The aim of this study was to evaluate if bone marrow (BM) SUVmax measured on pre-treatment
18F-FDG PET/CT predicts the clinical outcome of locally advanced
cervical cancer (LACC). We recruited retrospectively patients with LACC who underwent staging
18F-FDG PET/CT and had baseline blood tests, then treated by chemoradiation
therapy (CRT), followed by image-guided adaptive
brachytherapy (IGABT). BM SUVmax was calculated and correlated to inflammatory blood markers.
Tumor size and pelvic lymph node involvement were evaluated on baseline MRI. Prognostic value of SUV uptake and blood markers regarding overall survival (OS), pelvic and extra-pelvic recurrence-free survival (PRFS and EPRFS respectively) was assessed using Cox models with adjusted p-values. 116 patients with FIGO stage Ib-IVa
cervical cancer, treated between 2005 and 2014, were analyzed. The median follow-up was 75.5 months. BM SUVmax was significantly correlated to
tumor SUVmax. In multivariate analysis, PRFS was significantly poorer in patients with high BM SUVmax (>2.8) and neutrophilia (p < .05).
Tumor size (>5 vs ≤5 cm) could predict PRFS, EPRFS and OS (p < .05). In our cohort, FIGO stage (I-II
vs III-IV), pelvic lymph node involvement and
tumor SUVmax (>12 vs ≤12) were not prognostic for OS or pelvic and extra-pelvic relapses. Patients with LACC and high BM SUVmax on
18F-FDG PET have worse PFRS following CRT plus IGABT. These results can be potentially explained by the pro-inflammatory role of the tumor microenvironment and
G-CSF expressed by
tumor cells. These data support the role of PET as a potential
indicator of disease aggressiveness beyond
tumor staging.