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Intratumoral Heterogeneity of 64Cu-ATSM Uptake is a Prognostic Indicator in Patients with Cervical Cancer | OMICS International | Abstract

OMICS Journal of Radiology
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Review Article

Intratumoral Heterogeneity of 64Cu-ATSM Uptake is a Prognostic Indicator in Patients with Cervical Cancer

Albert J Chang1, Farrokh Dehdashti2,3, Barry A Siegel2,3, Michael J Welch3,4, Julie K Schwarz1,3,5 and Perry W Grigsby1,2,3,5*
1Department of Radiation Oncology, Mallinckrodt Institute of Radiology, USA
2Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, USA
3Alvin J. Siteman Cancer Center, USA
4Division of Radiological Sciences, Mallinckrodt Institute of Radiology, USA
5Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri USA
Corresponding Author : Perry W Grigsby
Washington University School of Medicine
Department of Radiation Oncology–Campus Box 8224
Mallinckrodt Institute of Radiology, St. Louis, MO 63110, USA
Tel: (314) 362-8502
Fax: (314) 747-9557
E-mail: [email protected]
Received March 20, 2013; Accepted May 15, 2013; Published May 21, 2013
Citation: Chang AJ, Dehdashti AJ, Siegel BA, Welch MJ, Schwarz JK, et al. (2013) Intratumoral Heterogeneity of 64Cu-ATSM Uptake is a Prognostic Indicator in Patients with Cervical Cancer. OMICS J Radiology 2:130. doi: 10.4172/2167-7964.1000130
Copyright: © 2013 Chang AJ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


 Introduction: Intratumoral heterogeneity determined by FDG-PET is a poor prognostic factor in cervical cancer. Cu-

ATSM has been used to evaluate hypoxia in cervical cancer. In this study, FDG and 64Cu-ATSM uptake patterns were
compared and the prognostic significance of 64Cu-ATSM heterogeneity was determined.
Methods: 15 patients with cervical cancer who underwent pretreatment 64Cu-ATSM- and FDG-PET/CT were
included. The 64Cu-ATSM- and FDG-PET/CT images were co-registered and tumor volumes were autocontoured for
each image set in 10% increments of the SUVmax ranging from 40% to 80%. The hypoxic fraction defined by 64Cu-ATSM
uptake was determined. Concordance between 64Cu-ATSM and FDG uptake was determined by Dice’s coefficient.
Heterogeneity of 64Cu-ATSM and FDG uptake was calculated as the variance of the 40-80% isothreshold volumes. The
association between heterogeneity of 64Cu-ATSM uptake with tumor-specific factors and outcomes was determined.
Results: The hypoxic fraction ranged from 0.773 ± 0.013 to 0.087 ± 0.010 as defined by the 40% to 80% Cu-ATSM
isothreshold volumes, respectively. Dice’s similarity coefficients for the FDG and 64Cu-ATSM 40 to 80% isothreshold
volumes ranged from 0.476 ± 0.012 to 0.112 ± 0.017. Greater 64Cu-ATSM heterogeneity was associated with increased
risk of lymph node metastasis at diagnosis (p<0.01), persistent disease after therapy, (p<0.01), and decreased median
progression-free survival (11 months vs. not reached, p=0.03).
Conclusion: Significant fractions of cervical tumors are hypoxic. Regions of highest 64Cu-ATSM and FDG uptake
were discordant. Elevated 64Cu-ATSM heterogeneity may predict for increased risk of lymph node metastases, decreased
responsiveness to treatment, and decreased progression-free survival.


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