Prognostic value of midtreatment FDG‐PET in oropharyngeal cancer

Pollom, Erqi L.; Song, Jie; Durkee, Ben Y.; Aggarwal, S.; Bui, Timothy T.; Eyben, Rie von; Li, Ruijiang; Brizel, David M.; Loo, Billy W.; Le, Quynh‐Thu; Hara, Wendy

doi:10.1002/hed.24454

Cited by 30 publications

(34 citation statements)

References 18 publications

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“…Several studies have demonstrated the ability of MTV and TLG to predict treatment outcomes in OPSCC. [16][17][18][19][20]22,[24][25][26][27][28][29] However, literature testing of its prognostic value specifically in patients with HPV-related OPSCC patients and a ≤10 packyear smoking history is scarce. Given the need for and lack of effective prognostic biomarkers for LRF in HPV-related OPSCC, we sought to investigate the prognostic value of MTV and TLG in this patient group.…”

Section: Introductionmentioning

confidence: 99%

Volumetric ¹⁸F‐FDG‐PET parameters as predictors of locoregional failure in low‐risk HPV‐related oropharyngeal cancer after definitive chemoradiation therapy

et al. 2018

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Background We sought to investigate the prognostic value of volumetric positron emission tomography (PET) parameters in patients with human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (OPSCC) and a ≤10 pack‐year smoking history treated with chemoradiation. Methods A total of 142 patients were included. Maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of the primary tumor, involved regional lymph nodes, and total lesion were calculated. Cox proportional hazard modeling was used to evaluate associations of clinical and PET parameters with locoregional failure‐free survival (LRFFS), distant metastasis‐free survival (DMFS), and overall survival (OS). Results On univariate analysis, volumetric PET parameters were significantly associated with all endpoints, and 8th edition American Joint Committee on Cancer/Union Internationale Contre le Cancer staging was significantly associated with DMFS and OS. On multivariate analysis, total lesion TLG was significantly associated with LRFFS, while staging was most significantly prognostic for DMFS and OS. Conclusion Volumetric PET parameters are uniquely prognostic of LRFFS in low‐risk HPV‐related OPSCC and may be useful for directing de‐intensification strategies.

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Section: Introductionmentioning

confidence: 99%

Volumetric ¹⁸F‐FDG‐PET parameters as predictors of locoregional failure in low‐risk HPV‐related oropharyngeal cancer after definitive chemoradiation therapy

et al. 2018

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“…Imaging with CT and 18 F-FDG PET is often used in staging, radiation treatment planning, and response evaluation for patients with OPSCC (6,7). Numerous studies have investigated imaging characteristics associated with treatment outcomes, with limited success (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Most previous studies, however, analyzed baseline imaging before the initiation of therapy.…”

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confidence: 99%

Tumor Subregion Evolution-Based Imaging Features to Assess Early Response and Predict Prognosis in Oropharyngeal Cancer

Gensheimer

Zhang

et al. 2019

J Nucl Med

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The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has been rapidly increasing. Disease stage and smoking history are often used in current clinical trials to select patients for deintensification therapy, but these features lack sufficient accuracy for predicting disease relapse. Our purpose was to develop an imaging signature to assess early response and predict outcomes of OPSCC. Methods: We retrospectively analyzed 162 OPSCC patients treated with concurrent chemoradiotherapy, equally divided into separate training and validation cohorts with similar clinical characteristics. A robust consensus clustering approach was used to spatially partition the primary tumor and involved lymph nodes into subregions (i.e., habitats) based on 18 F-FDG PET and contrast CT imaging. We proposed quantitative image features to characterize the temporal volumetric change of the habitats and peritumoral/nodal tissue between baseline and midtreatment. The reproducibility of these features was evaluated. We developed an imaging signature to predict progression-free survival (PFS) by fitting an L1-regularized Cox regression model. Results: We identified 3 phenotypically distinct intratumoral habitats: metabolically active and heterogeneous, enhancing and heterogeneous, and metabolically inactive and homogeneous. The final Cox model consisted of 4 habitat evolution-based features. In both cohorts, this imaging signature significantly outperformed traditional imaging metrics, including midtreatment metabolic tumor volume for predicting PFS, with a C-index of 0.72 versus 0.67 (training) and 0.66 versus 0.56 (validation). The imaging signature stratified patients into high-risk versus low-risk groups with 2-y PFS rates of 59.1% versus 89.4% (hazard ratio, 4.4; 95% confidence interval, 1.4-13.4 [training]) and 61.4% versus 87.8% (hazard ratio, 4.6; 95% confidence interval, 1.7-12.1 [validation]). The imaging signature remained an independent predictor of PFS in multivariable analysis adjusting for stage, human papillomavirus status, and smoking history. Conclusion: The proposed imaging signature allows more accurate prediction of disease progression and, if prospectively validated, may refine OPSCC patient selection for risk-adaptive therapy.

