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Julie K. Schwarz, MD, PhD; Barry A. Siegel, MD; Farrokh Dehdashti, MD; Perry W. Grigsby, MD, MS

JAMA. 2007;298(19):2289-2295.

Context  Retrospective studies have demonstrated that the use of positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) in the posttherapy evaluation of patients with cervical carcinoma is predictive of survival outcome.

Objective  To validate the association between the metabolic response on the 3-month posttherapy FDG-PET and long-term survival outcome.

Design, Setting, and Patients  A prospective cohort study designed to validate our previous finding that the results of a 3-month posttherapy FDG-PET are predictive of long-term clinical outcome. A total of 92 women were treated with external irradiation, brachytherapy, and concurrent chemotherapy from January 2003 through September 2006. Posttherapy whole-body FDG-PET was performed 2 to 4 months (mean, 3 months) after completion of therapy.

Main Outcome Measures  The primary outcome end points were metabolic response, progression-free survival, and cause-specific survival.

Results  Posttherapy FDG-PET showed a complete metabolic response in 65 patients (70%), a partial metabolic response in 15 (16%), and progressive disease in 12 (13%). Their 3-year progression-free survival rates were 78%, 33%, and 0%, respectively (P < .001). Multivariate analysis demonstrated that the hazard ratio (HR) for risk of recurrence based on the posttherapy metabolic response showing progressive disease was 32.57 (95% confidence interval [CI], 10.22-103.82). A partial metabolic response had an HR of 6.30 (95% CI, 2.73-14.56). These were more predictive of survival outcome than the pretreatment lymph node status (HR, 3.54; 95% CI, 1.54-8.09).

Conclusion  In this single-site study population of women with cervical cancer, 3-month posttherapy FDG uptake, as detected by whole-body PET, was predictive of survival.

Author Affiliations: Departments of Radiation Oncology (Drs Schwarz and Grigsby) and Obstetrics and Gynecology (Dr Grigsby), Division of Nuclear Medicine, Mallinckrodt Institute of Radiology (Drs Siegel, Dehdashti, and Grigsby), and the Alvin J. Siteman Cancer Center (Drs Siegel, Dehdashti, and Grigsby), Washington University School of Medicine, St Louis, Missouri.

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