Gynecological Cancer

PD 15 - GYN 2 - Poster Discussion

1132 - Changes on Mid-Treatment FDG-PET/CT for Cervical Cancer Treated With Chemoradiotherapy Are Associated With Prognosis

Wednesday, October 24
11:36 AM - 11:42 AM
Location: Room 217 A/B

Changes on Mid-Treatment FDG-PET/CT for Cervical Cancer Treated With Chemoradiotherapy Are Associated With Prognosis
C. D. Jacobs, D. J. Carpenter, and J. P. Chino; Duke University Medical Center, Durham, NC

Purpose/Objective(s): To assess whether radiographic/metabolic changes on mid-chemoradiation (CRT) FDG-PET/CT for cervical cancer predict outcome.

Materials/Methods: Thirty women with FIGO stage IB1-IVB cervical cancer treated with concurrent cisplatin-based CRT and brachytherapy (BT) were prospectively enrolled between Feb 2012 and Jun 2016. FDG-PET/CT was obtained pre-CRT and ~3 weeks intra-CRT. Max and mean standard uptake values (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for the primary tumor and clinically involved lymph nodes (LN+) from the pre-CRT and intra-CRT FDG-PET/CT were recorded. Clinical endpoints analyzed include overall survival (OS), disease-free survival (DFS), and rates of cervical recurrence (CR), nodal recurrence (NR), and distant metastasis (DM). FDG-PET/CT variables and other prognostic factors associated with clinical endpoints were identified via univariate Cox proportional hazards modeling, with multivariate modeling performed for PET-derived variables where p<0.1.

Results: Median patient age was 41 (interquartile range 37-51), most common FIGO stage was IIB (40%), 24 (80%) women had pelvic LN+, 8 (27%) women had para-aortic LN+, and 2 (7%) had IVB disease due to supraclavicular LN+. Median dose to the elective volume, pelvic sidewall, and LN+ were 45 Gy, 55 Gy, and 65 Gy, respectively. Median BT dose was 27.5 Gy in 5 fractions. All received concurrent cisplatin and 3 women with small cell histology also received etoposide. After a median follow up of 22 months for living patients, 2 year rates of CR, NR, DM, DFS, and OS were 11% (95% confidence interval [CI] 0-22%), 21% (95% CI 4-38%), 45% (95% CI 25-65%), 44% (95% CI 26-63%), and 72% (95% CI 55-89%), respectively. While several PET metrics were associated with individual clinical endpoints, TLG was more consistently associated across endpoints on univariate analysis. Intra-CRT TLG was associated with NR (HR 1.40, 95% CI 1.09-1.76; p=0.016), DFS (HR 1.19, 95% CI 1.03-1.34; p=0.018), and OS (HR 1.33, 95% CI 1.13-1.54; p=0.002), with a trend for DM (HR 1.20, 95% CI 0.99-1.40; p=0.053). Relative change in TLG was associated with CR (p=0.021) and NR (p=0.035). Pre-CRT TLG was significantly associated with DM (HR 1.06, 95% CI 1.001-1.12; p=0.031), with a trend for DFS (HR 1.05, 95% CI 0.999-1.10; p=0.059) and OS (HR 1.06, 95% CI 0.98-1.12; p=0.057). On multivariate analysis, DFS was significantly associated with the difference in pre- to intra-CRT SUVmean (HR 3.00, 95% CI 1.09-12.7; p=0.031) with a trend for intra-CRT SUVmean (HR 2.11, 95% CI 0.90-4.92; p=0.064), while controlling for age, FIGO, grade, and LN+.

Conclusion: In this group of high-risk cervical cancer patients treated with CRT+BT, TLG on mid-treatment FDG-PET/CT was associated with recurrence and OS, while the difference in SUVmean between pre- and mid-CRT scans was independently associated with DFS. These metrics may provide an early signal for selective treatment intensification, with either dose escalation or adjuvant chemotherapy.

Author Disclosure: C.D. Jacobs: None. D.J. Carpenter: None. J.P. Chino: Partner; Duke University Cancer Center. Stock; NanoScint. Co-Founder/Owner; NanoScint.

Corbin Jacobs, MD

Disclosure:
No relationships to disclose.

Biography:
Corbin Jacobs, MD is a resident physician at Duke University who will complete his radiation oncology training in June 2020. He graduated summa cum laude from Brigham Young University and received a Bachelor of Science degree in Exercise Science as well as a minor in Spanish. Corbin completed his medical school training at the University of Texas Southwestern where he graduated first in his class with distinction in research, and received the American Medical Association Foundation Physicians of Tomorrow Award. His mother, who valiantly battled colorectal cancer for 24 years, is his inspiration for pursing a career in oncology and contributing to cancer research. Corbin is happily married and has two rambunctious children – or three if you count the fluffy golden doodle.

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