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Hindi 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: pgrigsby@wustl.edu |
| 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. | |
Abstract
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.
