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Yamakawa N, Nakayama Y, Ueda N, Yagyuu T, Tamaki S, Kirita T. Volume-based 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters correlate with delayed neck metastasis in clinical early-stage oral squamous cell carcinoma. Oral Radiol 2023; 39:668-682. [PMID: 37081306 DOI: 10.1007/s11282-023-00686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE There is no known preoperative marker that can effectively predict the risk of delayed neck metastasis (DNM), which is an important factor that determines the prognosis of early-stage oral cancer. In this study, we examined whether 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET)/computed tomography (CT) uptake parameters of primary cancer can predict the risk of DNM in early-stage oral squamous cell carcinoma (OSCC). METHODS Data from patients with stage I-II OSCC who underwent surgical resection of the primary tumor without elective neck dissection between January 2009 and December 2016 were retrospectively reviewed. Patient characteristics, histopathological factors, and PET/CT parameters (maximum standardized uptake value [SUVmax], metabolic tumor volume [MTV], and total lesion glycolysis [TLG]) were evaluated for their association with DNM. DNM rates were calculated, and the parameters that were statistically significant in the univariate analysis were used as explanatory variables. Independent factors associated with DNM were identified using multivariate analysis. For all statistical analyses, p-values < 0.05 were considered statistically significant. RESULTS Data from 71 patients were analyzed in the study. The overall DNM rate among all patients was 21.8%. The univariate analysis showed that the T classification, depth of invasion, pattern of invasion, lymphovascular invasion, SUVmax, MTV, and TLG were significant predictors of DNM. However, the multivariate analysis revealed that only the depth of invasion, MTV, and TLG were independent predictors of DNM. CONCLUSION This study suggests that, in addition to conventional predictors, volume-based PET parameters are useful predictors of DNM in those with early-stage OSCC.
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Affiliation(s)
- Nobuhiro Yamakawa
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
| | - Yohei Nakayama
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Nobuhiro Ueda
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Takahiro Yagyuu
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Shigehiro Tamaki
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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Fatima N, Zaman A, Zaman U, Zaman S, Tahseen R, Zaman MU. Impact of Primary Tumor Size, SUVmax of Primary Tumor and the Most Avid Neck Node on Baseline 18 FDG PET/CT upon Disease Recurrence in Head and Neck Oropharyngeal SCC Using Standardized Imaging Protocol. World J Nucl Med 2022; 21:9-17. [PMID: 35502274 PMCID: PMC9056128 DOI: 10.1055/s-0042-1744197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective The purpose fo this prospective study was to find the impact of primary tumor size (Ts), standardized uptake values (SUVmax) of primary tumor, and the most avid neck node on disease recurrence in patients with head and neck oropharyngeal squamous cell carcinoma (HNOP-SCC). Material and methods We included patients with HNOP-SCC (without distant metastasis-M0 disease) who had pre- and post-treatment F-18 fluorodeoxyglucose positron emission tomography/computed tomography ( 18 FDG PET/CT) using strict standardized imaging protocol from 2017 to 2019. Based on follow-up ( 18 FDG PET/CT) findings, patients were categorized as disease free (no or minimal 18 FDG uptake ≤ background over surgical bed and no distant metastasis) and disease recurrence ( 18 FDG uptake > background over surgical bed with or without nodal and/or distant metastasis). Ts and SUVmax of primary tumor and the most avid neck node were compared and impact of these was studied upon disease recurrence. Results Total 112 patients were included. No significant difference was seen in mean age (overall: 60 ± 14 years), gender distribution (overall M:F: 69:31%), body mass index (overall: 25.20 ± 5.82), and history of diabetes (overall: 19%) between disease-free and disease recurrence groups. Similarly, no significant difference was observed for fasting blood sugar (overall: 110 ± 28 mg%), 18 FDG dose (overall: 169 ± 37 MBq), and uptake period (overall: 70 ± 12 minutes) between two groups ensuring strict adherence to standardized imaging protocol. Significant difference ( p < 0.05) was observed between disease-free and disease recurrence for Ts (25 ± 10 vs. 33 ± 14 mm), SUVmax of primary tumor (6.2 ± 6.8 vs. 9.3 ± 7.2) and the most avid neck node (2.1 ± 3.3 vs. 4.7 ± 5.9) and median follow-up (13 ± 12 vs. 08 ± 13 months), respectively. Using receiver operating characteristic analysis, Ts greater than 29 mm, baseline tumor SUVmax greater than 4.6, and nodal SUVmax greater than 6.2 were found independent predictors for disease recurrence. Nodal SUVmax greater than 6.2 was found an independent predictor of shortest disease-free survival (DFS) than Ts and tumor SUVmax. Conclusion We conclude that in HNOP-SCC, primary Ts (> 29 mm), SUVmax of primary tumor (> 4.6), and the most avid neck node (> 6.2) in baseline 18 FDG PET/CT using standardized imaging protocol are the independent predictors of disease recurrence. Furthermore, SUVmax greater than 6.2 of the most avid node predicts the shortest DFS than primary Ts and SUVmax of primary tumor.
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Affiliation(s)
- Nosheen Fatima
- Section of NM and PET/CT, Department of Radiology, The Aga Khan University Hospital (AKUH), Karachi, Pakistan
| | - Areeba Zaman
- Department of Medicine, Dow Medical College, Dow University Health Sciences (DUHS), Karachi, Pakistan
| | - Unaiza Zaman
- Department of Medicine, Kings County Hospital/SUNY Downstate Hospital, New York, United States
| | - Sidra Zaman
- Department of Medicine, Dow Medical College, Dow University Health Sciences (DUHS), Karachi, Pakistan
| | - Rabia Tahseen
- Department of Radiation Oncology, The Aga Khan University Hospital (AKUH), Karachi, Pakistan
| | - Maseeh Uz Zaman
- Section of NM and PET/CT, Department of Radiology, The Aga Khan University Hospital (AKUH), Karachi, Pakistan
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Evensen ME, Furre T, Malinen E, Løndalen AM, Dale E. Mucosa-sparing dose painting of head and neck cancer. Acta Oncol 2022; 61:141-145. [PMID: 34991431 DOI: 10.1080/0284186x.2021.2022200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
| | - Torbjørn Furre
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Eirik Malinen
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | | | - Einar Dale
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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Connor S, Sit C, Anjari M, Szyszko T, Dunn J, Pai I, Cook G, Goh V. Correlations between DW-MRI and 18 F-FDG PET/CT parameters in head and neck squamous cell carcinoma following definitive chemo-radiotherapy. Cancer Rep (Hoboken) 2021; 4:e1360. [PMID: 33960739 PMCID: PMC8388179 DOI: 10.1002/cnr2.1360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Posttreatment diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxygluocose (18 F-FDG) positron emission tomography (PET) with computed tomography (PET/CT) have potential prognostic value following chemo-radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). Correlations between these PET/CT (standardized uptake value or SUV) and DW-MRI (apparent diffusion coefficient or ADC) parameters have only been previously explored in the pretreatment setting. AIM To evaluate stage III and IV HNSCC at 12-weeks post-CRT for the correlation between SUVmax and ADC values and their interval changes from pretreatment imaging. METHODS Fifty-six patients (45 male, 11 female, mean age 59.9 + - 7.38) with stage 3 and 4 HNSCC patients underwent 12-week posttreatment DW-MRI and 18 F-FDG PET/CT studies in this prospective study. There were 41/56 patients in the cohort with human papilloma virus-related oropharyngeal cancer (HPV OPC). DW-MRI (ADCmax and ADCmin) and 18 F-FDG PET/CT (SUVmax and SUVmax ratio to liver) parameters were measured at the site of primary tumors (n = 48) and the largest lymph nodes (n = 52). Kendall's tau evaluated the correlation between DW-MRI and 18 F-FDG PET/CT parameters. Mann-Whitney test compared the post-CRT PET/CT and DW-MRI parameters between those participants with and without 2-year disease-free survival (DFS). RESULTS There was no correlation between DW-MRI and 18 F-FDG PET/CT parameters on 12-week posttreatment imaging (P = .455-.794; tau = -0.075-0.25) or their interval changes from pretreatment to 12-week posttreatment imaging (P = .1-.946; tau = -0.194-0.044). The primary tumor ADCmean (P = .03) and the interval change in nodal ADCmin (P = .05) predicted 2-year DFS but none of the 18 F-FDG PET/CT parameters were associated with 2-year DFS. CONCLUSIONS There is no correlation between the quantitative DWI-MRI and 18 F-FDG PET/CT parameters derived from 12-week post-CRT studies. These parameters may be independent biomarkers however in this HPV OPC dominant cohort, only selected ADC parameters demonstrated prognostic significance. Study was prospectively registered at http://www.controlled-trials.com/ISRCTN58327080.
