Prediction of treatment response in patients with locally advanced cervical cancer using midtreatment PET/MRI during concurrent chemoradiotherapy. In regard to Vojtíšek et al.

Abstract

We read the article by Vojtíšek et al. [1] with great interest and commend all authors for demonstrating the feasibility of midtreatment metabolic parameters measured with positron-emission tomography/magnetic resonance imaging (PET/MRI) in 66 patients with locally advanced cervical cancer undergoing concurrent chemoradiotherapy (ChRT). Although the authors demonstrated that metabolic parameters could be used to distinguish patients with incomplete responses, a few points need to be clarified. The treatment of choice for locally advanced cervical cancer is concurrent ChRT and complete response is achieved in 70 to 90% of patients [2, 3]. 18F-fluorodeoxyglucose positron-emission tomography integrated with computed tomography (FDG-PET/CT) incorporates metabolic tumor function with anatomic localization. We previously reported an 82% complete metabolic response rate in 152 cervical cancer patients treated with definitive chemoradiotherapy, which is higher than the 75.8% complete metabolic response rate observed in the current study [4]. In our previous study, all patients were treated with concurrent ChRT: 108 patients (89%) completed at least four cycles of ChRT, 10 patients (8%) completed three cycles, and 4 patients (3%) received two cycles of ChRT during radiotherapy. However, only 19 patients (29.7%) received at least five cycles of chemotherapy and 13 patients