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Seol JH, Kim J, Lee JD, Lee JG, Yoon JH, Kim CH. The feasibility of 18F-fluorodeoxyglucose-positron emission tomography uptake as a prognostic factor for paranasal sinus malignancy. Am J Rhinol Allergy 2013; 27:118-22. [PMID: 23562200 DOI: 10.2500/ajra.2013.27.3848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is a correlation between (18)F-fluorodeoxyglucose (FDG) uptake and the level of intracellular metabolic tumor activity, which in turn may be associated with active proliferation, invasion, and prognosis as well as distant metastases in head and neck cancer. This study was designed to assess whether tumor uptake of FDG positron emission tomography (PET) expressed as the maximum standardized uptake value (SUVmax) can be used to predict survival in subjects with paranasal sinus malignancy. METHODS We enrolled 42 consecutive subjects with a histological diagnosis of squamous cell carcinoma in paranasal sinus malignancy, into a retrospective institutional imaging trial. Thirty-eight subjects (90.5%) underwent a baseline FDG-PET scan before curative treatment and were eligible for analysis. RESULTS A total of 38 subjects with paranasal sinus malignancy undergoing PET/computed tomography imaging in the initial stages were assessed separately for a potential correlation between SUVmax and T staging, histological grading, and overall survival. Log-rank testing revealed a significant correlation between overall survival and histological grading (p = 0.046); and there was some correlation between SUVmax and histological grading, but not significantly different. The receiver operation characteristic curve was identified for cutoff value of SUVmax as a prognostic factor. We compared the low tumor of the SUVmax group with the high tumor of the SUVmax group divided by the cutoff value of SUVmax. We did find a significant correlation between SUVmax and disease control and mortality (p = 0.003, p < 0.001). CONCLUSION In our study, we concluded that subjects with higher tumor FDG uptakes should be considered for a more aggressive disease.
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Affiliation(s)
- Jeong-Hun Seol
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Rusten E, Rødal J, Bruland ØS, Malinen E. Biologic targets identified from dynamic 18FDG-PET and implications for image-guided therapy. Acta Oncol 2013; 52:1378-83. [PMID: 23981046 DOI: 10.3109/0284186x.2013.813071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The outcome of biologic image-guided radiotherapy depends on the definition of the biologic target. The purpose of the current work was to extract hyperperfused and hypermetabolic regions from dynamic positron emission tomography (D-PET) images, to dose escalate either region and to discuss implications of such image guided strategies. METHODS Eleven patients with soft tissue sarcomas were investigated with D-PET. The images were analyzed using a two-compartment model producing parametric maps of perfusion and metabolic rate. The two image series were segmented and exported to a treatment planning system, and biological target volumes BTVper and BTVmet (perfusion and metabolism, respectively) were generated. Dice's similarity coefficient was used to compare the two biologic targets. Intensity-modulated radiation therapy (IMRT) plans were generated for a dose painting by contours regime, where planning target volume (PTV) was planned to 60 Gy and BTV to 70 Gy. Thus, two separate plans were created for each patient with dose escalation of either BTVper or BTVmet. RESULTS BTVper was somewhat smaller than BTVmet (209 ± 170 cm(3) against 243 ± 143 cm(3), respectively; population-based mean and s.d.). Dice's coefficient depended on the applied margin, and was 0.72 ± 0.10 for a margin of 10 mm. Boosting BTVper resulted in mean dose of 69 ± 1.0 Gy to this region, while BTVmet received 67 ± 3.2 Gy. Boosting BTVmet gave smaller dose differences between the respective non-boost DVHs (such as D98). CONCLUSIONS Dose escalation of one of the BTVs results in a partial dose escalation of the other BTV as well. If tumor aggressiveness is equally pronounced in hyperperfused and hypermetabolic regions, this should be taken into account in the treatment planning.
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Affiliation(s)
- Espen Rusten
- Department of Physics, University of Oslo , Oslo , Norway
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Prognostic significance of preoperative metabolic tumour volume and total lesion glycolysis measured by (18)F-FDG PET/CT in squamous cell carcinoma of the oral cavity. Eur J Nucl Med Mol Imaging 2013; 41:452-61. [PMID: 24081448 DOI: 10.1007/s00259-013-2571-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Metabolic tumour volume (MTV) and total lesion glycolysis (TLG) from (18)F-FDG PET/CT are emerging prognostic biomarkers in human solid cancers; yet few studies have investigated their clinical and prognostic significance in oral cavity squamous cell carcinoma (OSCC). The present retrospective study evaluated the utility of pretreatment MTV and TLG measured by (18)F-FDG PET/CT to predict survival and occult metastasis (OM) in OSCC. METHODS Of 162 patients with OSCC evaluated preoperatively by (18)F-FDG PET/CT, 105 who underwent definitive surgery with or without adjuvant therapy were eligible. Maximum standardized uptake value (SUVmax), MTV and TLG were measured. For calculation of MTV, 3-D regions of interest were drawn and a SUV threshold of 2.5 was used for defining regions. Univariate and multivariate analyses identified clinicopathological and imaging variables associated with OM, disease-free survival (DFS) and overall survival (OS). RESULTS The median (range) SUVmax, MTV and TLG were 7.3 (0.7-41.9), 4.5 ml (0.7-115.1 ml) and 18.3 g (2.4-224.1 g), respectively. Of 53 patients with clinically negative lymph nodes, OM was detected in 19 (36%). By univariate and multivariate analyses, MTV (P = 0.018) and TLG (P = 0.011) were both independent predictive factors for OM, although they were not independent of each other. The 4-year DFS and OS rates were 53.0% and 62.0%, respectively. Univariate and multivariate analyses revealed that MTV (P = 0.001) and TLG (P = 0.006), with different cut-off levels, were both independent predictive factors for DFS, although they were not independent of each other, and MTV (P = 0.001), TLG (P = 0.002) and the involved resection margin (P = 0.007) were independent predictive factors for OS. CONCLUSION Pretreatment MTV and TLG may be useful in stratifying the likelihood of survival and predicting OM in OSCC.
