Long-Term Outcomes of Cervical Cancer Patients Treated With Definitive Chemoradiation Following a Complete Metabolic Response

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 fai...

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Published in:Clinical oncology (Royal College of Radiologists (Great Britain)) 2021-05, Vol.33 (5), p.300-306
Main Authors: Lin, A.J., Dehdashti, F., Massad, L.S., Thaker, P.H., Powell, M.A., Mutch, D.G., Schwarz, J.K., Markovina, S., Siegel, B.A., Grigsby, P.W.
Format: Article
Language:English
Subjects:
Cervical cancer
chemoradiation
complete metabolic response
FDG-PET
Female
Fluorodeoxyglucose F18
Humans
Lymphatic Metastasis
Positron-Emission Tomography
prognosis
recurrence
Retrospective Studies
Uterine Cervical Neoplasms - diagnostic imaging
Uterine Cervical Neoplasms - therapy
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Summary: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. 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. 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). T3–4 tumours and para-aortic nodal involvement at diagnosis are poor prognostic factors, even after a CMR following chemoradiation. •Complete metabolic response (CMR) on 3-month PET has non-homogeneous cervical cancer control rates.•Distant recurrence is the most common pattern of failure.•Initial T and N stage independently stratify risk of distant recurrence after CMR.
ISSN:0936-6555
1433-2981
DOI:10.1016/j.clon.2021.01.010