Association of posttherapy positron emission tomography with tumor response and survival in cervical carcinoma

JAMA. 2007 Nov 21;298(19):2289-95. doi: 10.1001/jama.298.19.2289.


Context: Retrospective studies have demonstrated that the use of positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) in the posttherapy evaluation of patients with cervical carcinoma is predictive of survival outcome.

Objective: To validate the association between the metabolic response on the 3-month posttherapy FDG-PET and long-term survival outcome.

Design, setting, and patients: A prospective cohort study designed to validate our previous finding that the results of a 3-month posttherapy FDG-PET are predictive of long-term clinical outcome. A total of 92 women were treated with external irradiation, brachytherapy, and concurrent chemotherapy from January 2003 through September 2006. Posttherapy whole-body FDG-PET was performed 2 to 4 months (mean, 3 months) after completion of therapy.

Main outcome measures: The primary outcome end points were metabolic response, progression-free survival, and cause-specific survival.

Results: Posttherapy FDG-PET showed a complete metabolic response in 65 patients (70%), a partial metabolic response in 15 (16%), and progressive disease in 12 (13%). Their 3-year progression-free survival rates were 78%, 33%, and 0%, respectively (P < .001). Multivariate analysis demonstrated that the hazard ratio (HR) for risk of recurrence based on the posttherapy metabolic response showing progressive disease was 32.57 (95% confidence interval [CI], 10.22-103.82). A partial metabolic response had an HR of 6.30 (95% CI, 2.73-14.56). These were more predictive of survival outcome than the pretreatment lymph node status (HR, 3.54; 95% CI, 1.54-8.09).

Conclusion: In this single-site study population of women with cervical cancer, 3-month posttherapy FDG uptake, as detected by whole-body PET, was predictive of survival.

MeSH terms

  • Adult
  • Cohort Studies
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Middle Aged
  • Positron-Emission Tomography*
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Radiopharmaceuticals
  • Reproducibility of Results
  • Salvage Therapy
  • Survival Analysis
  • Uterine Cervical Neoplasms / diagnostic imaging*
  • Uterine Cervical Neoplasms / mortality
  • Uterine Cervical Neoplasms / therapy


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18