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Prognostic value of preoperative 18F-FDG PET/CT for primary head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 2013; 271:1685-91. [DOI: 10.1007/s00405-013-2605-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/12/2013] [Indexed: 12/12/2022]
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Joo YH, Yoo IR, Cho KJ, Park JO, Nam IC, Kim MS. Preoperative 18F-FDG PET/CT and high-risk HPV in patients with oropharyngeal squamous cell carcinoma. Head Neck 2013; 36:323-7. [PMID: 23729374 DOI: 10.1002/hed.23296] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To evaluate the association of (18)F-fluorodeoxyglucose-positron emission tomography ((18)F-FDG PET/CT) and high-risk human papillomavirus (HPV) status and to establish the histologic correlates in oropharyngeal cancer (OPSCC). METHOD The medical records of 78 patients who underwent (18)F-FDG PET/CT for OPSCC before surgery were reviewed. RESULTS The positive rate of high-risk HPV in situ hybridization was 36% (28 of 78). The maximum standardized uptake values (SUVmax ) of negativity for the high-risk HPV subtypes (10.29 ± 4.30) and positivity (6.69 ± 4.17) were found to be significantly different (p = .001). The SUVmax cutoff value for differentiating negativity for the high-risk HPV subtypes from positivity was 7.10, with the sensitivity of 78% and the specificity of 68%. A median SUVmax (using 7.10 as a cutoff) (p = .041) and high-risk HPV status (p = .040) were found to be associated with 5-year disease-specific survival (DSS). CONCLUSIONS Median (18)F-FDG PET/CT SUVmax cutoff values 7.10 or greater are associated with a high-risk HPV negativity in OPSCC patients.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Ryu IS, Kim JS, Roh JL, Lee JH, Cho KJ, Choi SH, Nam SY, Kim SY. Prognostic value of preoperative metabolic tumor volume and total lesion glycolysis measured by 18F-FDG PET/CT in salivary gland carcinomas. J Nucl Med 2013; 54:1032-8. [PMID: 23670902 DOI: 10.2967/jnumed.112.116053] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) from (18)F-FDG PET/CT are emerging prognostic biomarkers in various human cancers. This study examined the prognostic value of these metabolic tumor parameters measured by pretreatment (18)F-FDG PET/CT in patients with salivary gland carcinomas. METHODS Forty-nine patients with intermediate- or high-grade salivary gland carcinomas who underwent definitive surgery with or without radiotherapy or chemoradiotherapy were evaluated preoperatively by (18)F-FDG PET/CT. Maximum standardized uptake values (SUV max), MTV, and TLG were measured for each patient. Univariate and multivariate analyses were used to identify clinicopathologic and imaging variables associated with progression-free survival (PFS) and overall survival (OS). Univariate analyses included the following variables: age, sex, pT and pN classifications, overall pTNM stage, histologic grade, resection margin, tumor lymphovascular invasion and perineural invasion, postoperative adjuvant therapy, gross total volume, SUV max, MTV, and TLG. RESULTS The 3-y PFS and OS rates for all study patients were 66.9% and 81.6%, respectively. The median SUV max, MTV, and TLG were 5.1 (range, 1.7-21.5), 16.2 mL (1.0-115.1 mL), and 24.4 g (2.1-224.4 g), respectively. Univariate analyses showed that there were significant correlations between pT classification, pN classification, MTV, and TLG and both PFS and OS (P < 0.05). However, SUV max was not associated with either PFS (P = 0.111) or OS (P = 0.316). Multivariate analyses revealed that MTV (P = 0.011; hazard ratio, 11.50; 95% confidence interval, 1.45-91.01) and TLG (P = 0.038; hazard ratio, 3.55; 95% confidence interval, 1.07-11.76) were independent variables for PFS. CONCLUSION Pretreatment values of MTV and TLG are independent prognostic factors in patients with intermediate or high-grade salivary gland carcinomas.
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Affiliation(s)
- In Sun Ryu
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Curry JM, Tuluc M, Whitaker-Menezes D, Ames JA, Anantharaman A, Butera A, Leiby B, Cognetti DM, Sotgia F, Lisanti MP, Martinez-Outschoorn UE. Cancer metabolism, stemness and tumor recurrence: MCT1 and MCT4 are functional biomarkers of metabolic symbiosis in head and neck cancer. Cell Cycle 2013; 12:1371-84. [PMID: 23574725 PMCID: PMC3674065 DOI: 10.4161/cc.24092] [Citation(s) in RCA: 182] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Here, we interrogated head and neck cancer (HNSCC) specimens (n = 12) to examine if different metabolic compartments (oxidative vs. glycolytic) co-exist in human tumors. A large panel of well-established biomarkers was employed to determine the metabolic state of proliferative cancer cells. Interestingly, cell proliferation in cancer cells, as marked by Ki-67 immunostaining, was strictly correlated with oxidative mitochondrial metabolism (OXPHOS) and the uptake of mitochondrial fuels, as detected via MCT1 expression (p < 0.001). More specifically, three metabolic tumor compartments were delineated: (1) proliferative and mitochondrial-rich cancer cells (Ki-67+/TOMM20+/COX+/MCT1+); (2) non-proliferative and mitochondrial-poor cancer cells (Ki-67−/TOMM20−/COX−/MCT1−); and (3) non-proliferative and mitochondrial-poor stromal cells (Ki-67−/TOMM20−/COX−/MCT1−). In addition, high oxidative stress (MCT4+) was very specific for cancer tissues. Thus, we next evaluated the prognostic value of MCT4 in a second independent patient cohort (n = 40). Most importantly, oxidative stress (MCT4+) in non-proliferating epithelial cancer cells predicted poor clinical outcome (tumor recurrence; p < 0.0001; log-rank test), and was functionally associated with FDG-PET avidity (p < 0.04). Similarly, oxidative stress (MCT4+) in tumor stromal cells was specifically associated with higher tumor stage (p < 0.03), and was a highly specific marker for cancer-associated fibroblasts (p < 0.001). We propose that oxidative stress is a key hallmark of tumor tissues that drives high-energy metabolism in adjacent proliferating mitochondrial-rich cancer cells, via the paracrine transfer of mitochondrial fuels (such as L-lactate and ketone bodies). New antioxidants and MCT4 inhibitors should be developed to metabolically target “three-compartment tumor metabolism” in head and neck cancers. It is remarkable that two “non-proliferating” populations of cells (Ki-67−/MCT4+) within the tumor can actually determine clinical outcome, likely by providing high-energy mitochondrial “fuels” for proliferative cancer cells to burn. Finally, we also show that in normal mucosal tissue, the basal epithelial “stem cell” layer is hyper-proliferative (Ki-67+), mitochondrial-rich (TOMM20+/COX+) and is metabolically programmed to use mitochondrial fuels (MCT1+), such as ketone bodies and L-lactate. Thus, oxidative mitochondrial metabolism (OXPHOS) is a common feature of both (1) normal stem cells and (2) proliferating cancer cells. As such, we should consider metabolically treating cancer patients with mitochondrial inhibitors (such as Metformin), and/or with a combination of MCT1 and MCT4 inhibitors, to target “metabolic symbiosis.”