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Affiliation(s)
- Steve Connor
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- Department of NeuroradiologyKing's College Hospital NHS Foundation TrustLondonUK
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Cherry Sit
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Mustafa Anjari
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Teresa Szyszko
- King's College London & Guy's and St. Thomas' PET CentreLondonUK
| | - Joel Dunn
- King's College London & Guy's and St. Thomas' PET CentreLondonUK
| | - Irumee Pai
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- Department of OtolaryngologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Gary Cook
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- King's College London & Guy's and St. Thomas' PET CentreLondonUK
| | - Vicky Goh
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
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Bos-Liedke A, Cegla P, Matuszewski K, Konstanty E, Piotrowski A, Gross M, Malicki J, Kozak M. Differences among [ 18F]FDG PET-derived parameters in lung cancer produced by three software packages. Sci Rep 2021; 11:13942. [PMID: 34230642 PMCID: PMC8260625 DOI: 10.1038/s41598-021-93436-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Investigation of differences in derived [18F]FDG PET metabolic and volumetric parameters among three different software programs in lung cancer. A retrospective analysis was performed on a group of 98 lung cancer patients who underwent a baseline [18F]FDG PET/CT study. To assess appropriate delineation methods, the NEMA phantom study was first performed using the following software: Philips EBW (Extended Brilliance Workstation), MIM Software and Rover. Based on this study, the best cut-off methods (dependent on tumour size) were selected, extracted and applied for lung cancer delineation. Several semiquantitative [18F]FDG parameters (SUVmax, SUVmean, TLG and MTV) were assessed and compared among the three software programs. The parameters were assessed based on body weight (BW), lean body mass (LBM) and Bq/mL. Statistically significant differences were found in SUVmean (LBM) between MIM Software and Rover (4.62 ± 2.15 vs 4.84 ± 1.20; p < 0.005), in SUVmean (Bq/mL) between Rover and Philips EBW (21,852.30 ± 21,821.23 vs 19,274.81 ± 13,340.28; p < 0.005) and Rover and MIM Software (21,852.30 ± 21,821.23 vs 19,399.40 ± 10,051.30; p < 0.005), and in MTV between MIM Software and Philips EBW (19.87 ± 25.83 vs 78.82 ± 228.00; p = 0.0489). This study showed statistically significant differences in the estimation of semiquantitative parameters using three independent image analysis tools. These findings are important for performing further diagnostic and treatment procedures in lung cancer patients.
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Affiliation(s)
- Agnieszka Bos-Liedke
- Department of Macromolecular Physics, Adam Mickiewicz University, 61-614, Poznan, Poland
| | - Paulina Cegla
- Department of Nuclear Medicine, Greater Poland Cancer Centre, 61-866, Poznan, Poland.
| | | | - Ewelina Konstanty
- Department of Medical Physics, Greater Poland Cancer Centre, 61-866, Poznan, Poland
| | - Adam Piotrowski
- Department of Macromolecular Physics, Adam Mickiewicz University, 61-614, Poznan, Poland
| | - Magdalena Gross
- Department of Macromolecular Physics, Adam Mickiewicz University, 61-614, Poznan, Poland
| | - Julian Malicki
- Department of Medical Physics, Greater Poland Cancer Centre, 61-866, Poznan, Poland
- Chair, Department of Electroradiology, Poznan University of Medical Science, 61-701, Poznan, Poland
| | - Maciej Kozak
- Department of Macromolecular Physics, Adam Mickiewicz University, 61-614, Poznan, Poland
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Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence. Cancers (Basel) 2021; 13:cancers13112835. [PMID: 34200193 PMCID: PMC8201377 DOI: 10.3390/cancers13112835] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Sinonasal squamous cell carcinomas are a group of diverse tumors affecting the nasal cavity and paranasal sinuses. As a direct consequence of their rarity and heterogeneity, diagnosis is challenging, and treatment does not follow universally accepted protocols. Though surgery represents the mainstay of treatment, neoadjuvant and adjuvant therapies have pivotal roles in improving outcomes of patients treated with curative intent. Indications to endoscopic surgery have been expanding over the last three decades, but a considerable number of patients affected by sinonasal squamous cell carcinoma still need open surgical procedures. Management of the neck in patients affected by sinonasal squamous cell carcinoma is controversial. Curative-intended treatment of recurrent and/or metastatic tumors, alongside palliation of uncurable cases, represent poorly explored aspects of this disease. Abstract Sinonasal squamous cell carcinoma is a rare tumor affecting the nasal cavity and paranasal sinuses. Several aspects of this disease, ranging from epidemiology to biology, pathology, diagnosis, staging, treatment, and post-treatment surveillance are controversial, and consensus on how to manage this sinonasal cancer is lacking. A narrative literature review was performed to summarize the current evidence and provide the reader with available data supporting the decision-making process in patients affected by sinonasal squamous cell carcinoma, alongside the authors’ personal opinion on the unsolved issues of this tumor. The review has highlighted several advances in molecular definition of epithelial cancers of the sinonasal tract. Surgery represents the pivot of treatment and is performed through an endoscopic transnasal approach whenever feasible. Open surgery is required for a large proportion of cases. Reconstruction of the defect follows principles of skull base and cranio-maxillo-facial reconstruction. Chemotherapy is given as neoadjuvant treatment or concomitantly to radiotherapy. Photon-based radiation therapy has a crucial role in the adjuvant setting. Particle therapy is providing promising results. Management of the neck should be planned based on the presence of clinically appreciable metastases, primary tumor extension, and need for recipient vessels. Biotherapy and immunotherapy are still underexplored therapeutical modalities.
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Choi KH, Song JH, Park EY, Hong JH, Yoo IR, Lee YS, Sun DI, Kim MS, Kim YS. Analysis of PET parameters as prognosticators of survival and tumor extent in Oropharyngeal Cancer treated with surgery and postoperative radiotherapy. BMC Cancer 2021; 21:317. [PMID: 33765966 PMCID: PMC7992344 DOI: 10.1186/s12885-021-08035-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Positron-emission tomography (PET) is widely used to detect malignancies, but consensus on its prognostic value in oropharyngeal cancer has not been established. The purpose of this study was to analyze the PET parameters associated with tumor extent and survival in resectable oropharyngeal cancer. METHODS The PET parameters in oropharyngeal cancer patients with regional node metastasis who underwent surgery and postoperative radiotherapy between January 2005 and January 2019 were analyzed. We calculated the SUVmax, tumor-to-liver ratio (TLR), metabolic tumor volume (MTV, volume over SUV 2.5), and total lesion glycolysis (TLG, MTV x mean SUV) of the primary lesion and metastatic nodes. Histologic findings, patient survival, and recurrence were reviewed in the medical records. RESULTS Fifty patients were included, and the PET parameters were extracted for 50 primary lesions and 104 nodal lesions. In the survival analysis, MTV and TLG of the primary lesions showed significant differences in overall survival (OS) and recurrence-free survival (RFS). In the multiple regression analysis, TLG of the primary lesion was associated with the depth of invasion (DOI). MTV of the nodes was a significant factor affecting extranodal extension (ENE). CONCLUSIONS PET parameters could be related with OS, RFS, DOI of the primary tumor, and ENE. PET would be expected to be a useful diagnostic tool as a prognosticator of survival and pathologic findings in oropharyngeal cancer.
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Affiliation(s)
- Kyu Hye Choi
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Ho Song
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Young Park
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hyun Hong
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ie Ryung Yoo
- Department of Nuclear Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youn Soo Lee
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Il Sun
- Department of Otorhinolaryngology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Sik Kim
- Department of Otorhinolaryngology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon-Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Radiomic Model Predicts Lymph Node Response to Induction Chemotherapy in Locally Advanced Head and Neck Cancer. Diagnostics (Basel) 2021; 11:diagnostics11040588. [PMID: 33806029 PMCID: PMC8064478 DOI: 10.3390/diagnostics11040588] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 12/24/2022] Open
Abstract
This study developed a pretreatment CT-based radiomic model of lymph node response to induction chemotherapy in locally advanced head and neck squamous cell carcinoma (HNSCC) patients. This was a single-center retrospective study of patients with locally advanced HPV+ HNSCC. Forty-one enlarged lymph nodes were found from 27 patients on pretreatment CT and were split into 3:1 training and testing cohorts. Ninety-three radiomic features were extracted. A radiomic model and a combined radiomic-clinical model predicting lymph node response to induction chemotherapy were developed using multivariable logistic regression. Median age was 57 years old, and 93% of patients were male. Post-treatment evaluation was 32 days after treatment, with a median reduction in lymph node volume of 66%. A three-feature radiomic model (minimum, skewness, and low gray level run emphasis) and a combined radiomic-clinical model were developed. The combined model performed the best, with AUC = 0.85 on the training cohort and AUC = 0.75 on the testing cohort. A pretreatment CT-based lymph node radiomic signature combined with clinical parameters was able to predict nodal response to induction chemotherapy for patients with locally advanced HNSCC.
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Spanier G, Weidt D, Hellwig D, Meier JKH, Reichert TE, Grosse J. Total lesion glycolysis in oral squamous cell carcinoma as a biomarker derived from pre-operative FDG PET/CT outperforms established prognostic factors in a newly developed multivariate prediction model. Oncotarget 2021; 12:37-48. [PMID: 33456712 PMCID: PMC7800778 DOI: 10.18632/oncotarget.27857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/16/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Retrospective study to investigate the impact of image derived biomarkers from [18F]FDG PET/CT prior to surgical resection in patients with initial diagnosis of oral squamous cell carcinoma (OSCC), namely SUVmax, SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary tumor to predict overall survival (OS). MATERIALS AND METHODS 127 subsequent patients with biopsy-proven OSCC were included who underwent [18F]FDG PET/CT before surgery. SUVmax, SUVmean, MTV and TLG of the primary tumor were measured. OS was estimated according to Kaplan-Meier and compared between median-splitted groups by the log-rank test. Prognostic parameters were analyzed by uni-/multivariate Cox-regression. RESULTS During follow-up 52 (41%) of the patients died. Median OS was longer for patients with lower MTV or lower TLG. SUVmax and SUVmean failed to be significant predictors for OS. Univariate Cox-regression identified MTV, TLG, lymph node status and UICC stage as prognostic factors. By multivariate Cox-regression MTV and TLG turned out to be independent prognostic factors for OS. CONCLUSIONS The pre-therapeutic [18F]FDG PET/CT parameters MTV and TLG in the primary tumor are prognostic for OS of patients with an initial diagnosis of OSCC. TLG is the strongest independent prognostic factor for OS and outperforms established prognostic parameters in OSCC.
