FDG-PET/CT as prognostic factor and surveillance tool for postoperative radiation recurrence in locally advanced head and neck cancer

Abstract

PurposeTo evaluate the prognostic value of metabolic tumor volume (MTV) and maximum standardized uptake value (SUVmax) on initial positron emission tomography-computed tomography (PET-CT) and investigate the clinical value of SUVmax for early detection of locoregional recurrent disease after postoperative radiotherapy in patients with locally advanced head and neck squamous cell carcinoma (HNSCC).Materials and MethodsA total of 100 patients with locally advanced HNSCC received primary tumor excision and neck dissection followed by adjuvant radiotherapy with or without chemotherapy. The MTV and SUVmax were measured from primary sites and neck nodes. The prognostic value of MTV and SUVmax were assessed using initial staging PET/CT (study A). Follow-up PET/CT scan available after postoperative concurrent chemoradiotherapy or radiotherapy were evaluated for the SUVmax value and correlated with locoregional recurrence (study B). A receiver operating characteristic (ROC) curve analysis was used to define a threshold value of SUVmax with the highest accuracy for recurrent disease assessment.ResultsHigh MTV (>41 mL) is negative prognostic factor for disease free survival (p = 0.041). Postradiation SUVmax was significantly correlated with locoregional recurrence (hazard ratio, 1.812; 95% confidence interval, 1.361 to 2.413; p < 0.001). A cut-off value of 5.38 from follow-up PET/CT was identified as having maximal accuracy for detecting locoregional recurrence by ROC analysis.ConclusionMTV at staging work-up was significantly associated with disease free survival. The SUVmax value from follow-up PET/CT showed high diagnostic accuracy for the detection of locoregional recurrence in postoperatively irradiated HNSCC.

Prognostic Value of Metabolic Tumor Volume and Total Lesion Glycolysis in Head and Neck Cancer: A Systematic Review and Meta-Analysis

“…Either MTV (2,(15)(16)(17) or TLG (18) was measured in 5 studies, and both were measured in 8 studies (8,(19)(20)(21)(22)(23)(24)(25). The VOI was defined as the tumor (2,8,(17)(18)(19)(20)(21)(22)(23) or tumor plus metastatic lymph nodes (LNs) (15,16,24,25). Three threshold methods were adapted to segment VOIs.…”

“…Three threshold methods were adapted to segment VOIs. A fixed SUV of 2.5 (2,8,(15)(16)(17)(18)(19)22) or 3.0 (23) was used in 9 studies. The gradient segmentation method was applied in 1 study (20), and a percentage of SUVmax (30%, 42%, or 50%) was used in 3 studies (21,24,25).…”

“…In each study, patients were divided into 2 groups (high and low volume) based on cutoff values. A minimum P value was used in 4 studies (15,16,19,22), receiveroperating characteristics (ROCs) in 4 studies (2,7,23,24), and median value in 5 studies (16,18,20,21,23). High volumetric parameters were significant variables in predicting a worse prognosis except in 1 study (20).…”

18F-FDG PET/CT: Therapy Response Assessment Interpretation (Hopkins Criteria) and Survival Outcomes in Lung Cancer Patients

“…The 5-y survival rate in lung cancer patients is less than 15% (2). 18 F-FDG PET/CT is well integrated in the routine staging of lung cancer patients. The use of 18 F-FDG PET/CT could provide more accurate staging of nodal and metastatic sites than CT and has a high negative predictive value (3)(4)(5).…”

“…18 F-FDG PET/CT is well integrated in the routine staging of lung cancer patients. The use of 18 F-FDG PET/CT could provide more accurate staging of nodal and metastatic sites than CT and has a high negative predictive value (3)(4)(5). Studies have also shown that preoperative staging PET/CT leads to change in the treatment planning and reduces the frequency of futile thoracotomies and the total number of thoracotomies (6,7).…”