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Affiliation(s)
- Joseph M Curry
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA, USA.
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Varoquaux A, Rager O, Lovblad KO, Masterson K, Dulguerov P, Ratib O, Becker CD, Becker M. Functional imaging of head and neck squamous cell carcinoma with diffusion-weighted MRI and FDG PET/CT: quantitative analysis of ADC and SUV. Eur J Nucl Med Mol Imaging 2013; 40:842-52. [PMID: 23436068 PMCID: PMC3644194 DOI: 10.1007/s00259-013-2351-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/15/2013] [Indexed: 12/17/2022]
Abstract
Purpose Head and neck squamous cell carcinoma (HNSCC) may cause a decreased apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging (DW MRI) and an increased standardized uptake value (SUV) on fluorodeoxyglucose (FDG) positron emission tomography (PET/CT). We analysed the reproducibility of ADC and SUV measurements in HNSCC and evaluated whether these biomarkers are correlated or independent. Methods This retrospective analysis of DW MRI and FDG PET/CT data series included 34 HNSCC in 33 consecutive patients. Two experienced readers measured tumour ADC and SUV values independently. Statistical comparison and correlation with histopathology was done. Intra- and inter-observer agreement for ADC and SUV measurements was assessed. Results Intraclass correlation coefficient (ICC) analysis showed almost perfect reproducibility (>0.90) for ADCmean, ADCmin, SUVmax and SUVmean values for intra-observer and inter-observer agreement. Mean ADCmean and ADCmin in HNSCC were 1.05 ± 0.34 × 10−3 mm2/s and 0.65 ± 0.29 × 10−3 mm2/s, respectively. Mean SUVmean and mean SUVmax were 7.61 ± 3.87 and 12.8 ± 5.0, respectively. Although statistically not significant, a trend towards higher SUV and lower ADC was observed with increasing tumour dedifferentiation. Pearson’s correlation analysis showed no significant correlation between ADC and SUV measurements (r −0.103, −0.051; p 0.552, 0.777). Conclusion Our data suggest that ADC and SUV values are reproducible and independent biomarkers in HNSCC.
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Affiliation(s)
- Arthur Varoquaux
- Department of Radiology, Geneva University Hospital, Geneva 14, Switzerland
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Functional imaging of head and neck squamous cell carcinoma with diffusion-weighted MRI and FDG PET/CT: quantitative analysis of ADC and SUV. Eur J Nucl Med Mol Imaging 2013. [PMID: 23436068 DOI: 10.1007/s00259-013-2351-9.pubmed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE Head and neck squamous cell carcinoma (HNSCC) may cause a decreased apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging (DW MRI) and an increased standardized uptake value (SUV) on fluorodeoxyglucose (FDG) positron emission tomography (PET/CT). We analysed the reproducibility of ADC and SUV measurements in HNSCC and evaluated whether these biomarkers are correlated or independent. METHODS This retrospective analysis of DW MRI and FDG PET/CT data series included 34 HNSCC in 33 consecutive patients. Two experienced readers measured tumour ADC and SUV values independently. Statistical comparison and correlation with histopathology was done. Intra- and inter-observer agreement for ADC and SUV measurements was assessed. RESULTS Intraclass correlation coefficient (ICC) analysis showed almost perfect reproducibility (>0.90) for ADCmean, ADCmin, SUVmax and SUVmean values for intra-observer and inter-observer agreement. Mean ADCmean and ADCmin in HNSCC were 1.05 ± 0.34 × 10(-3) mm(2)/s and 0.65 ± 0.29 × 10(-3) mm(2)/s, respectively. Mean SUVmean and mean SUVmax were 7.61 ± 3.87 and 12.8 ± 5.0, respectively. Although statistically not significant, a trend towards higher SUV and lower ADC was observed with increasing tumour dedifferentiation. Pearson's correlation analysis showed no significant correlation between ADC and SUV measurements (r -0.103, -0.051; p 0.552, 0.777). CONCLUSION Our data suggest that ADC and SUV values are reproducible and independent biomarkers in HNSCC.
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Paidpally V, Chirindel A, Lam S, Agrawal N, Quon H, Subramaniam RM. FDG-PET/CT imaging biomarkers in head and neck squamous cell carcinoma. ACTA ACUST UNITED AC 2012; 4:633-647. [PMID: 23482696 DOI: 10.2217/iim.12.60] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article discusses the value of 18F-fluoro-2-deoxyglucose PET/CT imaging biomarkers in head and neck squamous cell carcinoma. 18F-fluoro-2-deoxyglucose PET/CT is valuable at baseline staging, radiotherapy planning, therapy response assessment and in the follow-up of patients with head and neck squamous cell carcinoma. Maximum and peak standardized uptake value (SUVmax and SUVpeak), metabolic tumor volume and total lesion glycolysis are the common 18F-fluoro-2-deoxyglucose quantitative parameters that have been studied, along with qualitative assessments. These parameters will be evaluated with respect to their established or potential role as noninvasive biomarkers for patient risk stratification, treatment response and survival outcome.