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Affiliation(s)
- Gerrit Spanier
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Daniela Weidt
- Department of Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Dirk Hellwig
- Department of Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Johannes K H Meier
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Torsten E Reichert
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Jirka Grosse
- Department of Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
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Multiple Testing, Cut-Point Optimization, and Signs of Publication Bias in Prognostic FDG-PET Imaging Studies of Head and Neck and Lung Cancer: A Review and Meta-Analysis. Diagnostics (Basel) 2020; 10:diagnostics10121030. [PMID: 33271785 PMCID: PMC7761090 DOI: 10.3390/diagnostics10121030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/23/2022] Open
Abstract
Positron emission tomography (PET) imaging with 2-deoxy-2-[18F]-fluorodeoxyglucose (FDG) was proposed as prognostic marker in radiotherapy. Various uptake metrics and cut points were used, potentially leading to inflated effect estimates. Here, we performed a meta-analysis and systematic review of the prognostic value of pretreatment FDG–PET in head and neck squamous cell carcinoma (HNSCC) and non-small cell lung cancer (NSCLC), with tests for publication bias. Hazard ratio (HR) for overall survival (OS), disease free survival (DFS), and local control was extracted or derived from the 57 studies included. Test for publication bias was performed, and the number of statistical tests and cut-point optimizations were registered. Eggers regression related to correlation of SUVmax with OS/DFS yielded p = 0.08/p = 0.02 for HNSCC and p < 0.001/p = 0.014 for NSCLC. No outcomes showed significant correlation with SUVmax, when adjusting for publication bias effect, whereas all four showed a correlation in the conventional meta-analysis. The number of statistical tests and cut points were high with no indication of improvement over time. Our analysis showed significant evidence of publication bias leading to inflated estimates of the prognostic value of SUVmax. We suggest that improved management of these complexities, including predefined statistical analysis plans, are critical for a reliable assessment of FDG–PET.
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Paterson C, Hargreaves S, Rumley CN. Functional Imaging to Predict Treatment Response in Head and Neck Cancer: How Close are We to Biologically Adaptive Radiotherapy? Clin Oncol (R Coll Radiol) 2020; 32:861-873. [PMID: 33127234 DOI: 10.1016/j.clon.2020.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
It is increasingly recognised that head and neck cancer represents a spectrum of disease with a differential response to standard treatments. Although prognostic factors are well established, they do not reliably predict response. The ability to predict response early during radiotherapy would allow adaptation of treatment: intensifying treatment for those not responding adequately or de-intensifying remaining therapy for those likely to achieve a complete response. Functional imaging offers such an opportunity. Changes in parameters obtained with functional magnetic resonance imaging or positron emission tomography-computed tomography during treatment have been found to be predictive of disease control in head and neck cancer. Although many questions remain unanswered regarding the optimal implementation of these techniques, current, maturing and future studies may provide the much-needed homogeneous cohorts with larger sample sizes and external validation of parameters. With a stepwise and collaborative approach, we may be able to develop imaging biomarkers that allow us to deliver personalised, biologically adaptive radiotherapy for head and neck cancer.
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Affiliation(s)
- C Paterson
- Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | | | - C N Rumley
- Department of Radiation Oncology, Townsville University Hospital, Douglas, Australia; South Western Clinical School, University of New South Wales, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia
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Subramanyam P, Palaniswamy SS, Numani SP. Precision Radiotherapy: 18F-FDG PET-based radiotherapy planning in Head and Neck cancers. World J Nucl Med 2020; 19:197-204. [PMID: 33354173 PMCID: PMC7745861 DOI: 10.4103/wjnm.wjnm_91_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/25/2020] [Accepted: 02/09/2020] [Indexed: 11/18/2022] Open
Abstract
Precision medicine is gaining importance in this era of molecular imaging where the molecular features of a disease can be noninvasively assessed and treated with personalized medicine. This is especially suited for head and neck cancers (HNCa). Early stage HNCa are ideally managed with radiotherapy (RT) or surgery. Head and neck (HN) is a complex region and its tumors respond to RT differently due to dissimilar structures and moving organs such as tongue. Radiation oncologists are always in the process of trying and investigating newer RT techniques in order to achieve precise and targetted therapy to tumour/s. One such innovation is Intensity modulated RT (IMRT) using 3 Dimensional conformal RT (3DCRT). This 3DCRT resizes the radiation beams to match the shape of the tumor. Such focused dose escalation may improve local control in HNCa. Image guided RT in conjunction with IMRT is the most advanced form of RT planning being used these days. Simulation computerized tomography (CT) images are usually incorporated into RT planning module. But limitations of CT such as poor soft tissue contrast than magnetic resonance imaging and inability to clearly define solid / cystic / necrotic areas and viable tumour exist. Functional imaging such as Positron Emission Tomography (PET) has established its superiority over CT in delineating the actual site and extent of HN tumors. A combination of IMRT with BTV (Biological Tumour Volume) may be the most ideal technique to deliver a homogeneous radiation boost to tumour. This review shall discuss PET based RT planning, challenges, practical tips, and how to optimize therapy with the least side effects to the normal surrounding tissues.
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Affiliation(s)
- Padma Subramanyam
- Department of Nuclear Medicine and Molecular Imaging, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Shanmuga Sundaram Palaniswamy
- Department of Nuclear Medicine and Molecular Imaging, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Shah Pervez Numani
- Department of Nuclear Medicine, Hamad Medical Corporation Hospitals, Doha, Qatar
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Radiomic biomarkers for head and neck squamous cell carcinoma. Strahlenther Onkol 2020; 196:868-878. [PMID: 32495038 DOI: 10.1007/s00066-020-01638-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/13/2020] [Indexed: 12/22/2022]
Abstract
Tumor heterogeneity is a well-known prognostic factor in head and neck squamous cell carcinoma (HNSCC). A major limitation of tissue- and blood-derived tumor markers is the lack of spatial resolution to image tumor heterogeneity. Tissue markers derived from tumor biopsies usually represent only a small tumor subregion at a single timepoint and are therefore often not representative of the tumors' biology or the biological alterations during and after treatment. Similarly, liquid biopsies give an overall picture of the tumors' secreted factors but completely lack any spatial resolution. Radiomics has the potential to give complete three-dimensional information about the tumor. We conducted a comprehensive literature search to assess the correlation of radiomics to tumor biology and treatment outcome in HNSCC and to assess current limitations of the radiomic biomarkers. In total, 25 studies that explored the ability of radiomics to predict tumor biology and phenotype in HNSCC and 28 studies that explored radiomics to predict post-treatment events were identified. Out of these 53 studies, only three failed to show a significant correlation. The major technical challenges are currently artifacts due to metal implants, non-standardized contrast injection, and delineation uncertainties. All studies to date were retrospective and none of the above-mentioned radiomics signatures have been validated in an independent cohort using an independent software implementation, which shows that transferability due to the numerous technical challenges is currently a major limitation. However, radiomics is a very young field and these studies hopefully pave the way for clinical implementation of radiomics for HNSCC in the future.
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Oyama T, Hosokawa Y, Abe K, Hasegawa K, Fukui R, Aoki M, Kobayashi W. Prognostic value of quantitative FDG-PET in the prediction of survival and local recurrence for patients with advanced oral cancer treated with superselective intra-arterial chemoradiotherapy. Oncol Lett 2020; 19:3775-3780. [PMID: 32382329 PMCID: PMC7202323 DOI: 10.3892/ol.2020.11488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/24/2020] [Indexed: 11/06/2022] Open
Abstract
The current study aimed to evaluate the relationship between 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET-CT) standardized uptake value (SUV) [pre-treatment SUV (pre-SUV) and post-treatment SUV (post-SUV)] and treatment results in patients with advanced oral cancer treated with superselective intra-arterial chemoradiotherapy (SSIACRT). A total of 37 patients with advanced oral cancer were treated with SSIACRT. The treatment consisted of superselective intra-arterial chemotherapy (docetaxel (DOC) 40 mg/mm2 and nedaplatin (CDGP) 80 mg/mm2) and concurrent radiotherapy (60-70 Gy) for a period of seven weeks. Pre-SUV and post-SUV of the primary tumor were measured. Overall survival (OS) and local control (LC) rates were selected as endpoints to evaluate prognosis. The median follow-up was 40 months (range 6-112 months). The 5-year OS and LC rates were 64.5 and 85.5%, respectively, and SSIACRT achieved high LC rate even in advanced oral cancers. In the log-rank test, post-SUV was a significant prognostic factor for OS and LC rates. The results of the current study demonstrated that SSIACRT is a reliable treatment with respect to survival in advanced oral cancer and post-SUV was a significant prognostic factor for OS and LC rates.
