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

Abstract

Purpose We assessed the prognostic value of metabolic tumor volume (MTV) measured using 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) inpatients with locally advanced head and neck squamous cell carcinoma (HNSCC). Methods We retrospectively reviewed 56 patients (51 men, five women; mean age 56.0±8.8years) who had locally advanced HNSCC and underwent FDG PET/CT for initial evaluation. All patients had surgical resection and radiotherapy with or without concurrent chemotherapy. The peak standardized uptake value (SUV peak ) and MTV of the target lesion, including primary HNSCC andmetastatic cervical lymph nodes, were measured from FDG PET/CT images. We compared SUV peak , MTV, and clinicopathologic variables such as age, Eastern Cooperative Oncology Group (ECOG) performance status, pN stage, pT stage, TNM stage, histologic grade and treatment modality to disease-free survival (DFS) and overall survival (OS). Results On the initial FDG PET/CT scans, the median SUV peak was 7.8 (range, 1.8-19.0) and MTV was17.0 cm 3 (range, 0.1-131.0 cm 3 ). The estimated 2-year DFS and OS rates were 67.2% and 81.8%. The cutoff points of SUV peak 6.2 and MTV 20.7 cm 3 were the best discriminative values for predicting clinical outcome. MTV and ECOG performance status were significantly related to DFS and OS on univariate and multivariate analyses (p<0.05). Conclusion The MTV obtained from initial FDG PET/CT scan is a significant prognostic factor for disease recurrence and mortality in locally advanced HNSCC treated with surgery and radiotherapy with or without chemotherapy.

Prognostic Significance of Volume-Based PET Parameters in Cancer Patients

“…It has been reported that as the volume-based parameters of a tumor become smaller and lower, the prognosis for lung cancer improves (25, 30, 31). Similar results have been shown for head and neck cancers (9, 32-36), colorectal cancers (37, 38), esophageal cancers (23, 27), gynecological cancers (39, 40), and others (41-44). Figure 2 illustrates the survival curves according to PET parameters in tonsilar cancer (9).…”

Usefulness of Combined Metabolic–Volumetric Indices of 18F-FDG PET/CT for the Early Prediction of Neoadjuvant Chemotherapy Outcomes in Breast Cancer

“…MTV and TLG of 18 F-FDG PET/CT are suggested to be better indicators of whole tumor burden than SUVmax, and proved to be prognostic factors at diagnosis in a variety of malignancies. [12][13][14][15][16][17]. Moreover, these indices demonstrated the possibility of predicting chemotherapy effect in osteogenic sarcoma, not only at the end of the neoadjuvant chemotherapy [18,19], but also after the second cycle [20].…”

Metabolic Tumor Volume Measured by F-18 FDG PET/CT can Further Stratify the Prognosis of Patients with Stage IV Non-Small Cell Lung Cancer

“…Standardized uptake value (SUV)-based PET parameter can predict therapeutic outcome and overall survival in many types of malignancies [6][7][8][9][10][11][12]. Recently, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) have been reported as additional diagnostic and prognostic imaging biomarkers for maximum SUV (SUVmax) [13][14][15]. MTV and TLG are valuable markers in the prediction of prognosis in NSCLC patients, mostly in operable or up to stage III patients [16][17][18].…”