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Affiliation(s)
- Vasavi Paidpally
- Russel H Morgan Department of Radiology & Radiology Science, Johns Hopkins Medical Institutions, 601 North Caroline Street/JHOC 3235, Baltimore, MD 21287, USA
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Siddiqui F, Faulhaber PF, Yao M, Le QT. The Application of FDG-PET as Prognostic Indicators in Head and Neck Squamous Cell Carcinoma. PET Clin 2012; 7:381-94. [PMID: 27157645 DOI: 10.1016/j.cpet.2012.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This article discusses the role of FDG-PETederived parameters as prognostic indicators in patients with squamous cell carcinoma of the head and neck. The basic underlying biology of FDG-PET scans and the quantitative information that can be derived are discussed. A review of the literature is performed. Potential applications in the management of head and neck cancer and future directions in clinical trials are discussed.
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Affiliation(s)
- Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Peter F Faulhaber
- Division of Nuclear Medicine, Department of Radiology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Min Yao
- Department of Radiation Oncology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
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FDG PET/CT and diffusion-weighted imaging of head and neck squamous cell carcinoma: comparison of prognostic significance between primary tumor standardized uptake value and apparent diffusion coefficient. Clin Nucl Med 2012; 37:475-80. [PMID: 22475897 DOI: 10.1097/rlu.0b013e318248524a] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare primary tumor (18)F-fluorodeoxyglucose (FDG) maximum standardized uptake value (SUV(max)) and diffusion-weighted imaging (DWI) apparent diffusion coefficient (ADC) obtained in the same patients with head and neck squamous cell carcinoma (HNSCC) to clarify the prognostic significance of both indexes. MATERIALS AND METHODS The study population comprised 26 patients with HNSCC visible on both pretreatment FDG PET/CT and DWI. Correlation between SUV(max) and ADC (b values; 0 and 800 seconds/mm(2)) was analyzed by the Spearman's rank test. Disease-free survival (DFS) was calculated by the Kaplan-Meier method. Prognostic significance was assessed by the long-rank test and Cox proportional hazards analysis. RESULTS SUV(max) and ADC correlated significantly and negatively (ρ = -0.566, P = 0.005). High (>12.1) SUV(max) (P < 0.001), low (≤ 0.88) ADC (P = 0.009), high (T3-4) T stage (P = 0.030), and high (N2-3) N stage (P = 0.007) were significant in predicting poor 2-year DFS. The accuracy for predicting disease events was 81% (21/26) for SUV(max) (>12.1) and 73% (19/26) for ADC(≤ 0.88) without significant difference between them (P = 0.52). Disease event hazards ratios for significant unadjusted SUV(max) (P = 0.015) and ADC (P = 0.039) remained significant when adjusted for other dichotomized clinical covariates (SUV(max); P = 0.009-0.039, ADC; P = 0.017-0.037) except SUV(max) for ADC and ADC for SUV(max) and T stage. CONCLUSION These results suggest that pretreatment primary tumor SUV(max) and ADC correlate significantly and negatively and both may have similar potential to predict DFS or disease events of HNSCC.
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Zhao K, Luo XM, Zhou SH, Liu JH, Yan SX, Lu ZJ, Yang SY, Lin LL, Dong MJ. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography as an effective diagnostic workup in cervical metastasis of carcinoma from an unknown primary tumor. Cancer Biother Radiopharm 2012; 27:685-93. [PMID: 22834634 DOI: 10.1089/cbr.2011.1134] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The purpose of this study is to assess the potential of ¹⁸F-fluorodeoxyglucose (¹⁸FDG) positron emission tomography/computed tomography (PET/CT) imaging for the diagnosis of cervical metastasis of carcinoma of an unknown primary tumor (CUP) and to determine whether the maximum standardized uptake value (SUV(max)) is a prognostic factor. METHODS Twenty-five consecutive patients with cervical metastasis of CUP were retrospectively analyzed by PET/CT between July 2007 and July 2011. RESULTS FDG PET/CT suggested a primary tumor in 21 out of 25 patients (84.0%). The sensitivity of FDG PET/CT in detecting the primary tumor was 73.3% (11 of 15), and the positive predictive value was 52.4% (11 of 21). The median follow-up duration of survival patients was 10.4 months (range: 0-30 months). The estimated 2-year overall survival rate of all patients was 50.0%. Univariate analyses did not reveal a significant difference in overall survival between the group of 11 patients identified by pathology and the 14 patients not identified by pathology (overall survival was 57.1% and 49.1%, respectively; p=0.468). The median SUV(max) was 7.6. In the log-rank test, patients with a low SUV(max) (≤ 7.0) in cervical lymph nodes had a significantly higher survival rate at 2 years (87.5% vs. 21.2%; p=0.007) than patients with a high SUV(max) (>7.0). CONCLUSIONS Although our study was inconclusive due to the small sample size, our results suggest that FDG PET/CT may be an effective diagnostic workup in the cervical metastasis of carcinoma from an unknown primary tumor (UPT). In the present study, SUV(max) of PET/CT in the cervical lymph node may serve as a prognostic factor of cervical metastasis of carcinoma from a UPT based on the limited number of patients. Further studies are needed to confirm these findings.
