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Clin Cancer Res. 2008 Aug 15;14(16):5236-41. doi: 10.1158/1078-0432.CCR-07-5252.

Intratumoral metabolic heterogeneity of cervical cancer.

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Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, Missouri, USA.



Previous research has shown that the intertumoral maximum standardized uptake value (SUVMax) of F-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) for cervical cancer predicts disease outcome. The purpose of this study was to evaluate the pretreatment intratumoral metabolic heterogeneity of FDG.


This is a prospective cohort study of 72 patients with International Federation of Gynecology and Obstetrics stages Ib1 to IVa cervical cancer treated with chemoradiation. Three-dimensional FDG-PET threshold tumor volumes were calculated using image segmentation and an adaptive thresholding method for the primary cervix tumor from the pretreatment FDG-PET/computerized tomography. Intratumor heterogeneity was obtained for each patient's cervical tumor by taking the derivative (dV/dT) of the volume-threshold function from 40% to 80%. The association between intratumoral heterogeneity and tumor-specific factors and patient outcomes were determined.


The mean cervix tumor SUV(Max) was 12.4 (range, 3.0-38.4). The mean differential tumor heterogeneity was -1.074 (range, -0.107 to -5.623). There was no association between dV/dT and SUVMax (R2 = 0.069), but there was a relationship with dV/dT and tumor volume (R2 = 0.881). There was no correlation of dV/dT with tumor histology (P = 0.4905). Heterogeneity was significantly associated with the risk of lymph node metastasis at diagnosis (P = 0.0009), tumor response to radiation as evaluated by FDG-PET obtained 3 months after completing treatment (P = 0.0207), risk of pelvic recurrence (P = 0.0017), and progression-free survival (P = 0.03).


Cervical intratumoral FDG metabolic heterogeneity on the pretreatment FDG-PET predicts risk of lymph node involvement at diagnosis, response to therapy, and risk of pelvic recurrence.

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