Metabolic Tumor Volume as a Prognostic Imaging-Based Biomarker for Head-and-Neck Cancer: Pilot Results From Radiation Therapy Oncology Group Protocol 0522

Abstract

Purpose To evaluate candidate FDG-PET/CT imaging biomarkers for head and neck chemoradiotherapy outcomes in the cooperative group trial setting. Methods RTOG 0522 patients consenting to a secondary FDG-PET/CT sub-study were serially imaged at baseline and 8 weeks following radiation. Maximum standardized uptake value (SUVmax), SUV peak (mean SUV within a 1 cm sphere centered on SUVmax), and metabolic tumor volume (MTV) using 40% of SUVmax as threshold were obtained from primary tumor and involved nodes. Results Out of 940 patients entered onto RTOG 0522, 74 were analyzable for this sub-study. Neither high baseline SUVmax nor SUVpeak from primary or nodal disease were associated with poor treatment outcomes. However, primary tumor MTV above the cohort median was associated with worse LRC (HR 4.01, 95% CI [1.28, 12.52], p = 0.02) and PFS (HR 2.34, 95% CI [1.02, 5.37], p = 0.05). Although MTV and T stage appeared to correlate (mean MTV 6.4, 13.2, 26.8 for T2, T3, and T4 tumors, respectively), MTV remained a strong independent prognostic factor for PFS in bivariate analysis that included T stage. Primary MTV remained prognostic in p16-associated oropharyngeal cancer cases, although sample size was limited. Conclusion High baseline primary tumor MTV was associated with worse treatment outcomes in this limited patient subset of RTOG 0522. Additional confirmatory work will be required to validate primary tumor MTV as a prognostic imaging biomarker for patient stratification in future trials.

Identification des sites de récidive sur la TEP/TDM initiale dans les cancers des VADS traités par radiochimiothérapie

“…En accord avec les données de la littérature [28][29][30], nous avons alors observé que le volume métabolique tumoral initial apparaît comme un facteur pronostique, puisqu'il était significativement plus important ( p = 0,0005) dans le groupe de patients ayant récidivé localement, comparativement aux patients en rémission. Cette information pourrait permettre dans un premier temps de sélectionner initialement les patients ayant un MTV élevé, les plus à risques de récidive, qui pourraient bénéficier d'un traitement plus agressif.…”

The Correlation Between Pre-treatment Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Parameters and Clinical Prognostic Factors in Pediatric Hodgkin Lymphoma

“…The threshold intensity value used in this study was 40% of maximal SUV of each tumor as validated in several previous studies (15,16). …”

Role of fluorine-18 fluorodeoxyglucose PET/CT in head and neck oncology: the point of view of the radiation oncologist

“…Indeed, high MTV and TLG increased the risk of disease progression and death. The studies evaluated in the meta-analysis and more recent contemporary studies 110,112,[114][115][116][117][118][119][120][121][122][123][124][125][126][127][128][129] are described in Table 5. In summary, meta-analysis and several studies showed that PETquantified data such as SUV max , SUV mean , MTV, TLG are strongly and negatively correlated with survival.…”