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Affiliation(s)
- Kui Zhao
- Department of PET Centre, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Quon H, Brizel DM. Predictive and Prognostic Role of Functional Imaging of Head and Neck Squamous Cell Carcinomas. Semin Radiat Oncol 2012; 22:220-32. [DOI: 10.1016/j.semradonc.2012.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Clinical significance of combined assessment of the maximum standardized uptake value of F-18 FDG PET with nodal size in the diagnosis of cervical lymph node metastasis of oral squamous cell carcinoma. Acad Radiol 2012; 19:708-17. [PMID: 22484437 DOI: 10.1016/j.acra.2012.02.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 02/15/2012] [Accepted: 02/16/2012] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to elucidate the diagnostic accuracy of F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for nodal involvement in oral squamous cell carcinoma (OSCC), and to reveal clinically useful factors to distinguish between true-positive (TP) and false-positive (FP) nodes. MATERIALS AND METHODS Thirty-eight patients with primary OSCC who underwent neck dissection were assessed. The diagnostic accuracy of F-18 FDG PET/CT was evaluated, and then compared with that of CT/ultrasonography (US). Furthermore, the association of the maximum standardized uptake value (SUVmax) and nodal size with the histopathologic findings was examined. RESULTS Sensitivity and specificity using F-18 FDG PET/CT were 77.1% and 97.3%, and those using CT/US were 72.9% and 98.9%, respectively. The SUVmax of TP nodes was significantly higher than that of FP nodes. Nodes with SUVmax >4.5 were pathologically confirmed as metastasis. Nodes with SUVmax ≤4.5 were further discriminated between TP and FP nodes by using the long axis diameters or the ratios of long to short axis diameter as clinical parameters. Positive correlation between the SUVmax and the short-axis diameter was found in TP nodes. The AUC obtained from the ROC curves of the SUVmax alone (AUC, 0.804) was improved by combination with the long-axis diameter (AUC, 0.867) or the short-axis diameter (AUC, 0.846), although no significant difference was found. CONCLUSIONS These results indicated that F-18 FDG PET/CT was potentially useful in diagnosing preoperative nodal state. Furthermore, combined assessment of SUVmax with nodal size could be significant in the identification of metastatic lymph nodes in OSCC patients.
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Romesser PB, Qureshi MM, Shah BA, Chatburn LT, Jalisi S, Devaiah AK, Subramaniam RM, Truong MT. Superior prognostic utility of gross and metabolic tumor volume compared to standardized uptake value using PET/CT in head and neck squamous cell carcinoma patients treated with intensity-modulated radiotherapy. Ann Nucl Med 2012; 26:527-34. [PMID: 22610386 PMCID: PMC4483182 DOI: 10.1007/s12149-012-0604-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 04/19/2012] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To compare the prognostic utility of the 2-[(18)F] fluoro-2-deoxy-D: -glucose (FDG) maximum standardized uptake value (SUV(max)), primary gross tumor volume (GTV), and FDG metabolic tumor volume (MTV) for disease control and survival in patients with head and neck squamous cell carcinoma (HNSCC) undergoing intensity-modulated radiotherapy (IMRT). METHODS Between 2007 and 2011, 41 HNSCC patients who underwent a staging positron emission tomography with computed tomography and definitive IMRT were identified. Local (LC), nodal (NC), distant (DC), and overall (OC) control, overall survival (OS), and disease-free survival (DFS) were assessed using the Kaplan-Meier product-limit method. RESULTS With a median follow-up of 24.2 months (range 2.7-56.3 months) local, nodal, and distant recurrences were recorded in 10, 5, and 7 patients, respectively. The median SUV(max), GTV, and MTV were 15.8, 22.2 cc, and 7.2 cc, respectively. SUV(max) did not correlate with LC (p = 0.229) and OS (p = 0.661) when analyzed by median threshold. Patients with smaller GTVs (<22.2 cc) demonstrated improved 2-year actuarial LC rates of 100 versus 56.4 % (p = 0.001) and OS rates of 94.4 versus 65.9 % (p = 0.045). Similarly, a smaller MTV (<7.2 cc) correlated with improved 2-year actuarial LC rates of 100 versus 54.2 % (p < 0.001) and OS rates of 94.7 versus 64.2 % (p = 0.04). Smaller GTV and MTV correlated with improved NC, DC, OC, and DFS, as well. CONCLUSION GTV and MTV demonstrate superior prognostic utility as compared to SUV(max), with larger tumor volumes correlating with inferior local control and overall survival in HNSCC patients treated with definitive IMRT.
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Affiliation(s)
- Paul B Romesser
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, 830 Harrison Ave, Moakley Building LL 238, Boston, MA 02118, USA
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Use of pretreatment metabolic tumour volumes to predict the outcome of pharyngeal cancer treated by definitive radiotherapy. Eur J Nucl Med Mol Imaging 2012; 39:1297-305. [DOI: 10.1007/s00259-012-2127-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
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Early evaluation of neoadjuvant chemotherapy response using FDG-PET/CT predicts survival prognosis in patients with head and neck squamous cell carcinoma. Int J Clin Oncol 2012; 18:402-10. [DOI: 10.1007/s10147-012-0393-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 02/12/2012] [Indexed: 11/25/2022]
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Han MW, Lee HJ, Cho KJ, Kim JS, Roh JL, Choi SH, Nam SY, Kim SY. Role of FDG-PET as a biological marker for predicting the hypoxic status of tongue cancer. Head Neck 2011; 34:1395-402. [PMID: 22052623 DOI: 10.1002/hed.21945] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2011] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND To determine whether 2-[(18)F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) could serve as a useful technique predicting tumor hypoxia and prognosis in tongue cancer, we assessed the relationship between FDG uptake and the levels of hypoxia-related markers. METHODS Tumor uptake of FDG in 33 patients with T2 tongue cancer was assessed by measuring maximum standardized uptake values (SUVmax). Expression of hypoxia-inducible factor (HIF)-1α, carbonic anhydrase (CA)-9, glucose transporter (GLUT)-1, and erythropoietin receptor (EPOR), was determined by immunohistochemical staining. Correlation between SUVmax and the expression of hypoxia-related markers was assessed and multivariate analysis was performed to determine what parameters affected clinical outcomes. RESULTS We observed strong correlations between SUVmax and expression of HIF-1α (p < .05), CA-9 (p < .01), and GLUT-1 (p < .01). SUVmax, HIF-1α expression, and tumor grade were significant independent predictors of disease-free survival (DFS). CONCLUSION SUVmax may be a good noninvasive biomarker for prediction of hypoxic status and prognosis of patients with T2 tongue cancer.
