well as MRI scans could be taken during CCRT to evaluate tumor response and allow personalized treatment of cervical cancer.
Literature
1.
go back to reference Hricak H, Gatsonis C, Coakley FV, Snyder B, Reinhold C, Schwartz LH, et al. Early invasive cervical cancer: CT and MR imaging in preoperative evaluation—ACRIN/GOG comparative study of diagnostic performance and interobserver variability. Radiology. 2007;245:491–8.PubMedCrossRef Hricak H, Gatsonis C, Coakley FV, Snyder B, Reinhold C, Schwartz LH, et al. Early invasive cervical cancer: CT and MR imaging in preoperative evaluation—ACRIN/GOG comparative study of diagnostic performance and interobserver variability. Radiology. 2007;245:491–8.PubMedCrossRef
2.
go back to reference Showalter TN, Miller TR, Huettner P, Rader J, Grigsby PW. 18F-fluorodeoxyglucose-positron emission tomography and pathologic tumor size in early-stage invasive cervical cancer. Int J Gynecol Cancer. 2009;19:1412–4.PubMedCrossRef Showalter TN, Miller TR, Huettner P, Rader J, Grigsby PW. 18F-fluorodeoxyglucose-positron emission tomography and pathologic tumor size in early-stage invasive cervical cancer. Int J Gynecol Cancer. 2009;19:1412–4.PubMedCrossRef
3.
go back to reference Grigsby PW. The role of FDG-PET/CT imaging after radiation therapy. Gynecol Oncol. 2007;107:S27–9.PubMedCrossRef Grigsby PW. The role of FDG-PET/CT imaging after radiation therapy. Gynecol Oncol. 2007;107:S27–9.PubMedCrossRef
4.
go back to reference Schwarz JK, Siegel BA, Dehdashti F, Grigsby PW. Association of posttherapy positron emission tomography with tumor response and survival in cervical carcinoma. JAMA. 2007;298:2289–95.PubMedCrossRef Schwarz JK, Siegel BA, Dehdashti F, Grigsby PW. Association of posttherapy positron emission tomography with tumor response and survival in cervical carcinoma. JAMA. 2007;298:2289–95.PubMedCrossRef
5.
go back to reference Lin LL, Yang Z, Mutic S, Miller TR, Grigsby PW. FDG-PET imaging for the assessment of physiologic volume response during radiotherapy in cervix cancer. Int J Radiat Oncol Biol Phys. 2006;65:177–81.PubMedCrossRef Lin LL, Yang Z, Mutic S, Miller TR, Grigsby PW. FDG-PET imaging for the assessment of physiologic volume response during radiotherapy in cervix cancer. Int J Radiat Oncol Biol Phys. 2006;65:177–81.PubMedCrossRef
6.
go back to reference Nam H, Park W, Huh SJ, Bae DS, Kim BG, Lee JH, et al. The prognostic significance of tumor volume regression during radiotherapy and concurrent chemoradiotherapy for cervical cancer using MRI. Gynecol Oncol. 2007;107:320–5.PubMedCrossRef Nam H, Park W, Huh SJ, Bae DS, Kim BG, Lee JH, et al. The prognostic significance of tumor volume regression during radiotherapy and concurrent chemoradiotherapy for cervical cancer using MRI. Gynecol Oncol. 2007;107:320–5.PubMedCrossRef
7.
go back to reference Ma DJ, Zhu JM, Grigsby PW. Tumor volume discrepancies between FDG-PET and MRI for cervical cancer. Radiother Oncol. 2011;98:139–42.PubMedCrossRef Ma DJ, Zhu JM, Grigsby PW. Tumor volume discrepancies between FDG-PET and MRI for cervical cancer. Radiother Oncol. 2011;98:139–42.PubMedCrossRef
8.
go back to reference Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.PubMedCrossRef Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.PubMedCrossRef
9.
