The value of 18F-FDG PET/CT in recurrent gynecologic malignancies prior to pelvic exenteration Journal Article


Authors: Burger, I. A.; Vargas, H. A.; Donati, O. F.; Andikyan, V.; Sala, E.; Gonen, M.; Goldman, D. A.; Chi, D. S.; Schoder, H.; Hricak, H.
Article Title: The value of 18F-FDG PET/CT in recurrent gynecologic malignancies prior to pelvic exenteration
Abstract: Objective In patients undergoing pelvic exenteration for recurrent gynecological malignancies, we assessed the performance of [18F]-FDG PET/CT for delineating disease extent and evaluated the association between quantitative FDG uptake metrics (SUVmax, total lesion glycolysis [TLG] and metabolic tumor volume [MTV]) and progression-free survival (PFS) and overall survival (OS). Methods Retrospective study of patients undergoing pelvic exenteration for gynecologic malignancies between January 2002 and November 2011 who had FDG PET/CT within 90 days before surgery. Two readers (R1, R2) independently determined the presence of bladder, rectum, vagina, cervix and pelvic side wall invasion and measured SUVmax, TLG and MTV in each patient. Areas under the curve (AUCs), for detecting organ invasion were calculated. Kaplan-Meier graphs were used to determine associations between FDG uptake and PFS/OS. Inter-reader agreement was assessed. Results 33 patients (mean age 56 years, range: 28-81) were included; primary sites of disease were the cervix (n = 18), uterus (n = 8) and vagina/vulva (n = 7). AUCs for organ invasion ranged from 0.74 to 0.96. There was a significant association between FDG uptake metrics incorporating tumor volume (TLG and MTV) and OS (p ≤ 0.001) as well as between MTV and PFS (p = 0.001). No significant association was identified between SUVmax and OS/PFS (p = 0.604/0.652). Inter-reader agreement for organ invasion was fair to substantial (k = 0.36-0.74) and almost perfect for FDG quantification (ICC = 0.97-0.99). Conclusion In patients undergoing pelvic exenteration for recurrent gynecological malignancies, 18F-FDG PET/CT is useful for preoperative assessment of disease extent. Furthermore, quantitative metrics of FDG uptake incorporating MTV serve as predictive biomarkers of progression-free and overall survival in this population. © 2013 Elsevier Inc.
Keywords: cancer recurrence; endometrial cancer; pet; cervical cancer; pelvic exenteration; total lesion glycolysis
Journal Title: Gynecologic Oncology
Volume: 129
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2013-06-01
Start Page: 586
End Page: 592
Language: English
DOI: 10.1016/j.ygyno.2013.01.017
PROVIDER: scopus
PUBMED: 23369941
PMCID: PMC4104687
DOI/URL:
Notes: --- - "Export Date: 3 June 2013" - "CODEN: GYNOA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Evis Sala
    95 Sala
  2. Dennis S Chi
    496 Chi
  3. Mithat Gonen
    716 Gonen
  4. Heiko Schoder
    289 Schoder
  5. Hedvig Hricak
    333 Hricak
  6. Debra Alyssa Goldman
    97 Goldman
  7. Olivio Fabrizio Manolo Donati
    16 Donati
  8. Irene Andrea Burger
    10 Burger