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Affiliation(s)
- Myung Woul Han
- Department of Otolaryngology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
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Fried D, Khandani A, Shores C, Weissler M, Hayes N, Hackman T, Rosenman J, Chera BS. Matched cohort analysis of the effect of pretreatment positron emission tomography on clinical outcomes of patients with head and neck cancer treated with definitive chemoradiotherapy. Head Neck 2011; 34:412-7. [PMID: 21853498 DOI: 10.1002/hed.21745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 01/04/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Pretreatment positron emission tomography (PET) has been shown to be useful for patients with head and neck squamous cell carcinoma (HNSCC) after definitive chemoradiotherapy (CRT). METHODS We conducted a retrospective analysis of a matched cohort of 116 patients with HNSCC that underwent CRT treatment at our institution. Pretreatment PET was performed in 58 patients and omitted in the other 58 patients. The 2 cohorts were matched for T classification, N classification, primary site, and smoking history. Kaplan-Meier 2-year estimates of local control (LC), regional control (RC), freedom from distant metastasis (FFDM), cause-specific survival (CSS), and overall survival (OS) were compared with log-rank tests. RESULTS There were no differences between the 2 cohorts for 2-year endpoints of LC, RC, FFDM, CSS, and OS. On multivariate analysis pretreatment PET imaging did not influence any endpoint. CONCLUSIONS PET imaging before definitive CRT may not significantly improve outcomes in patients with HNSCC.
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Affiliation(s)
- David Fried
- Department of Radiation Oncology, UNC Hospitals, NC Clinical Cancer Center, Chapel Hill, North Carolina, USA
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74
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Egelmeer AG, Velazquez ER, de Jong JM, Oberije C, Geussens Y, Nuyts S, Kremer B, Rietveld D, René Leemans C, de Jong MC, Rasch C, Hoebers F, Homer J, Slevin N, West C, Lambin P. Development and validation of a nomogram for prediction of survival and local control in laryngeal carcinoma patients treated with radiotherapy alone: A cohort study based on 994 patients. Radiother Oncol 2011; 100:108-15. [DOI: 10.1016/j.radonc.2011.06.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 06/11/2011] [Accepted: 06/11/2011] [Indexed: 10/18/2022]
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Haerle SK, Schmid DT, Ahmad N, Hany TF, Stoeckli SJ. The value of (18)F-FDG PET/CT for the detection of distant metastases in high-risk patients with head and neck squamous cell carcinoma. Oral Oncol 2011; 47:653-9. [PMID: 21658990 DOI: 10.1016/j.oraloncology.2011.05.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 05/17/2011] [Accepted: 05/18/2011] [Indexed: 01/23/2023]
Abstract
The aims of this study were to assess a cohort of patients with head and neck squamous cell carcinoma (HNSCC) for: (1) the prevalence of synchronous distant metastases (DM) as detected by the initial staging by using (18)F-FDG PET/CT, (2) the prevalence of metachronous DM, and (3) the validity of published risk factors with special emphasis on the maximum standardized uptake value (SUV max) for the prediction of DM. Two hundred and ninety nine patients with advanced HNSCC were included. Following risk factors at the time of diagnosis and during follow-up were analyzed: advanced T/N stage, poor histological differentiation, level IV/Vb lymph nodes, primary site in the larynx/hypopharynx, and SUV max. The prevalence of DM at initial staging and during follow-up was 10% and 11%, respectively. At initial staging, primary site in the larynx/hypopharynx and neck nodes in level IV/Vb, and during follow-up only level IV/Vb nodes achieved statistical significance. The sensitivity for (18)F-FDG PET/CT with regard to the detection of DM was 96.8%, the specificity 95.4%, the positive predictive value (PV) 69.8%, and the negative PV 99.6%. Patients without DM showed a significantly better overall survival (OS) than patients developing DM (p<0.001). There was no significant difference in OS with regard to the time of diagnosis of DM. The prevalence for synchronous and metachronous DM in advanced HNSCC is considerable. (18)F-FDG PET/CT is highly accurate for initial staging and follow-up. DM carries a bad prognosis regardless of the time of diagnosis.
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Affiliation(s)
- Stephan K Haerle
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Frauenklinikstrasse 24, CH-8091 Zurich, Switzerland.
