Evaluating repetitive ¹⁸F-fluoroazomycin-arabinoside (¹⁸FAZA) PET in the setting of MRI guided adaptive radiotherapy in cervical cancer

Figures & data

Table I. Patient and Treatment characteristics.

Patient No.	Age	Histology	FIGO	Pelvic lymph nodes	GTVin MRIat diagnosis*	FAZA uptakeat diagnosis	GTVin MRIat 1. BT*	FAZA uptake before 1. BT	HR CTV Vol.* in MRI	D90 for HR CTV^a	D100 for HR CTV^a	Outcome
1	38	SCC	IB2	Pos	103.3	positive	4.9	positive	37.8	91.4	73.7	CCR
2	74	AS	IIAB	Neg (CT)	69.2	positive	9.8	negative	35.4	91.1	71.7	CCR
3	66	SCC	IIAB	Neg	67	negative	1	negative	19.1	114.1	87.6	CCR
4	52	SCC	IIAB	Neg	17.9	negative	3.2	negative	25.8	109	72.6	CCR
5	79	AC	IIB	Pos (CT)	125	positive	66.1	positive	95	69.3	62.6	IR
6	40	AC	IIB	Pos	62.8	positive	7.4	positive	25.5	97.5	79.2	RR
7	77	SCC	IIB	Neg	55.1	positive	14.2	positive	28.5	102.7	66.1	CCR
8	51	SCC	IB1	Neg	1.6	negative	0.5	negative	18.8	113.5	86.2	CCR
9	29	SCC	IIAB	Pos	108	negative	4	negative	40.8	95.4	68.2	DM
10	39	SCC	IIIB	Neg	54.8	negative	6	negative	27.5	100.3	74.8	DM
11	41	SCC	IIB	Pos	62.5	negative	34.2	negative	93.4	81.9	58.1	DM
12	46	SCC	IIAB	Neg	41.1	negative	9.3	negative	42.4	94	75.6	CCR
13	82	SCC	IB1	Pos	11.7	negative	3.6	negative	17.8	110.5	78.4	DM
14	56	AS	IB1	Pos	4.9	negative	3.6	negative	23.7	109.6	81.4	CCR
15	80	SCC	IIB	Neg	38.1	negative	10.9	negative	48	103	72	CCR

CCR - continous complete remission; IR - incomplete remission; RR - regional recurrence; DM - distant metastasis; SCC - Sqamous Cell Carcinoma; AC - Adenocarcinoma; AS - Adenosquamous Carcinoma; GTV - Gross Target Volume.

*Volume in cm³.

^aDose in Gy.

Figure 1. Sagittal and axial MRI (i) and sagittal and axial ¹⁸FAZA PET (ii) imaging in a patient with cervical cancer FIGO stage IIb before therapy (A) and during RT (B) (patient number 6). Arrows indicate the tumor on the MRI (i) and the hypoxic areas within the tumor (ii).

Figure 2. Clinical results from repetitive ¹⁸FAZA PET within MRI guided adaptive radiotherapy in cervical cancer after a mean follow-up of 27 months for all patients.

Table II. ¹⁸FAZA -PET one hour after application in cervical cancer patients at the time of diagnosis obtained before (Scan I), during (Scan II) and after radiotherapy (Scan III).

	^18FAZA uptake
Pts. no	Scan I	Scan II	Scan III	Outcome
1	Positive	Positive	Negative	CCR	NED
2	Positive	Negative	Negative	CCR	NED
5	Positive	Positive	Negative	IR	DOOD
6	Positive	Positive	Negative*	RR	DOD
7	Positive	Positive	Negative	CCR	NED
3	Negative	Negative	Negative	CCR	NED
4	Negative	Negative	Negative	CCR	NED
8	Negative	Negative	Negative	CCR	DOOD
9	Negative	Negative	Negative	DM	DOD
10	Negative	Negative	Negative	DM	DOD
11	Negative	Negative	Negative	DM	DOD
12	Negative	Negative	Negative	CCR	NED
13	Negative	Negative	Negative	DM	AWD
14	Negative	Negative	Negative	CCR	NED
15	Negative	Negative	Negative	CCR	NED

CCR: continuous complete remission; IR: incomplete remission; RR: regional recurrence; DM: distant metastases; NED: no evidence of disease; DOD: dead of disease; DOOD: dead of other disease; AWD: Alive with disease.

*Primary tumor negative/ovarian metastasis positive.