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Affiliation(s)
- Tomoyuki Oyama
- Faculty of Graduate School of Biomedical Sciences and Engineering, Hokkaido University, Hokkaido 061-0293, Japan
| | - Yoichiro Hosokawa
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Aomori 036-8564, Japan
| | - Kazuki Abe
- Faculty of Graduate School of Biomedical Sciences and Engineering, Hokkaido University, Hokkaido 061-0293, Japan
| | - Kazuki Hasegawa
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Aomori 036-8564, Japan
| | - Roman Fukui
- Department of Radiation Science, Graduate School of Health Sciences, Hirosaki University, Aomori 036-8564, Japan
| | - Masahiko Aoki
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, Aomori 036-8562, Japan
| | - Wataru Kobayashi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Hirosaki University, Aomori 036-8562, Japan
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15
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Tixier F, Cheze-le-Rest C, Schick U, Simon B, Dufour X, Key S, Pradier O, Aubry M, Hatt M, Corcos L, Visvikis D. Transcriptomics in cancer revealed by Positron Emission Tomography radiomics. Sci Rep 2020; 10:5660. [PMID: 32221360 PMCID: PMC7101432 DOI: 10.1038/s41598-020-62414-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 03/13/2020] [Indexed: 11/09/2022] Open
Abstract
Metabolic images from Positron Emission Tomography (PET) are used routinely for diagnosis, follow-up or treatment planning purposes of cancer patients. In this study we aimed at determining if radiomic features extracted from 18F-Fluoro Deoxy Glucose (FDG) PET images could mirror tumor transcriptomics. In this study we analyzed 45 patients with locally advanced head and neck cancer (H&N) that underwent FDG-PET scans at the time of diagnosis and transcriptome analysis using RNAs from both cancer and healthy tissues on microarrays. Association between PET radiomics and transcriptomics was carried out with the Genomica software and a functional annotation was used to associate PET radiomics, gene expression and altered biological pathways. We identified relationships between PET radiomics and genes involved in cell-cycle, disease, DNA repair, extracellular matrix organization, immune system, metabolism or signal transduction pathways, according to the Reactome classification. Our results suggest that these FDG PET radiomic features could be used to infer tissue gene expression and cellular pathway activity in H&N cancers. These observations strengthen the value of radiomics as a promising approach to personalize treatments through targeting tumor-specific molecular processes.
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Affiliation(s)
- Florent Tixier
- Department of Nuclear Medicine, Poitiers University Hospital, Poitiers, France.
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France.
| | - Catherine Cheze-le-Rest
- Department of Nuclear Medicine, Poitiers University Hospital, Poitiers, France
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
| | - Ulrike Schick
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
- Radiation Oncology Department, University Hospital, Brest, France
| | - Brigitte Simon
- INSERM, UMR 1078, Université de Brest, Génétique Génomique Fonctionnelle et Biotechnologies, Etablissement Français du Sang, Brest, France
| | - Xavier Dufour
- Head and Neck Department, Poitiers University Hospital, Poitiers, France
| | - Stéphane Key
- Radiation Oncology Department, University Hospital, Brest, France
| | - Olivier Pradier
- Radiation Oncology Department, University Hospital, Brest, France
| | - Marc Aubry
- CNRS, UMR 6290, IGDR, Université de Rennes 1, Rennes, France
| | - Mathieu Hatt
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
| | - Laurent Corcos
- INSERM, UMR 1078, Université de Brest, Génétique Génomique Fonctionnelle et Biotechnologies, Etablissement Français du Sang, Brest, France
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Chan HP, Liu WS, Liou WS, Hu C, Chiu YL, Peng NJ. Comparison of FDG-PET/CT for Cancer Detection in Populations With Different Risks of Underlying Malignancy. In Vivo 2020; 34:469-478. [PMID: 31882515 PMCID: PMC6984113 DOI: 10.21873/invivo.11797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/09/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023]
Abstract
Background/Aim: Whole-body positron-emission tomography/computed tomography with the glucose analog 2-[ 18 F]fluoro-2-deoxy-D-glucose (FDG-PET/CT) has been used to screen examinees for underlying malignancy in many countries. The aim of this study was to compare the potential value of FDG-PET/CT application in asymptomatic individuals with those with suspected malignancy. Patients and Methods: A total of 9,408 examinees underwent whole-body FDG-PET/CT at our hospital from July 2006 to August 2013. Three thousand and seven hundred asymptomatic individuals and 848 individuals with laboratory and clinical/radiologicaI suspicion of malignancy who had undergone FDG-PET/CT for cancer screening were recruited. The final confirmation of cancer and outcomes were based on a pathological report and continuous follow-up. Results: Forty-five out of 3,700 asymptomatic individuals (1.2%) had proven malignancy, and 42 of them (93.3%) were found by FDG-PET/CT. Two hundred and twelve out of 848 with suspected malignancy (25%) had proven malignancy, and 196 of them (92.5%) were detected by FDG-PET/CT. Most of these cancers in asymptomatic individuals were clinically at an early stage. The discovery rate in asymptomatic individuals and those with suspected malignancy was 1.1% and 23.1%, respectively. The overall survival of patients with cancer diagnosed with PET/CT was higher than those with suspected malignancy (78.6% vs. 48.5%, p<0.001). Patients with a resectable lesion, early-stage disease, and lower maximal standardized uptake value had significantly better survival than those without. Conclusion: FDG-PET/CT is useful in the early diagnosis of cancer and thus might improve the survival rates of these patients. Considering the costs and risk of radiation exposure, it would be better used as a priority in patients with laboratory and clinical/radiologic suspicion of malignancy.
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Affiliation(s)
- Hung-Pin Chan
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Wen-Shan Liu
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Wen-Shiung Liou
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Chin Hu
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Yu-Li Chiu
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Nan-Jing Peng
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, R.O.C
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Prognostic value of 18F-FDG PET/CT parameters and histopathologic variables in head and neck cancer. Braz J Otorhinolaryngol 2019; 87:452-456. [PMID: 31899125 PMCID: PMC9422361 DOI: 10.1016/j.bjorl.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/28/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. OBJECTIVE To investigate the prognostic value of these parameters in patients with head and neck cancers. METHODS We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. RESULTS The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63cm3 (0.6-34.3), 68.9g (2.58-524.5g), 13.89 (4.89-33.03g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. CONCLUSION Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.
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18
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Matic N, Ressner M, Wiechec E, Roberg K. In vitro measurement of glucose uptake after radiation and cetuximab treatment in head and neck cancer cell lines using 18F-FDG, gamma spectrometry and PET/CT. Oncol Lett 2019; 18:5155-5162. [PMID: 31620196 PMCID: PMC6788167 DOI: 10.3892/ol.2019.10916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022] Open
Abstract
The standard treatment for head and neck squamous cell carcinoma (HNSCC) is radiotherapy, often in combination with chemotherapy or surgery. However, a novel monoclonal antibody, cetuximab (Erbitux®), has also been approved for patient therapy. The aim of present study was to develop an in vitro method for the measurement of 18F-fluoro-2deoxy-D-glucose (FDG) to determine if cellular 18F-FDG uptake is associated with response to radiotherapy or cetuximab treatment. In the current study, HNSCC cell lines were treated with radiation or with cetuximab. Next, the uptake of 18F-FDG was measured using a gamma spectrometer (GS). Thereafter, uptake after radiation was measured first with GS and then compared with positron emission tomography (PET)/computed tomography (CT) imaging. Furthermore, the mRNA expression of glucose transporter 1 (GLUT1) was measured following cetuximab treatment via reverse transcription-quantitative PCR. A study protocol was developed to measure the cellular uptake of 18F-FDG via gamma-ray spectrometry and comparable results were obtained with those of clinical PET/CT. The results revealed a decrease in 18F-FDG after radiation and cetuximab treatment. The uptake of 18F-FDG following cetuximab treatment was significantly lower in the cetuximab-sensitive cell line UT-SCC-14 compared with the cetuximab-resistant cell lines UT-SCC-2 and UT-SCC-45. Furthermore, after treatment with cetuximab for 24 and 48 h, a significant increase in GLUT1 expression was detected in the sensitive cell line compared with the two resistant cell lines. In conclusion, a novel yet reliable method for the measurement of intracellular 18F-FDG via GS has been developed, and our results indicate that 18F-FDG uptake is associated with radiation and cetuximab response in HNSCC.
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Affiliation(s)
- Natasa Matic
- Division of Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Östergötland SE-58185, Sweden.,Department of Otorhinolaryngology in Linköping, Anesthetics, Operations and Specialty Surgery Center, University Hospital, Linköping, Östergötland SE-58185, Sweden
| | - Marcus Ressner
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Östergötland SE-58185, Sweden
| | - Emilia Wiechec
- Division of Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Östergötland SE-58185, Sweden
| | - Karin Roberg
- Division of Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Östergötland SE-58185, Sweden.,Department of Otorhinolaryngology in Linköping, Anesthetics, Operations and Specialty Surgery Center, University Hospital, Linköping, Östergötland SE-58185, Sweden
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Economopoulou P, de Bree R, Kotsantis I, Psyrri A. Diagnostic Tumor Markers in Head and Neck Squamous Cell Carcinoma (HNSCC) in the Clinical Setting. Front Oncol 2019; 9:827. [PMID: 31555588 PMCID: PMC6727245 DOI: 10.3389/fonc.2019.00827] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/12/2019] [Indexed: 12/19/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) represents a group of tumors arising in the oral cavity, oropharynx, and larynx. Although HNSCC is traditionally associated with tobacco and alcohol consumption, a growing proportion of head and neck tumors, mainly of the oropharynx, are associated with Human Papilloma Virus (HPV). Recurrent/metastatic disease is characterized by dismal prognosis and there is an unmet need for the development of biomarkers for detection of early disease, accurate prediction of prognosis, and appropriate selection of therapy. Based on the REMARK guidelines, a variety of diagnostic and prognostic biomarkers are being evaluated in clinical trials but their clinical significance is doubtful. Herein, we will focus on biomarkers in HNSCC used in the clinical setting and we will illustrate their clinical relevance.
