Metabolic Tumor Volume Predicts for Recurrence and Death in Head-and-Neck Cancer

Abstract

Purpose To evaluate the prognostic value of metabolic tumor volume measured on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging and other clinical factors in patients treated for locally advanced head and neck cancer at a single institution. Materials/Methods From March 2003 to August 2007, 85 patients received PET/CT-guided chemoradiotherapy for HNC. Metabolically active tumor regions were delineated on pretreatment PET scans semi-automatically using custom software. We evaluated the relationship of FDG-PET maximum standardized uptake value (SUV) and total metabolic tumor volume (MTV) with disease-free survival (DFS) and overall survival (OS). Results Mean follow-up for surviving patients was 20.4 months. The estimated 2-year locoregional control, DFS, and OS for the group were 88.0%, 69.5% and 78.4%, respectively. The median time to first failure was 9.8 months among the 16 patients with relapse. An increase in MTV of 17.4 mL (difference between the 75th and 25th percentiles) was significantly associated with an increased hazard of first event (recurrence or death) (1.9-fold, p<0.001), even after controlling for Karnofsky performance status (KPS) (1.8-fold, p=0.001), and of death (2.1-fold, p<0.001). We did not find a significant relationship of maximum SUV, stage, or other clinical factors with DFS or OS. Conclusion Metabolic tumor volume is an adverse prognostic factor for disease recurrence and death in HNC. MTV retained significance after controlling for KPS, the only other significant adverse prognostic factor found in this cohort. MTV is a direct measure of tumor burden and is a potentially valuable tool for risk stratification and guiding treatment in future studies.

Prognostic Value of Metabolic Tumor Volume Measured by 18F-FDG PET/CT in Locally Advanced Head and Neck Squamous Cell Carcinomas Treated by Surgery

“…Allal et al [7] and Roh et al [8] found that high FDG uptake correlated with advanced pT and pN stages. However, in several studies, the SUV max of primary tumor or all lesions, including regional metastatic lymph nodes, was not confirmed as a significant factor predicting clinical outcome in the patients with HNSCC undergoing radiation therapy with or without chemotherapy [11][12][13][26][27][28]. In our results, the lower The pT stage is defined as the extent of primary tumor in terms of size and invasion into the adjacent structure.…”

“…MTV is obtained by FDG PET/CT using dedicated software which measures the volume of FDG accumulation based on the high tumor-to-background intensity ratio after attenuation correction [12]. Because of the good correlation between the MTV and the GTV assessed by other imaging tools such as CT [11,12], we can expected that MTV may be another important factor to be considered in the management of HNSCC.…”

“…MTV can be readily measured semiautomatically with a dedicated software algorithm. In previous studies, GTV measured from CT was found to correlate well with MTV from PET scans in HNSCC cases [11,12]. The MTV of malignant tumor reflects not only the tumor burden but also the functional and biologic status of the tumor due to the biologic features of FDG, and MTV can be expected to be a significant novel quantitative biomarker in the management of HNSCC.…”

“…The MTV of malignant tumor reflects not only the tumor burden but also the functional and biologic status of the tumor due to the biologic features of FDG, and MTV can be expected to be a significant novel quantitative biomarker in the management of HNSCC. The value of MTV was already identified in studies performed in patients with HNSCC who received radiotherapy (RT) with or without chemotherapy [11][12][13]. To our knowledge, there has been no report on MTV as a factor predicting the clinical outcome in HNSCC cases with treatment based on surgery.…”

Overview of the predictive value of quantitative 18 FDG PET in head and neck cancer treated with chemoradiotherapy

“…Only two studies performed a validation on an independent dataset (Hofheinz et al, 2015;Tang et al, 2012). The first study (La et al, 2009) included 85 patients and showed that an increase of MTV of 17 cm 3 (from the 25th to 75th percentile) was significantly correlated with an increased risk of death (HR 2.1). The authors validated their results on a dataset of 83 patients treated in the same institution after the original dataset (Tang et al, 2012).…”