This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Kidd, E. A. Articles by Grigsby, P. W. PubMed PubMed Citation Articles by Kidd, E. A. Articles by Grigsby, P. W.

Intratumoral Metabolic Heterogeneity of Cervical Cancer

Authors' Affiliations: ¹ Department of Radiation Oncology, ² Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, ³ Department of Obstetrics and Gynecology, and ⁴ the Alvin J. Siteman Cancer Center, Washington University Medical Center, St. Louis, Missouri

Requests for reprints: Perry W. Grigsby, Washington University School of Medicine, Department of Radiation Oncology, Campus Box 8224, Mallinckrodt Institute of Radiology, 4921 Parkview Place, CAM Lower Level, St. Louis, MO 63110. Phone: 314-362-8502; Fax: 314-747-9557; E-mail: pgrigsby{at}wustl.edu.

Purpose: Previous research has shown that the intertumoral maximum standardized uptake value (SUV_Max) of F-18 fluorodeoxyglucose (FDG)–positron emission tomography (PET) for cervical cancer predicts disease outcome. The purpose of this study was to evaluate the pretreatment intratumoral metabolic heterogeneity of FDG.

Experimental Design: This is a prospective cohort study of 72 patients with International Federation of Gynecology and Obstetrics stages Ib1 to IVa cervical cancer treated with chemoradiation. Three-dimensional FDG-PET threshold tumor volumes were calculated using image segmentation and an adaptive thresholding method for the primary cervix tumor from the pretreatment FDG-PET/computerized tomography. Intratumor heterogeneity was obtained for each patient's cervical tumor by taking the derivative (dV/dT) of the volume-threshold function from 40% to 80%. The association between intratumoral heterogeneity and tumor-specific factors and patient outcomes were determined.

Results: The mean cervix tumor SUV_Max was 12.4 (range, 3.0-38.4). The mean differential tumor heterogeneity was –1.074 (range, –0.107 to –5.623). There was no association between dV/dT and SUV_Max (R² = 0.069), but there was a relationship with dV/dT and tumor volume (R² = 0.881). There was no correlation of dV/dT with tumor histology (P = 0.4905). Heterogeneity was significantly associated with the risk of lymph node metastasis at diagnosis (P = 0.0009), tumor response to radiation as evaluated by FDG-PET obtained 3 months after completing treatment (P = 0.0207), risk of pelvic recurrence (P = 0.0017), and progression-free survival (P = 0.03).

Conclusions: Cervical intratumoral FDG metabolic heterogeneity on the pretreatment FDG-PET predicts risk of lymph node involvement at diagnosis, response to therapy, and risk of pelvic recurrence.