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“…TLG was a significant prognostic factor for OS in patients with tonsil cancer [ 18 ]. In a study of 74 oropharyngeal cancer patients who received CCRT, both pre-treatment and midtreatment MTV were associated with OS and PFS [ 19 ]. In a meta-analysis of more than 1,100 head and neck cancer patients, both MTV and TLG of pretreatment PET/CT were prognostic factors for OS [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of FDG PET/CT during radiotherapy in head and neck cancer patients

Kim

et al. 2018

Radiat Oncol J

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PurposeTo evaluate the prognostic value of 18F-fluorodeoxyglucose positron-emission tomography (FDG PET) with computed tomography (CT) before and during radiotherapy (RT) in patients with head and neck cancer.MethodsTwenty patients with primary head and neck squamous cell carcinoma were enrolled in this study, of whom 6 had oropharyngeal cancer, 10 had hypopharyngeal cancer, and 4 had laryngeal cancer. Fifteen patients received concurrent cisplatin and 2 received concurrent cetuximab chemotherapy. FDG PET/CT was performed before RT and in the 4th week of RT. The parameters of maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of the primary tumor were measured, and the prognostic significance of each was analyzed with the Cox proportional hazards model.ResultsHigher TLG (>19.0) on FDG PET/CT during RT was a poor prognostic factor for overall survival (OS) (p = 0.001) and progression-free survival (PFS) (p = 0.007). In the multivariate analysis, TLG during RT as a continuous variable was significantly associated with OS and PFS rate (p = 0.023 and p = 0.016, respectively). Tumor response worse than partial remission at 1 month after RT was another independent prognostic factor for PFS (p = 0.024).conclusionsHigher TLG of the primary tumor on FDG PET/CT during RT was a poor prognostic factor for OS and PFS in patients with head and neck cancer.

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Prognostic value of midtreatment FDG‐PET in oropharyngeal cancer

Abstract: Metabolic response during chemoradiation is associated with survival in locally advanced oropharyngeal cancer and may aid with risk-adapting treatment. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1478, 2016.

Cited by 30 publications

References 18 publications

Volumetric ¹⁸F‐FDG‐PET parameters as predictors of locoregional failure in low‐risk HPV‐related oropharyngeal cancer after definitive chemoradiation therapy

Volumetric ¹⁸F‐FDG‐PET parameters as predictors of locoregional failure in low‐risk HPV‐related oropharyngeal cancer after definitive chemoradiation therapy

Tumor Subregion Evolution-Based Imaging Features to Assess Early Response and Predict Prognosis in Oropharyngeal Cancer

Prognostic value of FDG PET/CT during radiotherapy in head and neck cancer patients

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Prognostic value of midtreatment FDG‐PET in oropharyngeal cancer

Abstract: Metabolic response during chemoradiation is associated with survival in locally advanced oropharyngeal cancer and may aid with risk-adapting treatment. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1478, 2016.

Cited by 30 publications

References 18 publications

Volumetric 18F‐FDG‐PET parameters as predictors of locoregional failure in low‐risk HPV‐related oropharyngeal cancer after definitive chemoradiation therapy

Volumetric 18F‐FDG‐PET parameters as predictors of locoregional failure in low‐risk HPV‐related oropharyngeal cancer after definitive chemoradiation therapy

Tumor Subregion Evolution-Based Imaging Features to Assess Early Response and Predict Prognosis in Oropharyngeal Cancer

Prognostic value of FDG PET/CT during radiotherapy in head and neck cancer patients

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Volumetric ¹⁸F‐FDG‐PET parameters as predictors of locoregional failure in low‐risk HPV‐related oropharyngeal cancer after definitive chemoradiation therapy

Volumetric ¹⁸F‐FDG‐PET parameters as predictors of locoregional failure in low‐risk HPV‐related oropharyngeal cancer after definitive chemoradiation therapy