Use of 18F-FDG PET for Primary Treatment Strategy in Patients with Squamous Cell Carcinoma of the Oropharynx

Abstract

High tumor uptake of 18 F-FDG is associated with an unfavorable outcome in cancer patients. We evaluated pretreatment 18 F-FDG uptake as guidance for the primary treatment modality in patients with squamous cell carcinoma (SCC) of the oropharynx. Methods: Fifty-two consecutive patients with newly diagnosed resectable SCC of the oropharynx underwent 18 F-FDG PET before treatment. Primary treatment modalities consisted of surgical resection plus radiotherapy (RT) (surgery group, n 5 31) or radical RT plus chemotherapy (RT group, n 5 21). The sex, age, tumor stage, histologic grade, TNM classification, treatment strategy, and maximum standardized uptake value (SUV) categories were analyzed for association with local control (LC) and disease-free survival (DFS). The median follow-up of the surviving patients was 36 mo. Results: The median SUV was significantly higher in the 11 patients who failed treatment than that in the remaining controlled patients (8.0 vs. 5.4; P 5 0.021). Patients having tumors with a high SUV . 6.0 had poorer LC and DFS (P , 0.05). In multivariate analysis, the SUV remained an independent determinant of LC and DFS (P , 0.05). Patients with a SUV . 6.0 in the surgery group had a higher 3-y DFS than that in the RT group (78% vs. 33%; P 5 0.043). Conclusion: Pretreatment tumor 18 F-FDG uptake represents an independent prognostic factor in patients with oropharyngeal SCC. Patients with high 18 F-FDG uptake may be better treated by surgery followed by RT with or without chemotherapy, which needs to be verified by a prospective randomized study.

18F-FLT PET During Radiotherapy or Chemoradiotherapy in Head and Neck Squamous Cell Carcinoma Is an Early Predictor of Outcome

“…Previous studies on often nonuniformly treated cohorts of patients with head and neck cancer reported the prognostic potential for the more commonly used PET tracer 18 F-FDG (33)(34)(35). High pretreatment 18 F-FDG uptake was associated with poor outcome.…”

Aerobic glycolysis in cancers: Implications for the usability of oxygen‐responsive genes and fluorodeoxyglucose‐PET as markers of tissue hypoxia

“…Several studies have shown that high glucose uptake or Glut-1 expression predicts poor prognosis and that Glut-1 levels often are elevated in 18F-FDG-avid tumors, [30][31][32][33][34][35][36][37][38][39][40][41] but their regional or microregional spatial association has seldom been studied and remains unclear. Our colocalization analysis of 18 F-FDG uptake and Glut-1 expression shows some, albeit weak, spatial linkage and again the strongest correlation was observed in the relatively nonglycolytic tumor model (Table I).…”

Prognostic significance of standardized uptake value and metabolic tumour volume on 18F-FDG PET/CT in oropharyngeal squamous cell carcinoma

“…18 F-FDG PET/ CT can improve risk prediction and shows prognostic value as a biomarker of HNSCC [14,15]. The maximum standardized uptake value (SUV max ), which is currently the most commonly used parameter in 18 F-FDG PET/CT [12,13,16], is an easily readable value that can be determined by estimating the highest intensity of 18 F-FDG uptake. However, it does not reflect the metabolic activity of the whole tumour [17].…”