A J Lin1, F Dehdashti2, L S Massad3, P H Thaker3, M A Powell3, D G Mutch3, J K Schwarz4, S Markovina4, B A Siegel2, P W Grigsby5. 1. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA; Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA. Electronic address: alexanderlin@wustl.edu. 2. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA; Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA. 3. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA; Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA. 4. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA; Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA. 5. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA; Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA; Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
Abstract
AIMS: A complete metabolic response (CMR) on early post-treatment 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a positive prognostic factor for cervical cancer patients treated with definitive chemoradiation, but long-term outcomes of this group of patients are unknown. Patterns of failure and risk subgroups are identified. MATERIALS AND METHODS: Patients who received curative-intent chemoradiation from 1998 to 2018 for International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IVA cervical cancer and had a CMR on post-treatment FDG-PET within 5 months of treatment completion were included. Cox proportional hazards models determined factors associated with locoregional and distant failure. Kaplan-Meier estimates of freedom from any recurrence (FFR) of patient subgroups were compared with Log-rank tests. RESULTS: There were 402 patients with a CMR after chemoradiation on FDG-PET. Initial T stage was T1 (38%)/T2 (40%)/T3 (20%)/T4 (2%); initial FDG-avid nodal status was no nodes (50%)/pelvic lymph nodes (40%)/pelvic and para-aortic lymph nodes (10%). After a median follow-up of 6 years, 109 (27%) recurred. The pattern of recurrence was locoregional (27%), distant (61%) or both (12%). No factors were associated with locoregional failure. Distant recurrence was more likely in patients with T3-4 lesions (hazard ratio = 2.4, 95% confidence interval 1.5-3.8) and involvement of pelvic (hazard ratio = 1.6, 95% confidence interval 1.0-2.7) or para-aortic lymph nodes (hazard ratio = 2.7, 95% confidence interval 1.4-5.0) at diagnosis. The 5-year FFR rates for T1-2 patients with no nodes, pelvic nodes alone or para-aortic nodes at diagnosis were 85, 76 and 62%, respectively (P = 0.04, none versus para-aortic nodes). The 5-year FFR for T3-4 patients with no nodes, pelvic nodes alone or para-aortic nodes at diagnosis were 68, 56 and 25%, respectively (P = 0.09, none versus para-aortic nodes). CONCLUSIONS: T3-4 tumours and para-aortic nodal involvement at diagnosis are poor prognostic factors, even after a CMR following chemoradiation.
AIMS: A complete metabolic response (CMR) on early post-treatment 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a positive prognostic factor for cervical cancer patients treated with definitive chemoradiation, but long-term outcomes of this group of patients are unknown. Patterns of failure and risk subgroups are identified. MATERIALS AND METHODS: Patients who received curative-intent chemoradiation from 1998 to 2018 for International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IVA cervical cancer and had a CMR on post-treatment FDG-PET within 5 months of treatment completion were included. Cox proportional hazards models determined factors associated with locoregional and distant failure. Kaplan-Meier estimates of freedom from any recurrence (FFR) of patient subgroups were compared with Log-rank tests. RESULTS: There were 402 patients with a CMR after chemoradiation on FDG-PET. Initial T stage was T1 (38%)/T2 (40%)/T3 (20%)/T4 (2%); initial FDG-avid nodal status was no nodes (50%)/pelvic lymph nodes (40%)/pelvic and para-aortic lymph nodes (10%). After a median follow-up of 6 years, 109 (27%) recurred. The pattern of recurrence was locoregional (27%), distant (61%) or both (12%). No factors were associated with locoregional failure. Distant recurrence was more likely in patients with T3-4 lesions (hazard ratio = 2.4, 95% confidence interval 1.5-3.8) and involvement of pelvic (hazard ratio = 1.6, 95% confidence interval 1.0-2.7) or para-aortic lymph nodes (hazard ratio = 2.7, 95% confidence interval 1.4-5.0) at diagnosis. The 5-year FFR rates for T1-2 patients with no nodes, pelvic nodes alone or para-aortic nodes at diagnosis were 85, 76 and 62%, respectively (P = 0.04, none versus para-aortic nodes). The 5-year FFR for T3-4 patients with no nodes, pelvic nodes alone or para-aortic nodes at diagnosis were 68, 56 and 25%, respectively (P = 0.09, none versus para-aortic nodes). CONCLUSIONS: T3-4 tumours and para-aortic nodal involvement at diagnosis are poor prognostic factors, even after a CMR following chemoradiation.
Authors: Jocelyn S Chapman; I-Chow Hsu; Pamela N Peters; William E Pierson; Lee-May Chen; Antonio C Westphalen Journal: Abdom Radiol (NY) Date: 2020-07-08
Authors: Alfonso Dueñas-González; Juan J Zarbá; Firuza Patel; Juan C Alcedo; Semir Beslija; Luis Casanova; Pittayapoom Pattaranutaporn; Shahid Hameed; Julie M Blair; Helen Barraclough; Mauro Orlando Journal: J Clin Oncol Date: 2011-03-28 Impact factor: 44.544
Authors: Alexander J Lin; Jason D Wright; Farrokh Dehdashti; Barry A Siegel; Stephanie Markovina; Julie Schwarz; Premal H Thaker; David G Mutch; Matthew A Powell; Perry W Grigsby Journal: Int J Gynecol Cancer Date: 2019-08-30 Impact factor: 3.437
Authors: Rebecca A Brooks; Janet S Rader; Farrokh Dehdashti; David G Mutch; Matthew A Powell; Premal H Thaker; Barry A Siegel; Perry W Grigsby Journal: Gynecol Oncol Date: 2008-10-16 Impact factor: 5.482
Authors: Jyoti S Mayadev; Danielle Enserro; Yvonne G Lin; Diane M Da Silva; Heather A Lankes; Carol Aghajanian; Sharad Ghamande; Kathleen N Moore; Vanessa A Kennedy; Paula M Fracasso; Russell J Schilder Journal: JAMA Oncol Date: 2020-01-01 Impact factor: 31.777
Authors: Steven H Lin; Ash A Alizadeh; Maximilian Diehn; Everett J Moding; Yufei Liu; Barzin Y Nabet; Jacob J Chabon; Aadel A Chaudhuri; Angela B Hui; Rene F Bonilla; Ryan B Ko; Christopher H Yoo; Linda Gojenola; Carol D Jones; Jianzhong He; Yawei Qiao; Ting Xu; John V Heymach; Anne Tsao; Zhongxing Liao; Daniel R Gomez; Millie Das; Sukhmani K Padda; Kavitha J Ramchandran; Joel W Neal; Heather A Wakelee; Billy W Loo Journal: Nat Cancer Date: 2020-01-20
Authors: David A Palma; Robert Olson; Stephen Harrow; Stewart Gaede; Alexander V Louie; Cornelis Haasbeek; Liam Mulroy; Michael Lock; George B Rodrigues; Brian P Yaremko; Devin Schellenberg; Belal Ahmad; Sashendra Senthi; Anand Swaminath; Neil Kopek; Mitchell Liu; Karen Moore; Suzanne Currie; Roel Schlijper; Glenn S Bauman; Joanna Laba; X Melody Qu; Andrew Warner; Suresh Senan Journal: J Clin Oncol Date: 2020-06-02 Impact factor: 44.544