A PET-based nomogram for oropharyngeal cancers

Abstract

Purpose: In the context of locally advanced oropharyngeal cancer (LAOC) treated with definitive radiotherapy (RT) (combined with chemotherapy or cetuximab), the aims of this study were: (1) to identify PET-FDG parameters correlated with overall survival (OS) from a first cohort of patients; then (2) to compute a prognostic score; and (3) finally to validate this scoring system in a second independent cohort of patients. Materials and methods: A total of 76 consecutive patients (training cohort from Rennes) treated with chemoradiotherapy or RT with cetuximab for LAOC were used to build a predictive model of locoregional control (LRC) and OS based on PET-FDG parameters. After internal calibration and validation of this model, a nomogram and a scoring system were developed and tested in a validation cohort of 46 consecutive patients treated with definitive RT for LAOC in Lausanne. Results: In multivariate analysis, the metabolic tumour volume (MTV) of the primary tumour and the lymph nodes were independent predictive factors for LRC and OS. Internal calibration showed a very good adjustment between the predicted OS and the observed OS at 24 months. Using the predictive score, two risk groups were identified (median OS 42 versus 14 months, p < 0.001) and confirmed in the validation cohort from Lausanne (median OS not reached versus 26 months, p Z 0.008). Conclusions: This is the first report of a PET-based nomogram in oropharyngeal cancer. Interestingly, it appeared stronger than the classical prognostic factors and was validated in independent cohorts markedly diverging in many aspects, which suggest that the observed signal was robust. ª

What is the prognostic impact of FDG PET in locally advanced head and neck squamous cell carcinoma treated with concomitant chemo-radiotherapy? A systematic review and meta-analysis

“…of cycles (median) Number of patients Type of chemotherapy No. of cycles (median) 3DCRT IMRT Total (median) Per fraction [ 18 ] 32 30 Conventional 70 2 20 Docetaxel/cisplatin ns 35 Cisplatin 40 mg/m 2 every 7 days 6 [ 19 ] 0 26 Conventional 70 1.8 0 Not administered 0 26 Cetuximab ns [ 20 ] 0 122 Conventional 70 2 0 Not administered 0 122 Cisplatin 100 mg/m 2 every 21 days ns [ 21 ] 0 51 Conventional 70 ns 0 Not administered 0 51 Cisplatin 100 mg/m 2 every 21 days ns [ 22 ] ns ns Conventional 72 2 0 Not administered 0 44 Cisplatin 100 mg/m 2 every 21 days ns [ 23 ] ns ns Conventional 72 2 0 Not administered 0 68 Cisplatin 100 mg/m 2 every 21 days ns [ …”

“…A total of 11 [ 20 – 22 , 25 , 34 – 37 , 40 , 43 , 45 ], 8 [ 20 – 23 , 35 , 36 , 38 , 40 ] and 4 [ 21 , 25 , 37 , 40 ] independent studies provided RR estimates for the association between baseline FDG PET and OS, PFS and LRC, respectively. These studies were thus included in the meta-analysis aiming to assess the potential prognostic impact of pretreatment metabolic features on patient outcome.…”

A critical appraisal of the clinical applicability and risk of bias of the predictive models for mortality and recurrence in patients with oropharyngeal cancer: Systematic review

“…With respect to Participants , the three most recent studies used high‐stage patients and the rest considered any degree of severity. It should also be noted that four studies used external validation cohorts after having previously internally validated the models developed . Finally, one of the studies did not include treatment as a candidate predictor .…”

Personalized prognostication in head and neck cancer: A systematic review of nomograms according to the AJCC precision medicine core (PMC) criteria

“…The level of agreement for the second phase was 88% with a kappa of 0.77. A total of 44 studies remained for the final analysis . The list of excluded papers with the reasons for exclusion can be found in the Supporting Information S3.…”