go back to reference Hardt N, van Nagell JR, Hanson M, Donaldson E, Yoneda J, Maruyama Y. Radiation-induced tumor regression as a prognostic factor in patients with invasive cervical cancer. Cancer. 1982;49:35–9.PubMedCrossRef Hardt N, van Nagell JR, Hanson M, Donaldson E, Yoneda J, Maruyama Y. Radiation-induced tumor regression as a prognostic factor in patients with invasive cervical cancer. Cancer. 1982;49:35–9.PubMedCrossRef
10.
go back to reference Hong JH, Chen MS, Lin FJ, Tang SG. Prognostic assessment of tumor regression after external irradiation for cervical cancer. Int J Radiat Oncol Biol Phys. 1992;22:913–7.PubMedCrossRef Hong JH, Chen MS, Lin FJ, Tang SG. Prognostic assessment of tumor regression after external irradiation for cervical cancer. Int J Radiat Oncol Biol Phys. 1992;22:913–7.PubMedCrossRef
11.
go back to reference Jacobs AJ, Faris C, Perez CA, Kao MS, Galakatos A, Camel HM. Short-term persistence of carcinoma of the uterine cervix after radiation. An indicator of long-term prognosis. Cancer. 1986;57:944–50.PubMedCrossRef Jacobs AJ, Faris C, Perez CA, Kao MS, Galakatos A, Camel HM. Short-term persistence of carcinoma of the uterine cervix after radiation. An indicator of long-term prognosis. Cancer. 1986;57:944–50.PubMedCrossRef
12.
go back to reference Mayr NA, Magnotta VA, Ehrhardt JC, Wheeler JA, Sorosky JI, Wen BC, et al. Usefulness of tumor volumetry by magnetic resonance imaging in assessing response to radiation therapy in carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys. 1996;35:915–24.PubMedCrossRef Mayr NA, Magnotta VA, Ehrhardt JC, Wheeler JA, Sorosky JI, Wen BC, et al. Usefulness of tumor volumetry by magnetic resonance imaging in assessing response to radiation therapy in carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys. 1996;35:915–24.PubMedCrossRef
13.
go back to reference Schwarz JK, Lin LL, Siegel BA, Miller TR, Grigsby PW. 18-F-fluorodeoxyglucose-positron emission tomography evaluation of early metabolic response during radiation therapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2008;72:1502–7.PubMedCrossRef Schwarz JK, Lin LL, Siegel BA, Miller TR, Grigsby PW. 18-F-fluorodeoxyglucose-positron emission tomography evaluation of early metabolic response during radiation therapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2008;72:1502–7.PubMedCrossRef
14.
go back to reference Kong FM, Frey KA, Quint LE, Ten Haken RK, Hayman JA, Kessler M, et al. A pilot study of [18F]fluorodeoxyglucose positron emission tomography scans during and after radiation-based therapy in patients with non-small-cell lung cancer. J Clin Oncol. 2007;36:3116–23.CrossRef Kong FM, Frey KA, Quint LE, Ten Haken RK, Hayman JA, Kessler M, et al. A pilot study of [18F]fluorodeoxyglucose positron emission tomography scans during and after radiation-based therapy in patients with non-small-cell lung cancer. J Clin Oncol. 2007;36:3116–23.CrossRef
15.
go back to reference Wieder HA, Brücher BL, Zimmermann F, Becker K, Lordick F, Beer A, et al. Time course of tumor metabolic activity during chemoradiotherapy of esophageal squamous cell carcinoma and response to treatment. J Clin Oncol. 2004;22:900–8.PubMedCrossRef Wieder HA, Brücher BL, Zimmermann F, Becker K, Lordick F, Beer A, et al. Time course of tumor metabolic activity during chemoradiotherapy of esophageal squamous cell carcinoma and response to treatment. J Clin Oncol. 2004;22:900–8.PubMedCrossRef
16.
go back to reference Hautzel H, Müller-Gärtner HW. Early changes in fluorine-18-FDG uptake during radiotherapy. J Nucl Med. 1997;38:1384–6.PubMed Hautzel H, Müller-Gärtner HW. Early changes in fluorine-18-FDG uptake during radiotherapy. J Nucl Med. 1997;38:1384–6.PubMed
17.
