Interim FDG PET/CT for predicting the outcome in patients with head and neck cancer

• Published in: The Laryngoscope Vol. 124; no. 12; p. 2732
• Main Authors: Chen, Shang-Wen, Hsieh, Te-Chun, Yen, Kuo-Yang, Yang, Shih-Neng, Wang, Yao-Ching, Chien, Chun-Ru, Liang, Ji-An, Kao, Chia-Hung
• Format: Journal Article
• Language: English
• Published: United States 01.12.2014
• Subjects: Adult; Aged; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy; Disease-Free Survival; Fluorodeoxyglucose F18; Follow-Up Studies; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - therapy; Humans; Male; Middle Aged; Multimodal Imaging; Neoplasm Recurrence, Local - diagnosis; Neoplasm Staging - methods; Positron-Emission Tomography - methods; Prognosis; Prospective Studies; Radiopharmaceuticals; Reproducibility of Results; ROC Curve; Squamous Cell Carcinoma of Head and Neck; Tomography, X-Ray Computed - methods; chemoradiotherapy; response marker; 18Fluoro-2-deoxy-D-glucose; head and neck cancer; PET/CT
• ISSN: 1531-4995
• DOI: 10.1002/lary.24826

The study aimed to investigate the prognostic effects of interim (18) fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (PET/CT) during definitive radiotherapy (RT) or chemoradiotherapy (CRT) in patients with head and neck cancer. This is a prospectively treatment study. The pretreatment and interim PET/CT images of 51 patients with advanced pharyngeal cancers receiving definitive RT/CRT were evaluated prospectively. The interim PET/CT images were taken at a cumulative RT dose ranging from 41.4 to 46.8 Gy. The maximum standardized uptake value (SUVm) of the interim PET/CT and the reduction ratio of the SUVm (SRR) between the two images were measured. The differences between patients with or without local failures were examined using the Mann-Whitney test. Overall survival (OS), disease-free survival (DFS), and primary and nodal relapse-free survival rates were calculated using the Kaplan-Meier method. Independent prognosticators were identified using Cox regression analysis. After a median follow-up duration of 23 months, a higher interim SUVm was associated with local failures. Conducting a multivariate analysis revealed that a SUVmax reduction ratio of primary tumor (SRR-P) < 0.64 was associated with the inferior OS (hazard ratio 2.64; P =0.035) and DFS (hazard ratio 2.33; P = 0.045). Patients who had tumors with an SRR-P < 0.64 had a considerably lower 2-year OS and DFS compared with those who had SRR-P ≥ 0.64 (47% vs. 66%; 41% vs. 64%). A higher interim SUVm was associated with local recurrence. In addition, patients with a lower SRR-P should be considered to be at risk of primary failure. 4.