Survival effect of pre-RT PET-CT on cervical cancer: Image-guided intensity-modulated radiation therapy era

Chih-Hsiung Su; Wan-Ming Chen; Mingchih Chen; Ben-Chang Shia; Szu-Yuan Wu

doi:10.3389/fonc.2023.1012491

Survival effect of pre-RT PET-CT on cervical cancer: Image-guided intensity-modulated radiation therapy era

Front Oncol. 2023 Jan 31:13:1012491. doi: 10.3389/fonc.2023.1012491. eCollection 2023.

Authors

Chih-Hsiung Su¹, Wan-Ming Chen^{2

3}, Mingchih Chen², Ben-Chang Shia^{2

3}, Szu-Yuan Wu^{2

3

4

5

6

7

8

9

10}

Affiliations

¹ Department of Accounting Information, Chihlee University of Technology, Taipei, Taiwan.
² Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan.
³ Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan.
⁴ Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
⁵ Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
⁶ Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
⁷ Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
⁸ Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
⁹ Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
¹⁰ Department of Management, College of Management, Fo Guang University, Yilan, Taiwan.

Abstract

Condensed abstract: No large-scale, well-designed randomized study with a long-term follow-up has evaluated the survival effect of pretreatment 18-fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸FDG-PET-CT) on patients with stage IB-IVA cervical cancer receiving image-guided intensity-modulated radiation therapy (IG-IMRT). This is the first head-to-head propensity score-matched, nationwide population-based cohort study evaluating this survival effect. The results revealed that pretreatment ¹⁸FDG-PET-CT might be associated with longer survival in patients with stage IB-IVA cervical cancer receiving radiotherapy or concurrent chemoradiotherapy, especially in the IG-IMRT era.

Purpose: No large-scale, well-designed randomized study with a long-term follow-up has evaluated the survival effect of pretreatment 18-fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸FDG-PET-CT) on patients with stage IB-IVA cervical cancer receiving image-guided intensity-modulated radiation therapy (IG-IMRT). Therefore, in this propensity score-matched, population-based cohort study, we investigated these survival effects.

Patients and methods: We included 4167 patients with stage IB-IVA cervical cancer receiving radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) through the IG-IMRT technique. The patients were categorized into two 1:2 propensity score-matched groups depending on whether they underwent pretreatment ¹⁸FDG-PET-CT, and their outcomes were compared.

Results: We included 2778 and 1389 patients with cervical cancer in the nonpretreatment and pretreatment PET-CT groups, respectively. Univariable and multivariable analyses revealed an association between pretreatment PET-CT and improved survival in the patients (in the adjusted model, the adjusted hazard ratio [aHR] was 0.88; 95% confidence interval [CI], 0.80-0.97: P = 0.010). Regardless of the cancer stage (early or advanced), pretreatment PET-CT was significantly superior to nonpretreatment PET-CT in terms of all-cause death (aHR, 0.78; 95% CI, 0.60-0.92; P = 0.013 and aHR, 0.90; 95% CI, 0.81-0.99; P = 0.039 for the early [IB-IIA] and advanced stages [IIB-IVA], respectively).

Conclusions: Pretreatment ¹⁸FDG-PET-CT might be associated with longer survival in patients with stage IB-IVA cervical cancer receiving RT or CCRT, especially in the era of IG-IMRT.

Keywords: 18FDG-PET–CT; IG-IMRT; cervical carcinoma; clinical stages; survival.

Grants and funding

Lo-Hsu Medical Foundation, LotungPoh-Ai Hospital, supports S-YW’s work (Funding Number: 11001, 11010, 11013 and 11103).