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Affiliation(s)
- Panagiota Economopoulou
- Section of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ioannis Kotsantis
- Section of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Amanda Psyrri
- Section of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Mayo Z, Seyedin SN, Mallak N, Mott SL, Menda Y, Graham M, Anderson C. Clinical Utility of Pretreatment and 3-Month 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Standardized Uptake Value in Predicting and Assessing Recurrence in T3-T4 Laryngeal Carcinoma Treated With Definitive Radiation. Ann Otol Rhinol Laryngol 2019; 128:595-600. [PMID: 30808209 DOI: 10.1177/0003489419834312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the utility of pretreatment and 3-month 18F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) standardized uptake value (SUV) in predicting and assessing recurrence in T3-T4 laryngeal carcinoma treated with definitive radiation therapy (RT). METHODS Patients with newly diagnosed T3-T4 laryngeal squamous cell carcinoma treated with definitive RT from 2004 to 2014 were reviewed. Patients who underwent pretreatment or 3-month PET/CT 2 to 4 months after treatment were included. Those with prior systemic, surgical, or RT treatment were excluded. The primary objective was to assess whether pretreatment or posttreatment maximum SUV of the primary site (pSUV) of disease was associated with local recurrence-free survival. Overall survival was a secondary end point. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to assess the accuracy of 3-month PET/CT at the larynx primary. RESULTS Twenty-eight patients were eligible for analysis. Median follow-up time was 34.7 months (range, 5.3-138.7 months), and median age was 57 years. Most patients had supraglottic (71.4%), T3 (89.3%), N2 (50.0%) disease, received chemotherapy (96.4%), and had histories of tobacco use (96.4%). On univariate analysis, 3-month posttreatment pSUV was associated with local recurrence-free survival ( P < .01), while pretreatment pSUV was not ( P = .41). No other associations were found with local recurrence-free survival. Neither pretreatment nor 3-month pSUV was significantly associated with overall survival. The calculated sensitivity, specificity, positive predictive value, and negative predictive value of 3-month PET/CT at the primary site were 33%, 85%, 40%, and 81%, respectively. CONCLUSIONS High initial fluorodeoxyglucose uptake in T3-T4 laryngeal primaries did not show an association with the risk for postradiation local relapse or overall survival, while increased fluorodeoxyglucose uptake at 3 months was associated with increased local recurrence. At 3 months, the relatively low sensitivity and positive predictive value may limit the utility of PET/CT in the assessment of persistent advanced laryngeal cancer after definitive radiation.
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Affiliation(s)
- Zachary Mayo
- 1 Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Steven N Seyedin
- 1 Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Nadine Mallak
- 2 Department of Nuclear Medicine and PET Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sarah L Mott
- 3 Holden Comprehensive Cancer Center, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Yusuf Menda
- 2 Department of Nuclear Medicine and PET Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael Graham
- 2 Department of Nuclear Medicine and PET Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Carryn Anderson
- 1 Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Martens RM, Noij DP, Koopman T, Zwezerijnen B, Heymans M, de Jong MC, Hoekstra OS, Vergeer MR, de Bree R, Leemans CR, de Graaf P, Boellaard R, Castelijns JA. Predictive value of quantitative diffusion-weighted imaging and 18-F-FDG-PET in head and neck squamous cell carcinoma treated by (chemo)radiotherapy. Eur J Radiol 2019; 113:39-50. [PMID: 30927958 DOI: 10.1016/j.ejrad.2019.01.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/28/2018] [Accepted: 01/29/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE In head and neck squamous cell carcinoma (HNSCC) (chemo)radiotherapy is increasingly used to preserve organ functionality. The purpose of this study was to identify predictive pretreatment DWI- and 18F-FDG-PET/CT-parameters for treatment failure (TF), locoregional recurrence (LR) and death in HNSCC patients treated by (chemo)radiotherapy. MATERIALS AND METHODS We retrospectively included 134 histologically proven HNSCC patients treated with (chemo)radiotherapy between 2012-2017. In 58 patients pre-treatment DWI and 18F-FDG-PET/CT were performed, in 31 patients DWI only and in 45 patients 18F-FDG-PET/CT only. Primary tumor (PT) and largest lymph node (LN) metastasis were quantitatively assessed for TF, LR and death. Multivariate analysis was performed for 18F-FDG-PET/CT and DWI separately and thereafter combined. In patients with both imaging modalities, positive and negative predictive value in TF and differences in LR and death, were assessed. RESULTS Mean follow-up was 25.6 months (interquartile-range; 14.0-37.1 months). Predictors of treatment failure, corrected for TNM-stage and HPV-status, were SUVmax-PT, ADCmax-PT, total lesion glycolysis (TLG-LN), ADCp20-LN (P = 0.049, P = 0.024, P = 0.031, P = 0.047, respectively). TLG-PT was predictive for LR (P = 0.003). Metabolic active tumor volume (MATV-PT) (P = 0.003), ADCGTV-PT (P < 0.001), ADCSD (P = 0.048) were significant predictors for death. In patients with both imaging modalities SUVmax-PT remained predictive for treatment failure (P = 0.049), TLG-LN for LR (P = 0.003) and ADCGTV-PT for death (P < 0.001). Higher predictive value for treatment failure was found for the combination of SUVmax-PT and ADCmax-PT, compared to either one separately. CONCLUSION Both DWI- and 18F-FDG-PET/CT-parameters appear to have predictive value for treatment failure, locoregional recurrence and death. Combining SUVmax-PT and ADCmax-PT resulted in better prediction of treatment failure compared to single parameter assessment.
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Affiliation(s)
- Roland M Martens
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands.
| | - Daniel P Noij
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Thomas Koopman
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Ben Zwezerijnen
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Martijn Heymans
- Department of Epidemiology and Biostatistics, the Netherlands
| | - Marcus C de Jong
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Marije R Vergeer
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands; Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C René Leemans
- Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Jonas A Castelijns
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
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22
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Subramaniam N, Balasubramanian D, Sundaram PS, Murthy S, Thankappan K, Iyer S. Role of pretreatment fluorodeoxyglucose positron emission tomography quantitative parameters in prognostication of head-and-neck squamous cell carcinoma. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_253_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
In spite of the good organ preservation strategies available for locally advanced head-and-neck squamous cell carcinoma (HNSCC), failure rates have been reported to be as high as 35%–50%. There has been an increasing interest in predicting response to treatment, to aid early intervention and better outcomes. Fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) is a standard modality for posttreatment evaluation; however, it is still underutilized as a pretreatment investigative modality. Several articles have described quantitative parameters in pretreatment FDG-PET to prognosticate patients and determine the likelihood of response to treatment; however, they are still not used commonly. This article was a review of the literature available on pretreatment FDG-PET quantitative parameters and their value in predicting failure. A thorough review of literature from MEDLINE and EMBASE was performed on pretreatment quantitative parameters in HNSCC. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were reliable parameters to predict response to organ preservation therapy, disease-free survival, and overall survival. Maximum SUV (SUVmax) was an inconsistent parameter. MTV and TLG may help predict poor response to organ preservation to initiate early surgical salvage or modify therapeutic decisions to optimize clinical outcomes. Routine use may provide additional information over SUVmax alone.
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Affiliation(s)
- Narayana Subramaniam
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Deepak Balasubramanian
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - P Shanmuga Sundaram
- Department of Nuclear Medicine, Amrita Institute of Medical Sciences, Amrita Vidya Vidyapeetham, Kochi, Kerala, Indias
| | - Samskruthi Murthy
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Subramania Iyer
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Ishihara T, Kitajima K, Suenaga Y, Ejima Y, Komatsu H, Otsuki N, Nibu KI, Kiyota N, Takahashi S, Sasaki R. [18F]Fluorodeoxyglucose uptake by positron emission tomography predicts outcomes for oropharyngeal and hypopharyngeal cancer treated with definitive radiotherapy. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 79:27-36. [PMID: 28303058 PMCID: PMC5346617 DOI: 10.18999/nagjms.79.1.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study evaluated the prognostic significance of the maximum standardized uptake value of the primary site (pSUVmax) in 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scans of patients with oropharyngeal or hypopharyngeal cancer who were treated using definitive radiotherapy. The study included 86 patients who were primarily treated with radiotherapy for oropharyngeal or hypopharyngeal cancer. Sixty-nine patients underwent concurrent chemotherapy. The associations between pre-treatment pSUVmax and treatment outcomes were evaluated. The most appropriate pSUVmax cut-off value for predicting disease-free survival (DFS) and local control (LC) was selected using receiver operating characteristic (ROC) curves. The median follow-up time for surviving patients was 60 months, while the median survival time in the entire patient cohort was 55 months. A pSUVmax cut-off value of 9.0 showed the best discriminative performance. Five-year OS and DFS rates were 65.9% and 60.0%, respectively. In univariate analyses, pSUVmax (p = 0.009), T-stage (p = 0.001), N-stage (p = 0.039), and clinical stage (p = 0.017) were identified as significant prognostic predictors for DFS. The multivariate analysis did not identify any statistically significant factors, but the association between pSUVmax and DFS was borderline significant (p = 0.055). Interestingly, pSUVmax was predictive of local controllability in T1–T2 disease (p = 0.024), but there was no significant association for T3–T4 disease (p = 0.735). In this study, pSUVmax was predictive of DFS and LC in patients with oropharyngeal or hypopharyngeal cancer that was treated with definitive radiotherapy. pSUVmax was strongly associated with LC in T1–T2 disease.
