18F-FDG-PET/CT based total metabolic tumor volume change during neoadjuvant chemotherapy predicts outcome in advanced epithelial ovarian cancer

  • Tuulia Vallius
  • Johanna Hynninen
  • Jukka Kemppainen
  • Victor Alves
  • Kari Auranen
  • Jaakko Matomäki
  • Sinikka Oksa
  • Johanna Virtanen
  • Seija Grénman
  • Annika Auranen
  • Marko Seppänen
Original Article



To evaluate the predictive potential of total metabolic tumor volume (MTV) reduction during neoadjuvant chemotherapy (NACT) with 18F–FDG-PET/CT in an advanced FIGO stage III/IV epithelial ovarian cancer (EOC) patient cohort.


Twenty-nine primarily inoperable EOC patients underwent 18F–FDG-PET/CT before and after NACT. The pre- and post-NACT total MTV, in addition to the percentage MTV reduction during NACT, were compared with primary therapy outcome and progression-free survival (PFS). ROC-analysis determined an optimal threshold for MTV reduction identifying patients with progressive or stable disease (PD/SD) at the end of primary therapy. A multivariate analysis with residual tumor (0/>0), FIGO stage (III/IV) and MTV reduction compared to PFS was performed. The association between MTV reduction and overall survival (OS) was evaluated.


The median pre- and post-NACT total MTV were 352 cm3 (range 150 to 1322 cm3) and 51 cm3 (range 0 to 417 cm3), respectively. The median MTV reduction during NACT was 89% (range 24% to 100%). Post-NACT MTV and MTV reduction associated with primary therapy outcome (MTV post-NACT p = 0.007, MTV reduction p = 0.001) and PFS (MTV post-NACT p = 0.005, MTV reduction p = 0.005). MTV reduction <85% identified the PD/SD patients (sensitivity 70%, specificity 78%, AUC 0.79). In a multivariate analysis, MTV reduction (p = 0.002) and FIGO stage (p = 0.003) were statistically significant variables associated with PFS. MTV reduction during NACT corresponded to OS (p = 0.05).


18F–FDG-PET/CT is helpful in NACT response evaluation. Patients with total MTV reduction <85% during NACT might be candidates for second-line chemotherapy and clinical trials, instead of interval debulking surgery.


18F–FDG-PET/CT Ovarian cancer Neoadjuvant chemotherapy Treatment response Total metabolic tumor volume 



This study was financially supported by the Clinical Research (EVO) fund of the Turku University Hospital and grants from the Turku University Foundation, the Medical Faculty of University of Turku, the Finnish Cultural Foundation and Ida Montini Foundation.


This study was financially supported by the Clinical Research (EVO) fund of the Turku University Hospital and grants from the Turku University Foundation, the Medical Faculty of University of Turku, the Finnish Cultural Foundation and Ida Montini Foundation.

Compliance with ethical standards

Conflict of interest

Dr. Tuulia Vallius has received research grants from the Clinical Research (EVO) fund of the Turku University Hospital, the Turku University Foundation, the Medical Faculty of University of Turku, the Finnish Cultural Foundation and Ida Montini Foundation. All the other co-authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Tuulia Vallius
    • 1
  • Johanna Hynninen
    • 1
  • Jukka Kemppainen
    • 2
  • Victor Alves
    • 3
  • Kari Auranen
    • 4
  • Jaakko Matomäki
    • 5
  • Sinikka Oksa
    • 6
  • Johanna Virtanen
    • 7
  • Seija Grénman
    • 1
  • Annika Auranen
    • 8
  • Marko Seppänen
    • 2
  1. 1.Department of Obstetrics and GynecologyUniversity of Turku and Turku University HospitalTurkuFinland
  2. 2.Department of Clinical Physiology and Nuclear Medicine, Turku PET CentreUniversity of Turku and Turku University HospitalTurkuFinland
  3. 3.Department of Nuclear MedicineSao Joao Hospital CentreOportoPortugal
  4. 4.Center of Statistics and Department of Clinical MedicineUniversity of TurkuTurkuFinland
  5. 5.Turku University Hospital, Clinical Research CentreTurkuFinland
  6. 6.Department of Obstetrics and GynecologySatakunta Central HospitalPoriFinland
  7. 7.Medical Imaging centre of Southwest FinlandUniversity of Turku and Turku University HospitalTurkuFinland
  8. 8.Department of Obstetrics and GynecologyUniversity of Tampere and Tampere University HospitalTampereFinland

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