The Predictive Value of Pretreatment 18-F-FDG-PET-CT in Locally Advanced Nasopharyngeal Cancer Patients Treated Definitively with Induction Chemotherapy Followed by Concurrent Chemo-Radiotherapy

Abstract

AimsThis study aimed to evaluate the role of pretreatment 18F-Fluorodeoxyglucose positron emission tomography (18F-FDG-PET-CT) as a predictor of disease-free survival (DFS), and overall survival (OS) in locally advanced nasopharyngeal carcinoma (LANPC) patients treated definitively with docetaxel-based induction chemotherapy followed by concurrent chemoradiation (CRT).Materials and methodsThis is a retrospective study approved by the institutional review board and included LANC patients treated definitively and consecutively between January 2008 and December 2012 with induction chemotherapy; docetaxel, cisplatin, and 5-flurouracil (TPF) followed by CRT utilizing weekly cisplatin. All patients had baseline pretreatment 18F-FDG-PET-CT. We studied the association between the baseline primary tumor maximum standardized uptake value (SUVmax) and the treatment outcomes; OS and DFS.ResultsThe study included 70 eligible LANPC patients. The 4-year OS and DFS rates were 86.7% and 78.6%, respectively. The median OS and DFS intervals were not reached. On a univariate analysis, the 4-years DFS was significantly higher in patients with pretreatment SUVmax <8 compared versus ≥ 8 (95% vs 57.7%, P=0.002). Furthermore, DFS was significantly correlated with pretreatment T stage (P=0.01), N stage (P=0.02), treatment response (P<0.001) and treatment breaks (P<0.001). On a multivariate analysis, the SUVmax category was the only factor correlated with 4-year DFS (Hazard ratio=10.2, 95% C I 1.3-116.8, P=0.035) but not OS (P=0.085).Disclosure statementThere is no actual or potential conflict of interest with the production and publication of this work. No author has a direct or indirect commercial financial incentive associated with the publication of this article.ConclusionThis study shows that the pretreatment primary tumor 18F-FDG-PET-CT SUVmax is a potential independent prognostic predictor of clinical outcomes in patients with LANC treated definitively with TPF induction chemotherapy followed by CRT. Further controlled clinical trials are worthwhile.

Prognostic value of 18F-FDG-PET/CT in patients with nasopharyngeal carcinoma: a systematic review and meta-analysis

“…Moreover, the final result of our trim and fill sensitivity analysis was not affected after incorporating the hypothetical missing literatures, which demonstrates that our analysis was reliable. In addition, the included studies of this meta-analysis are almost in Asia, only one [ 41 ] in Africa, none in Europe and other continents. Because the incident of NPC is high in these regions and countries and it may cause the bias of the race of humans.…”

Predictive significance of pretreatment 18F‐FDG PET volumetric parameters on survival outcomes in pediatric patients with locally advanced undifferentiated nasopharyngeal carcinoma

“…and Lee et al. found agreement that high 18 F‐FDG uptake, indicated by a cutoff SUV max of ≥8, may indicate a poor outcome in newly diagnosed patients with locally advanced NPC receiving chemotherapy and radiotherapy 35,38 . In a more recent study by Zhang et al., SUV‐Tumor and SUV‐Nodal were identified as independent predictors for distant metastases‐free survival (DMFS) 39 …”

“…Several investigators suggested SUV would be valuable in prognosis, 23,[34][35][36][37] while other studies revealed its uselessness. 17 35,38 In a more recent study by Zhang et al, SUV-Tumor and SUV-Nodal were identified as independent predictors for distant metastases-free survival (DMFS). 39 Recently, researchers revealed that MTV and TLG were superior to SUV alone in predicting prognosis.…”

Prognostic Factors for Overall Survival in Nasopharyngeal Cancer and Implication for TNM Staging by UICC: A Systematic Review of the Literature

“…Among the 15 studies on FDG-PET included in the current review, most evaluated the maximum SUV (SUV max ), either alone (n = 11) ( 100 – 103 , 105 – 108 , 110 , 112 , 113 ); some also proposed other metabolic parameters, such as metabolic tumor volume (MTV; n = 1) ( 99 ) or TLG (n = 2) ( 104 , 111 ) ( Supplementary Table 6 ). A single study further evaluated the difference in prognosis between PET-CT-guided dose-painting intensity-modulated radiation therapy (IMRT) and CT-based IMRT ( 109 ).…”