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Affiliation(s)
- Takeaki Ishihara
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Japa
| | - Kazuhiro Kitajima
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuko Suenaga
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yasuo Ejima
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Japa
| | - Hirokazu Komatsu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naomi Kiyota
- Division of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Takahashi
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Japa
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Skjøtskift T, Evensen ME, Furre T, Moan JM, Amdal CD, Bogsrud TV, Malinen E, Dale E. Dose painting for re-irradiation of head and neck cancer. Acta Oncol 2018; 57:1693-1699. [PMID: 30280623 DOI: 10.1080/0284186x.2018.1512753] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND For patients with recurrent or second primary disease, re-irradiation can be challenging due to overlap with previously irradiated volumes. Dose painting may be attractive for these patients, as the focus is on delivering maximal dose to areas of high tumor activity. Here, we compare dose painting by contours (DPBC) treatment plans based on 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) with conventional plans. MATERIAL AND METHODS We included 10 patients with recurrent or second primary head and neck cancer (HNC) eligible for re-irradiation. Our conventional re-irradiation regimen is hyperfractionated radiotherapy 1.5 Gy twice daily over 4 weeks, giving a total dose of 60 Gy. For DPBC, we defined two prescription volumes, PV33 and PV66, corresponding to 33 and 66% of the highest FDG uptake in the tumor. The clinical target volume (CTV) prescription dose was 60 Gy, PV33; 65-67 Gy and PV66; 70-73 Gy. The DPBC plan is to be given the first 20 fractions and the conventional plan the last 20 fractions. Dose to organs at risk (OARs) were compared for DPBC and conventional treatment. By summation of the initial curative plan and the re-irradiation plan, we also evaluated differences in dose to the 2 ccm hot spot (D2cc). RESULTS We achieved DPBC plans with adequate target coverage for all 10 patients. There were no significant differences in OAR doses between the standard plans and the DPBC plans (p=.7). Summation of the initial curative plan and the re-irradiation plan showed that the median D2cc increased from 130 Gy (range 113-132 Gy; conventional) to 140 Gy (range 115-145 Gy; DPBC). CONCLUSIONS Our proposed DPBC could be straightforwardly implemented and all plans met the objectives. Re-irradiation of HNC with DPBC may increase tumor control without more side effects compared to conventional radiotherapy.
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Affiliation(s)
| | | | - Torbjørn Furre
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Jon M. Moan
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Trond V. Bogsrud
- Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Eirik Malinen
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Einar Dale
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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Hasegawa O, Satomi T, Kono M, Watanabe M, Ikehata N, Chikazu D. Correlation between the malignancy and prognosis of oral squamous cell carcinoma in the maximum standardized uptake value. Odontology 2018; 107:237-243. [PMID: 30039234 DOI: 10.1007/s10266-018-0379-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/12/2018] [Indexed: 12/19/2022]
Abstract
Positron emission tomography/computed tomography (PET/CT) examinations are indispensable in determining the stage, evaluating the treatment response, and diagnosing recurrence and metastasis during oral cancer treatment. In this study, we examined the correlation between the maximum standardized uptake value (SUVmax) for 18F-FDG PET/CT and the progressive factors, biological characteristics, and prognosis of oral cancer. We included 52 cases of oral squamous cell carcinoma with surgery as the initial treatment. Inclusion criteria included tumor diameter of ≥ 1 cm excluding superficial cancer. We performed 18F-FDG PET/CT examinations before surgery and determined the correlation between SUVmax and clinicopathological factors, such as histological grade, Ki-67 expression, as well as progress factors. SUVmax was significantly correlated with clinical T stage, vascular invasion, lymphatic invasion, Ki-67 expression, and postoperative event (recurrence or metastasis) in Student's t test. Using a cut-off SUVmax of 8.0, clinical T stage, lymph node metastasis, vascular invasion, infiltrative pattern, and Ki-67 expression significantly correlated in chi-squared test. Although observed and expected 3-year overall survival rates were not significantly different, observed and expected 3-year disease-free survival rates were significantly different. Analyzing each clinicopathological factor using various data obtained from 18F-FDG PET/CT scans may be useful to determine prognosis during oral cancer treatment.
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Affiliation(s)
- On Hasegawa
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjyuku, Shinjyuku-ku, Tokyo, 160-0023, Japan.
| | - Takafumi Satomi
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjyuku, Shinjyuku-ku, Tokyo, 160-0023, Japan
| | - Michihide Kono
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjyuku, Shinjyuku-ku, Tokyo, 160-0023, Japan
| | - Masato Watanabe
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjyuku, Shinjyuku-ku, Tokyo, 160-0023, Japan
| | - Naoki Ikehata
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjyuku, Shinjyuku-ku, Tokyo, 160-0023, Japan
| | - Daichi Chikazu
- Department of Oral and Maxillofacial Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjyuku, Shinjyuku-ku, Tokyo, 160-0023, Japan
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26
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Kim YI, Cheon GJ, Kang SY, Paeng JC, Kang KW, Lee DS, Chung JK. Prognostic value of simultaneous 18F-FDG PET/MRI using a combination of metabolo-volumetric parameters and apparent diffusion coefficient in treated head and neck cancer. EJNMMI Res 2018; 8:2. [PMID: 29322269 PMCID: PMC5762617 DOI: 10.1186/s13550-018-0357-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/04/2018] [Indexed: 01/16/2023] Open
Abstract
Background The aim of this study was to determine the usefulness of combined positron emission tomography (PET)/magnetic resonance imaging (MRI) parameters provided by simultaneous 18F-fluorodeoxyglucose (FDG) PET/MRI for the prediction of treatment failure in surgically resected head and neck cancer. We hypothesized that PET parameters corrected by tumor cellularity (combined PET/MRI parameters) could predict the prognosis. On regional PET, maximum standardized uptake value (SUVmax) was measured as metabolic parameters. In addition, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were checked as metabolo-volumetric parameters. Mean apparent diffusion coefficient (ADCmean) of tumor was evaluated as the MRI parameter on the ADC map. Ratios between metabolic/metabolo-volumetric parameters and ADC were calculated as combined PET/MRI parameters. PET, MRI, and combined PET/MRI parameters were compared with clinicopathologic parameters in terms of treatment failure. Results Seventy-two patients (mean age = 55.9 ± 14.6 year, M: F = 45: 27) who underwent simultaneous 18F-FDG PET/MRI before head and neck cancer surgery were retrospectively enrolled. Twenty-two patients (30.6%) showed tumor treatment failure after head and neck cancer surgery (mean treatment failure = 13.0 ± 7.0 months). In the univariate analysis, MTV (P = 0.044) and ratios between metabolo-volumetric parameters and ADC (MTV/ADCmean, P = 0.022; TLG/ADCmean, P = 0.044) demonstrated significance among 18F-FDG PET/MRI parameters. Lymphatic invasion (P = 0.044) and perineural invasion (P = 0.046) revealed significance among clinicopathologic parameters. In the multivariate analysis, MTV (P = 0.026), MTV/ADCmean (P = 0.011), and TLG/ADCmean (P = 0.002) with lymphatic invasion (P = 0.026, 0.026, and 0.044, respectively) showed significance. Conclusions Combined PET/MRI parameters (PET metabolo-volumetric parameters corrected by tumor cellularity) could be effective predictors of tumor treatment failure after head and neck cancer surgery in addition to MTV and clinicopathologic parameter. Electronic supplementary material The online version of this article (10.1186/s13550-018-0357-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yong-Il Kim
- Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.,Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Korea.
| | - Seo Young Kang
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - June-Key Chung
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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27
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Intraindividual homogeneity of 18 F-FDG PET/CT parameters in HPV-positive OPSCC. Oral Oncol 2017; 73:166-171. [DOI: 10.1016/j.oraloncology.2017.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/08/2017] [Accepted: 08/30/2017] [Indexed: 11/21/2022]
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28
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Castelli J, De Bari B, Depeursinge A, Simon A, Devillers A, Roman Jimenez G, Prior J, Ozsahin M, de Crevoisier R, Bourhis J. Overview of the predictive value of quantitative 18 FDG PET in head and neck cancer treated with chemoradiotherapy. Crit Rev Oncol Hematol 2016; 108:40-51. [PMID: 27931839 DOI: 10.1016/j.critrevonc.2016.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/08/2016] [Accepted: 10/26/2016] [Indexed: 02/03/2023] Open
Abstract
18 F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) allows to quantify the metabolic activity of a tumor (glycolysis) and has become a reference tool in oncology for the staging, restaging, radiotherapy planning and monitoring response in many cancers. Quantitative analyses have been introduced in order to overcome some of the limits of the visual methods, allowing an easier and more objective comparison of the inter- and intra-patients variations. The aims of this review were to report available evidences on the clinical value of quantitative PET/CT parameters in HNC. Forty-five studies, for a total of 2928 patients, were analyzed. Most of the data available dealt with the intensity of the metabolism, calculated from the Standard Uptake Value (SUV). Metabolic Tumor Volume (MTV) was well correlated with overall survival and disease free survival, with a higher predictive value than the maximum SUV. Spatial distribution of metabolism and textural analyses seems promising.