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Querellou S, Abgral R, Le Roux PY, Nowak E, Valette G, Potard G, Le Duc-Pennec A, Cavarec MB, Marianovski R, Salaün PY. Prognostic value of fluorine-18 fluorodeoxyglucose positron-emission tomography imaging in patients with head and neck squamous cell carcinoma. Head Neck 2011; 34:462-8. [DOI: 10.1002/hed.21765] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 12/09/2010] [Accepted: 01/24/2011] [Indexed: 11/11/2022] Open
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Shukla-Dave A, Lee NY, Jansen JFA, Thaler HT, Stambuk HE, Fury MG, Patel SG, Moreira AL, Sherman E, Karimi S, Wang Y, Kraus D, Shah JP, Pfister DG, Koutcher JA. Dynamic contrast-enhanced magnetic resonance imaging as a predictor of outcome in head-and-neck squamous cell carcinoma patients with nodal metastases. Int J Radiat Oncol Biol Phys 2011; 82:1837-44. [PMID: 21601373 DOI: 10.1016/j.ijrobp.2011.03.006] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 02/24/2011] [Accepted: 03/01/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE Dynamic contrast-enhanced MRI (DCE-MRI) can provide information regarding tumor perfusion and permeability and has shown prognostic value in certain tumors types. The goal of this study was to assess the prognostic value of pretreatment DCE-MRI in head and neck squamous cell carcinoma (HNSCC) patients with nodal disease undergoing chemoradiation therapy or surgery. METHODS AND MATERIALS Seventy-four patients with histologically proven squamous cell carcinoma and neck nodal metastases were eligible for the study. Pretreatment DCE-MRI was performed on a 1.5T MRI. Clinical follow-up was a minimum of 12 months. DCE-MRI data were analyzed using the Tofts model. DCE-MRI parameters were related to treatment outcome (progression-free survival [PFS] and overall survival [OS]). Patients were grouped as no evidence of disease (NED), alive with disease (AWD), dead with disease (DOD), or dead of other causes (DOC). Prognostic significance was assessed using the log-rank test for single variables and Cox proportional hazards regression for combinations of variables. RESULTS At last clinical follow-up, for Stage III, all 12 patients were NED. For Stage IV, 43 patients were NED, 4 were AWD, 11 were DOD, and 4 were DOC. K(trans) is volume transfer constant. In a stepwise Cox regression, skewness of K(trans) (volume transfer constant) was the strongest predictor for Stage IV patients (PFS and OS: p <0.001). CONCLUSION Our study shows that skewness of K(trans) was the strongest predictor of PFS and OS in Stage IV HNSCC patients with nodal disease. This study suggests an important role for pretreatment DCE-MRI parameter K(trans) as a predictor of outcome in these patients.
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Affiliation(s)
- Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Abstract
Positron emission tomography (PET) is a noninvasive imaging technique that provides a functional or metabolic assessment of normal tissue or disease conditions. Fluorine 18-fluorodeoxyglucose PET imaging (FDG-PET) is widely used clinically for tumor imaging due to increased glucose metabolism in most types of tumors, and has been shown to improve the diagnosis and subsequent treatment of cancers. We review its use in cancer diagnosis, staging, restaging, and assessment of response to treatment. In addition, other metabolic PET imaging agents in pre-clinical research or clinical trial stages of development are discussed, including amino acid analogs based on increased protein synthesis, and choline, which is based on increased membrane lipid synthesis. Amino acid analogs and choline are more specific to tumor cells than FDG, so they play an important role in differentiating cancers from benign conditions and in the diagnosis of cancers with low FDG uptake or high background FDG uptake. For decades, researchers have shown that tumors display altered metabolic profiles with elevated uptake of glucose, amino acids, and lipids. This can be used for cancer diagnosis and monitoring of the therapeutic response with excellent signal-to-noise ratios.
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Affiliation(s)
- Aizhi Zhu
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
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Can FDG PET predict radiation treatment outcome in head and neck cancer? Results of a prospective study. Eur J Nucl Med Mol Imaging 2011; 38:1449-58. [PMID: 21461734 PMCID: PMC3127003 DOI: 10.1007/s00259-011-1789-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 03/02/2011] [Indexed: 11/17/2022]
Abstract
Purpose In head and neck cancer (HNC) various treatment strategies have been developed to improve outcome, but selecting patients for these intensified treatments remains difficult. Therefore, identification of novel pretreatment assays to predict outcome is of interest. In HNC there are indications that pretreatment tumour 18F-fluorodeoxyglucose (FDG) uptake may be an independent prognostic factor. The aim of this study was to assess the prognostic value of FDG uptake and CT-based and FDG PET-based primary tumour volume measurements in patients with HNC treated with (chemo)radiotherapy. Methods A total of 77 patients with stage II–IV HNC who were eligible for definitive (chemo)radiotherapy underwent coregistered pretreatment CT and FDG PET. The gross tumour volume of the primary tumour was determined on the CT (GTVCT) and FDG PET scans. Five PET segmentation methods were applied: interpreting FDG PET visually (PETVIS), applying an isocontour at a standardized uptake value (SUV) of 2.5 (PET2.5), using fixed thresholds of 40% and 50% (PET40%, PET50%) of the maximum intratumoral FDG activity (SUVMAX) and applying an adaptive threshold based on the signal-to-background (PETSBR). Mean FDG uptake for each PET-based volume was recorded (SUVmean). Subsequently, to determine the metabolic volume, the integrated SUV was calculated as the product of PET-based volume and SUVmean. All these variables were analysed as potential predictors of local control (LC), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS). Results In oral cavity/oropharynx tumours PETVIS was the only volume-based method able to predict LC. Both PETVIS and GTVCT were able to predict DMFS, DFS and OS in these subsites. Integrated SUVs were associated with LC, DMFS, DFS and OS, while SUVmean and SUVMAX were not. In hypopharyngeal/laryngeal tumours none of the variables was associated with outcome. Conclusion There is no role yet for pretreatment FDG PET as a predictor of (chemo)radiotherapy outcome in HNC in daily routine. However, this potential application needs further exploration, focusing both on FDG PET-based primary tumour volume, integrated SUV and SUVMAX of the primary tumour.
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Woods C, Sohn J, Yao M. The Application of PET in Radiation Treatment Planning for Head and Neck Cancer. PET Clin 2011; 6:149-63. [DOI: 10.1016/j.cpet.2011.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Xie P, Li M, Zhao H, Sun X, Fu Z, Yu J. 18F-FDG PET or PET-CT to evaluate prognosis for head and neck cancer: a meta-analysis. J Cancer Res Clin Oncol 2011; 137:1085-93. [PMID: 21229262 DOI: 10.1007/s00432-010-0972-y] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 12/22/2010] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this meta-analysis was to evaluate the prognostic value of standard uptake value (SUV) from serial Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in patients with head and neck cancer. METHODS We searched for articles limited to head and neck cancer, dealt with the impact of SUV on survival and published in English. The endpoints were disease-free survival (DFS), overall survival (OS), and local control (LC). Two reviewers extracted data independently. RESULTS Thirty-five studies were identified; of which, 26 studies involving 1,415 patients met the inclusion criteria. Pooled survival data suggested better DFS, OS, and LC in patients with low SUV of pre-treatment, and the odds ratio (OR) was 0.23, 0.24, and 0.27, respectively. Patients having tumors with low SUV of post-treatment also had significantly better DFS (OR = 0.17) and OS (OR = 0.28) than those with high SUV. CONCLUSIONS The present meta-analysis showed that (18)F-FDG uptake, as measured by the SUV before treatment and metabolic response after treatment, are valuable for predicting long-term survival in head and neck cancer. High (18)F-FDG uptake may be useful for identifying patients requiring more aggressive treatment.