go back to reference Hatano K, Sekiya Y, Araki H, Sakai M, Togawa T, Narita Y, et al. Evaluation of the therapeutic effect of radiotherapy on cervical cancer using magnetic resonance imaging. Int J Radiat Oncol Biol Phys. 1999;45:639–44.PubMedCrossRef Hatano K, Sekiya Y, Araki H, Sakai M, Togawa T, Narita Y, et al. Evaluation of the therapeutic effect of radiotherapy on cervical cancer using magnetic resonance imaging. Int J Radiat Oncol Biol Phys. 1999;45:639–44.PubMedCrossRef
18.
go back to reference Devic S, Tomic N, Faria S, Menard S, Lisbona R, Lehnert S. Defining radiotherapy target volumes using 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography: still a Pandora’s box? Int J Radiat Oncol Biol Phys. 2010;78:1555–62.PubMedCrossRef Devic S, Tomic N, Faria S, Menard S, Lisbona R, Lehnert S. Defining radiotherapy target volumes using 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography: still a Pandora’s box? Int J Radiat Oncol Biol Phys. 2010;78:1555–62.PubMedCrossRef
19.
go back to reference Miller T, Grigsby P. Measurement of tumor volume by PET to evaluate prognosis in patients with advanced cervical cancer treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2002;53:353–9.PubMedCrossRef Miller T, Grigsby P. Measurement of tumor volume by PET to evaluate prognosis in patients with advanced cervical cancer treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2002;53:353–9.PubMedCrossRef
20.
go back to reference Paulino AC, Koshy M, Howell R, Schuster D, Davis LW. Comparison of CT- and FDG-PET-defined gross tumor volume in intensity-modulated radiotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2005;61:1385–92.PubMedCrossRef Paulino AC, Koshy M, Howell R, Schuster D, Davis LW. Comparison of CT- and FDG-PET-defined gross tumor volume in intensity-modulated radiotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2005;61:1385–92.PubMedCrossRef
21.
go back to reference Gien LT, Beauchemin MC, Thomas G. Adenocarcinoma: a unique cervical cancer. Gynecol Oncol. 2010;116:140–6.PubMedCrossRef Gien LT, Beauchemin MC, Thomas G. Adenocarcinoma: a unique cervical cancer. Gynecol Oncol. 2010;116:140–6.PubMedCrossRef
22.
go back to reference Bjurberg M, Kjellén E, Ohlsson T, Bendahl PO, Brun E. Prediction of patient outcome with 2-deoxy-2-[18F]fluoro-d-glucose-positron emission tomography early during radiotherapy for locally advanced cervical cancer. Int J Gynecol Cancer. 2009;19:1600–5.PubMedCrossRef Bjurberg M, Kjellén E, Ohlsson T, Bendahl PO, Brun E. Prediction of patient outcome with 2-deoxy-2-[18F]fluoro-d-glucose-positron emission tomography early during radiotherapy for locally advanced cervical cancer. Int J Gynecol Cancer. 2009;19:1600–5.PubMedCrossRef
23.
go back to reference Kidd EA, Thomas M, Siegel BA, Dehdashti F, Grigsby PW. Changes in cervical cancer FDG uptake during chemoradiation and association with response. Int J Radiat Oncol Biol Phys. 2012 (Epub ahead of print). Kidd EA, Thomas M, Siegel BA, Dehdashti F, Grigsby PW. Changes in cervical cancer FDG uptake during chemoradiation and association with response. Int J Radiat Oncol Biol Phys. 2012 (Epub ahead of print).
Metadata
Title
Early response of patients undergoing concurrent chemoradiotherapy for cervical cancer: a comparison of PET/CT and MRI
Authors
Jeong Eun Lee
Seung Jae Huh
Heerim Nam
Sang Gyu Ju
Publication date
01-01-2013
Publisher
Springer Japan
Published in
Annals of Nuclear Medicine / Issue 1/2013
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-012-0659-3

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