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Affiliation(s)
- J Castelli
- Radiotherapy Department, CHUV, Lausanne, Switzerland; INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France.
| | - B De Bari
- Radiotherapy Department, CHUV, Lausanne, Switzerland
| | - A Depeursinge
- University of Applied Sciences Western Switzerland, 3960 Sierre, Switzerland; Ecole Polytechnique Fédérale de Lausanne, CH-1015 Lausanne VD, Switzerland
| | - A Simon
- INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France
| | - A Devillers
- Nuclear Medecine Department, Centre Eugene Marquis, Rennes, F-35000, France
| | - G Roman Jimenez
- INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France; Keosys Medical imaging, 1 Impasse Augustin Fresnel, Saint-Herblain, F-44815, France
| | - J Prior
- Nuclear Medecine Department, CHUV, Switzerland
| | - M Ozsahin
- Radiotherapy Department, CHUV, Lausanne, Switzerland
| | - R de Crevoisier
- INSERM, U1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France; Radiotherapy Department, Centre Eugene Marquis, Rennes, F-35000, France
| | - J Bourhis
- Radiotherapy Department, CHUV, Lausanne, Switzerland
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29
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Jung J, Lee S, Son SH, Kim C, Lee C, Jeong JH, Jeong SY, Ahn B, Lee J. Clinical impact of
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F‐FDG positron emission tomography/CT on adenoid cystic carcinoma of the head and neck. Head Neck 2016; 39:447-455. [DOI: 10.1002/hed.24605] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/20/2016] [Accepted: 08/22/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ji‐hoon Jung
- Department of Nuclear MedicineKyungpook National University Medical Center and School of MedicineDaegu Republic of Korea
| | - Sang‐Woo Lee
- Department of Nuclear MedicineKyungpook National University Medical Center and School of MedicineDaegu Republic of Korea
| | - Seung Hyun Son
- Department of Nuclear MedicineKyungpook National University Medical Center and School of MedicineDaegu Republic of Korea
| | - Choon‐Young Kim
- Department of Nuclear MedicineKyungpook National University Medical Center and School of MedicineDaegu Republic of Korea
| | - Chang‐Hee Lee
- Department of Nuclear MedicineKyungpook National University Medical Center and School of MedicineDaegu Republic of Korea
| | - Ju Hye Jeong
- Department of Nuclear MedicineKyungpook National University Medical Center and School of MedicineDaegu Republic of Korea
| | - Shin Young Jeong
- Department of Nuclear MedicineKyungpook National University Medical Center and School of MedicineDaegu Republic of Korea
| | - Byeong‐Cheol Ahn
- Department of Nuclear MedicineKyungpook National University Medical Center and School of MedicineDaegu Republic of Korea
| | - Jaetae Lee
- Department of Nuclear MedicineKyungpook National University Medical Center and School of MedicineDaegu Republic of Korea
- DGMIFDaegu Republic of Korea
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Min M, Lin P, Liney G, Lee M, Forstner D, Fowler A, Holloway L. A review of the predictive role of functional imaging in patients with mucosal primary head and neck cancer treated with radiation therapy. J Med Imaging Radiat Oncol 2016; 61:99-123. [DOI: 10.1111/1754-9485.12496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 06/11/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Myo Min
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool New South Wales Australia
| | - Peter Lin
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
- Department of Nuclear Medicine and Positron Emission Tomography; Liverpool Hospital; Liverpool New South Wales Australia
- University of Western Sydney; Sydney New South Wales Australia
| | - Gary Liney
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool New South Wales Australia
- Centre for Medical Radiation Physics; University of Wollongong; Wollongong New South Wales Australia
| | - Mark Lee
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
| | - Dion Forstner
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool New South Wales Australia
| | - Allan Fowler
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
| | - Lois Holloway
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool New South Wales Australia
- Centre for Medical Radiation Physics; University of Wollongong; Wollongong New South Wales Australia
- Institute of Medical Physics; School of Physics; University of Sydney; Sydney New South Wales Australia
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31
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Preda L, Conte G, Bonello L, Giannitto C, Travaini LL, Raimondi S, Summers PE, Mohssen A, Alterio D, Cossu Rocca M, Grana C, Ruju F, Bellomi M. Combining standardized uptake value of FDG-PET and apparent diffusion coefficient of DW-MRI improves risk stratification in head and neck squamous cell carcinoma. Eur Radiol 2016; 26:4432-4441. [PMID: 26965504 DOI: 10.1007/s00330-016-4284-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/30/2015] [Accepted: 02/16/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess the independent prognostic value of standardized uptake value (SUV) and apparent diffusion coefficient (ADC), separately and combined, in order to evaluate if the combination of these two variables allows further prognostic stratification of patients with head and neck squamous cell carcinomas (HNSCC). METHODS Pretreatment SUV and ADC were calculated in 57 patients with HNSCC. Mean follow-up was 21.3 months. Semiquantitative analysis of primary tumours was performed using SUVmaxT/B, ADCmean, ADCmin and ADCmax. The prognostic value of SUVmaxT/B, ADCmean, ADCmin and ADCmax in predicting disease-free survival (DFS) was evaluated with log-rank test and Cox regression models. RESULTS Patients with SUVmaxT/B ≥5.75 had an overall worse prognosis (p = 0.003). After adjusting for lymph node status and diameter, SUVmaxT/B and ADCmin were both significant predictors of DFS with hazard ratio (HR) = 10.37 (95 % CI 1.22-87.95) and 3.26 (95 % CI 1.20-8.85) for SUVmaxT/B ≥5.75 and ADCmin ≥0.58 × 10-3 mm2/s, respectively. When the analysis was restricted to subjects with SUVmaxT/B ≥5.75, high ADCmin significantly predicted a worse prognosis, with adjusted HR = 3.11 (95 % CI 1.13-8.55). CONCLUSIONS The combination of SUVmaxT/B and ADCmin improves the prognostic role of the two separate parameters; patients with high SUVmaxT/B and high ADCmin are associated with a poor prognosis. KEY POINTS • High SUV maxT/B is a poor prognostic factor in HNSCC • High ADC min is a poor prognostic factor in HNSCC • In patients with high SUV maxT/B , high ADC min identified those with worse prognosis.
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Affiliation(s)
- Lorenzo Preda
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Giorgio Conte
- Specialisation School of Radiology, University of Milan, Milan, Italy.
| | - Luke Bonello
- Specialisation School of Radiology, University of Milan, Milan, Italy
| | | | - Laura L Travaini
- Department of Nuclear Medicine, European Institute of Oncology, Milan, Italy
| | - Sara Raimondi
- Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Paul E Summers
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Ansarin Mohssen
- Department of Head and Neck Surgery, European Institute of Oncology, Milan, Italy
| | - Daniela Alterio
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Maria Cossu Rocca
- Department of Urogenital Cancer Medical Treatment, European Institute of Oncology, Milan, Italy
| | - Chiara Grana
- Department of Nuclear Medicine, European Institute of Oncology, Milan, Italy
| | - Francesca Ruju
- Specialisation School of Radiology, University of Milan, Milan, Italy
| | - Massimo Bellomi
- Department of Radiology, European Institute of Oncology, Milan, Italy.,Department of Oncology and Haematology-Oncology, University of Milan, Milan, Italy
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Association between standardized uptake value and survival in patients with locally advanced or metastatic squamous cell head and neck cancer. JOURNAL OF ONCOLOGICAL SCIENCES 2016. [DOI: 10.1016/j.jons.2015.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Murphy CT, Devarajan K, Wang LS, Mehra R, Ridge JA, Fundakowski C, Galloway TJ. Pre-treatment tumor-specific growth rate as a temporal biomarker that predicts treatment failure and improves risk stratification for oropharyngeal cancer. Oral Oncol 2015; 51:1034-1040. [DOI: 10.1016/j.oraloncology.2015.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/28/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
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34
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Present and future role of FDG-PET/CT imaging in the management of head and neck carcinoma. Jpn J Radiol 2015; 33:776-89. [DOI: 10.1007/s11604-015-0495-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 10/16/2015] [Indexed: 01/09/2023]
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35
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¹⁸F-FDG PET/CT in hepatocellular carcinoma: detection of bone metastasis and prediction of prognosis. Nucl Med Commun 2015; 36:226-33. [PMID: 25460306 DOI: 10.1097/mnm.0000000000000246] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the diagnostic accuracy and prognostic value of 18F-fluorodeoxyglucose PET/computed tomography (CT) in bone metastases from hepatocellular carcinoma (HCC). PATIENTS AND METHODS Of 3912 consecutive HCC patients, 67 patients who had undergone both PET/CT and bone scintigraphy (BS) within a 3-month interval were evaluated. RESULTS Bone metastases were most frequently found in the pelvis (20%), followed by the lumbar spine (14%) and long bones (13%). PET/CT was significantly more sensitive than BS in region-based analyses, with 273 confirmed bone metastases (96.7 vs. 52.7%, respectively; P<0.001), and in patient-based analyses (99 vs. 85%; P=0.042). The median survival period was 5 (range, 0.4-18) months. On univariate analysis, poor prognostic factors included age (<60 years), multiple bone metastases, lymph node metastasis, high serum α-fetoprotein (≥400 IU/ml), Child-Pugh class B, and high maximum standardized uptake value (SUVmax) of bone metastasis (>5.0). Large metabolic volume (≥200 cm3) of bone metastasis was another poor prognostic factor. On Cox regression analysis, high α-fetoprotein was the only poor prognostic factor with statistical significance. CONCLUSION PET/CT was more sensitive than BS in bone metastasis from HCC by both patient-based and region-based analyses, and offered additional information on survival. PET/CT can be helpful in early diagnosis and opportune treatment of bone metastasis from HCC.