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Affiliation(s)
- Peng Xie
- Department of Radiation Oncology, Shandong Tumor Hospital and Institute, Key Laboratory of Radiation Oncology of Shandong Province, Jiyan Road 440, 250117, Jinan, Shandong Province, China
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Predictive value of fluorodeoxyglucose uptake in head and neck cancer: importance of standardization: editorial on EAORL-D-10-00277. Eur Arch Otorhinolaryngol 2010; 267:1491-3. [PMID: 20683605 DOI: 10.1007/s00405-010-1350-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 07/10/2010] [Indexed: 12/22/2022]
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Is there a correlation between 18F-FDG-PET standardized uptake value, T-classification, histological grading and the anatomic subsites in newly diagnosed squamous cell carcinoma of the head and neck? Eur Arch Otorhinolaryngol 2010; 267:1635-40. [PMID: 20680640 DOI: 10.1007/s00405-010-1348-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 07/14/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET)/CT imaging of squamous cell carcinoma of the head and neck (HNSCC) renders the possibility to study metabolic tumor activity by measuring FDG-uptake expressed as maximum standardized uptake value (SUV(max)). A correlation between SUV(max) and several factors including T-classification, histological tumor differentiation or different anatomic subsites is of potential interest in HNSCC. The aim of this study was to evaluate how metabolic tumor activity derived from FDG-PET correlates with prognostic clinical and pathological parameters including these factors. 262 patients with HNSCC undergoing PET/CT for initial staging were assessed separately for a potential correlation between SUV(max) and T-classification, histological grading, and anatomical subsites of the primary tumor. Nonparametric testing showed a significant correlation between SUV(max) and T-classification (P < 0.001). On the contrary, no statistically significant correlation was found between SUV(max) and histological tumor grading. Furthermore, no statistical significant correlation between the different anatomical subsites and SUV(max) were found. There was no significant correlation of SUV(max) and tumor grading after adjustment for T-stage and anatomical localization of the tumor, neither. CONCLUSION Metabolic tumor activity correlates with T-stage of HNSCC. However, histological tumor grading does not correlate with SUV(max). The role of primary tumor SUV(max) as a predictor of outcome or survival remains unclear. Clinicians should therefore exercise caution in attributing any clinical importance to SUV(max) obtained from a single PET/CT exam.
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Zhang B, Li X, Lu X. Standardized uptake value is of prognostic value for outcome in head and neck squamous cell carcinoma. Acta Otolaryngol 2010; 130:756-62. [PMID: 20085442 DOI: 10.3109/00016480903402981] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS The literature-based meta-analysis confirmed that increased standardized uptake value (SUV) of the primary tumor is a poor prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC), which should be further confirmed in a meta-analysis based on individual patient data. OBJECTIVES Primary tumor SUV, as measured by positron emission tomography (PET), has been studied as a potential prognostic factor for local control, disease-free survival, and overall survival. However, the limited sample sizes of the studies in the past led us to conduct a meta-analysis to improve the precision in estimating the effect of SUV on the prognosis of HNSCC. METHODS Eight articles were identified by searching electronic databases. Statistical analysis was performed with RevMan 4.2.2. SUV measurement and SUV threshold for defining high SUV were studied dependently. For each publication, we first obtained an estimate of the relative risk (RR) for comparing patients with a low and a high SUV. Subsequently, we aggregated the individual RRs into a combined RR, using a fixed-effects model. Publication bias was assessed with funnel plot. RESULTS We identified eight clinical trials dedicated to HNSCC. The combined RR from five reports for the local control was 0.71 (95% confidence interval [CI]: 0.63-0.81). The combined RR of the disease-free survival from six reports was 0.63 (95% CI: 0.54-0.73). Meanwhile, the combined RR of the overall survival from three reports was 0.57 (95% CI: 0.44-0.74). The funnel plot showed symmetrical distribution, indicating no evidence of substantial publication bias.
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Affiliation(s)
- Baitao Zhang
- First Hospital, Jilin University, Changchun, China
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:134-45. [PMID: 20234215 DOI: 10.1097/moo.0b013e3283383ef9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Functional imaging including single photon emission computed tomography, PET and MRI techniques in head and neck squamous cell cancer allows disease characterization beyond structure and morphology. RECENT FINDINGS In patients without clinical signs of lymph node involvement, sensitivity of fluoro-2-deoxy-D-glucose PET is only 50%. This has led to the use of sentinel lymph node scintigraphy that seems to be a valid alternative to elective stage dissection. Additionally, the use of single-photon emission computed tomography-computed tomography imaging enables a more accurate localization of the sentinel lymph node scintigraphy. The fluoro-2-deoxy-D-glucose uptake intensity of the head and neck squamous cell carcinoma sites is related to locoregional control and overall survival. In case of suspicion for residual or recurrent head and neck squamous cell carcinoma after surgery or (chemo)radiotherapy, fluoro-2-deoxy-D-glucose-PET has a high sensitivity and seems to be cost-effective in selecting patients for direct laryngoscopy. Diffusion-weighted MRI in combination with size and morphological criteria is a strong predictor of presence of malignant lymph nodes. Initial reports indicate the use of diffusion-weighted imaging for response assessment as early as 1 week after beginning of radiochemotherapy. Perfusion MRI is studied for the measurement of drug effects on tumour (micro)vascularity and capillary permeability. SUMMARY Functional imaging improves the initial staging and the detection of residual or recurrent disease following therapy.
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