Validation that Metabolic Tumor Volume Predicts Outcome in Head and Neck Cancer

Abstract

Purpose-We have previously reported that metabolic tumor volume (MTV) obtained from pretreatment FDG PET/CT predicted outcome in patients with head-and-neck cancer (HNC). The purpose of this study is to validate these results on an independent dataset, determine if the primary tumor or nodal MTV drives this correlation, and explore the interaction with p16 INK4a status as a surrogate marker for HPV.Methods and Materials-The validation dataset in this study included 83 patients with squamous cell HNC who had a FDG PET/CT scan prior to definitive radiotherapy. MTV and SUV max were calculated for the primary tumor, involved nodes, and the combination of both. The primary endpoint was to validate that MTV predicted progression-free survival and overall survival. Secondary analyses included determining the prognostic utility of primary tumor versus nodal MTV.Results-Similar to our prior findings, an increase in total MTV of 17 cm 3 (difference between 75 th and 25 th percentile) was associated with a 2.1 fold increase in the risk of disease progression (p=0.0002), and a 2.0 fold increase in the risk of death (p=0.0048). SUV max was not associated with either outcome. Primary tumor MTV predicted progression-free (HR=1.94; p<0.0001) and overall (HR=1.57; p<0.0001) survival, whereas nodal MTV did not. In addition, MTV predicted progression-free (HR=4.23; p<0.0001) and overall (HR=3.21; p=0.0029) survival in patients with p16 INK4a positive oropharyngeal cancer.Conclusions-This study validates our previous findings that MTV independently predicts outcomes in HNC. MTV should be considered as a potential risk stratifying biomarker in future studies of HNC.

Anal cancer FDG-PET standard uptake value: correlation with tumor characteristics, treatment response and survival

“…A possible limitation is that it represents the highest voxel value within a lesion. In this direction a growing body of literature has started to analyze more in deep SUVmean and metabolic tumor volume (MTV) [25,[30][31][32]. Actually, SUVmean represents the average of the intensity of uptake within a designated region of interest and MTV reflects the volume of tumor tissue with increased metabolic activity on PET.…”

Prognostic Value of FDG PET Imaging in Patients with Laryngeal Cancer

“…The prognostic value of primary tumor SUVmax in patients with head and neck cancer remains controversial, and many reports have indicated that it has positive [8] or negative [9] associations with outcome. Allal et al [8] demonstrated that a primary tumor SUV exceeding 4.76 posed a greater risk of poor outcome in 120 patients with various head and neck cancers including those of the oropharynx (n = 46), oral cavity (n = 32), larynx (n = 26), hypopharynx (n = 13), or unknown primary (n = 3) managed by radiotherapy or surgery.…”

Zone-size nonuniformity of 18F-FDG PET regional textural features predicts survival in patients with oropharyngeal cancer

“…Several segmentation methods have been proposed for the analysis of PET images in patients with head and neck malignancies, but no widely accepted guidelines exist. Although a fixed threshold of 50 % of the maximum SUV (SUV max 50 %) may be unsuitable for determining tumour volume in the presence of heterogeneous lesions [23], this threshold has been used successfully in head and neck cancer [24,25]. We selected this delineation method based on its availability and clinical usefulness.…”