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Varoquaux A, Rager O, Dulguerov P, Burkhardt K, Ailianou A, Becker M. Diffusion-weighted and PET/MR Imaging after Radiation Therapy for Malignant Head and Neck Tumors. Radiographics 2015; 35:1502-27. [PMID: 26252192 DOI: 10.1148/rg.2015140029] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Interpreting imaging studies of the irradiated neck constitutes a challenge because of radiation therapy-induced tissue alterations, the variable appearances of recurrent tumors, and functional and metabolic phenomena that mimic disease. Therefore, morphologic magnetic resonance (MR) imaging, diffusion-weighted (DW) imaging, positron emission tomography with computed tomography (PET/CT), and software fusion of PET and MR imaging data sets are increasingly used to facilitate diagnosis in clinical practice. Because MR imaging and PET often yield complementary information, PET/MR imaging holds promise to facilitate differentiation of tumor recurrence from radiation therapy-induced changes and complications. This review focuses on clinical applications of DW and PET/MR imaging in the irradiated neck and discusses the added value of multiparametric imaging to solve diagnostic dilemmas. Radiologists should understand key features of radiation therapy-induced tissue alterations and potential complications seen at DW and PET/MR imaging, including edema, fibrosis, scar tissue, soft-tissue necrosis, bone and cartilage necrosis, cranial nerve palsy, and radiation therapy-induced arteriosclerosis, brain necrosis, and thyroid disorders. DW and PET/MR imaging also play a complementary role in detection of residual and recurrent disease. Interpretation pitfalls due to technical, functional, and metabolic phenomena should be recognized and avoided. Familiarity with DW and PET/MR imaging features of expected findings, potential complications, and treatment failure after radiation therapy increases diagnostic confidence when interpreting images of the irradiated neck. Online supplemental material is available for this article.
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Affiliation(s)
- Arthur Varoquaux
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Olivier Rager
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Pavel Dulguerov
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Karim Burkhardt
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Angeliki Ailianou
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Minerva Becker
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
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Joo YH, Yoo IR, Cho KJ, Park JO, Nam IC, Kim CS, Kim SY, Kim MS. The value of preoperative 18F-FDG PET/CT for the assessing contralateral neck in head and neck cancer patients with unilateral node metastasis (N1-3). Clin Otolaryngol 2015; 39:338-44. [PMID: 25102759 DOI: 10.1111/coa.12295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether preoperative (18) F-FDG PET/CT is useful in assessing contralateral lymph node metastasis in the neck. DESIGN A retrospective review of medical records was performed. SETTING Patients treated at a single institute. PARTICIPANTS One hundred and fifty-seven patients whose pathology results were positive for unilateral node metastasis (N1-3) involvement and underwent preoperative (18) F-FDG PET/CT for head and neck squamous cell carcinoma (HNSCC) were reviewed. MAIN OUTCOME MEASURES Prognostic factors and nodal SUVmax were studied to identify the risk of contralateral disease. RESULTS Thirty-six (22.9%) patients had contralateral cervical lymph node metastases. The (18) F-FDG PET/CT had a sensitivity of 80% and a specificity of 96% in identifying the contralateral cervical lymph node metastases on a level-by-level basis. The median SUVmax values of the ipsilateral and contralateral lymph nodes were 3.99 ± 3.36 (range, 0-20.4) and 2.94 ± 2.04 (range, 0-8.7), respectively (P = 0.001). There was a significant difference in the median SUVmax of contralateral nodes between the benign and malignant cervical lymph nodes (2.31 ± 0.62 versus 3.28 ± 2.43, P = 0.014). The cut-off value of contralateral median SUVmax in the context of contralateral cervical metastasis was 2.5 with the sensitivity of 75% and the specificity of 94%. A median contralateral lymph node SUVmax ≥ 2.5 was associated with 5-year disease-specific survival (P = 0.038). CONCLUSION (18) F-FDG PET/CT median SUVmax cut-off values of contralateral lymph nodes ≥2.5 were associated with contralateral cervical lymph node metastases and 5-year disease-specific survival in HNSCC patients with unilateral metastases.
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Affiliation(s)
- Y-H Joo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Schouten CS, Hakim S, Boellaard R, Bloemena E, Doornaert PA, Witte BI, Braakhuis BJM, Brakenhoff RH, Leemans CR, Hoekstra OS, de Bree R. Interaction of quantitative (18)F-FDG-PET-CT imaging parameters and human papillomavirus status in oropharyngeal squamous cell carcinoma. Head Neck 2015; 38:529-35. [PMID: 25352335 DOI: 10.1002/hed.23920] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 07/23/2014] [Accepted: 10/24/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (SCC) have a better survival than with HPV-negative oropharyngeal SCC. An (18) F-fluorodeoxyglucose positron emission tomography-CT ((18) F-FDG-PET-CT) may also provide prognostic information. We evaluated glycolytic characteristics in HPV-negative and HPV-positive oropharyngeal SCC. METHODS Forty-four patients underwent pretreatment (18) F-FDG-PET-CT. Standardized uptake values (SUVs) and metabolic active tumor volumes (MATVs) were determined for primary tumors. HPV status was determined with p16 immunostaining, followed by high-risk HPV DNA detection on the positive cases. RESULTS Twenty-seven patients were HPV-positive (61.4%). Median MATV was 2.8 mL (range = 1.6-5.1 mL) for HPV-positive and 6.0 mL (range = 4.4-18.7 mL) for HPV-negative tumors (p < .001). SUV values are volume dependent (partial volume effect), therefore, MATV was included as covariate in multivariate analysis. In this multivariate analysis, the maximum SUV in HPV-positive tumors was 3.9 units lower than in HPV-negative tumors (p = .01). CONCLUSION The (18) F-FDG-PET-CT parameters are lower in HPV-positive than in HPV-negative patients. Low pretreatment SUV values in HPV-positive oropharyngeal SCC may be at least partly explained by HPV-induced tumor changes.
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Affiliation(s)
- Charlotte S Schouten
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Sara Hakim
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - R Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Elisabeth Bloemena
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.,Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Patricia A Doornaert
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Birgit I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Boudewijn J M Braakhuis
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Ruud H Brakenhoff
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Remco de Bree
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Welsh L, Panek R, McQuaid D, Dunlop A, Schmidt M, Riddell A, Koh DM, Doran S, Murray I, Du Y, Chua S, Hansen V, Wong KH, Dean J, Gulliford S, Bhide S, Leach MO, Nutting C, Harrington K, Newbold K. Prospective, longitudinal, multi-modal functional imaging for radical chemo-IMRT treatment of locally advanced head and neck cancer: the INSIGHT study. Radiat Oncol 2015; 10:112. [PMID: 25971451 PMCID: PMC4438605 DOI: 10.1186/s13014-015-0415-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/30/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Radical chemo-radiotherapy (CRT) is an effective organ-sparing treatment option for patients with locally advanced head and neck cancer (LAHNC). Despite advances in treatment for LAHNC, a significant minority of these patients continue to fail to achieve complete response with standard CRT. By constructing a multi-modality functional imaging (FI) predictive biomarker for CRT outcome for patients with LAHNC we hope to be able to reliably identify those patients at high risk of failing standard CRT. Such a biomarker would in future enable CRT to be tailored to the specific biological characteristics of each patients' tumour, potentially leading to improved treatment outcomes. METHODS/DESIGN The INSIGHT study is a single-centre, prospective, longitudinal multi-modality imaging study using functional MRI and FDG-PET/CT for patients with LAHNC squamous cell carcinomas receiving radical CRT. Two cohorts of patients are being recruited: one treated with, and another treated without, induction chemotherapy. All patients receive radical intensity modulated radiotherapy with concurrent chemotherapy. Patients undergo functional imaging before, during and 3 months after completion of radiotherapy, as well as at the time of relapse, should that occur within the first two years after treatment. Serum samples are collected from patients at the same time points as the FI scans for analysis of a panel of serum markers of tumour hypoxia. DISCUSSION The primary aim of the INSIGHT study is to acquire a prospective multi-parametric longitudinal data set comprising functional MRI, FDG PET/CT, and serum biomarker data from patients with LAHNC undergoing primary radical CRT. This data set will be used to construct a predictive imaging biomarker for outcome after CRT for LAHNC. This predictive imaging biomarker will be used in future studies of functional imaging based treatment stratification for patients with LAHNC. Additional objectives are: defining the reproducibility of FI parameters; determining robust methods for defining FI based biological target volumes for IMRT planning; creation of a searchable database of functional imaging data for data mining. The INSIGHT study will help to establish the role of FI in the clinical management of LAHNC. TRIAL REGISTRATION NCRI H&N CSG ID 13860.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/therapy
- Chemoradiotherapy/mortality
- Female
- Head and Neck Neoplasms/metabolism
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/therapy
- Humans
- Longitudinal Studies
- Magnetic Resonance Imaging/methods
- Male
- Middle Aged
- Multimodal Imaging/methods
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Neoplasm Staging
- Positron-Emission Tomography/methods
- Prognosis
- Prospective Studies
- Radiotherapy Planning, Computer-Assisted/methods
- Radiotherapy, Intensity-Modulated/methods
- Tomography, X-Ray Computed/methods
- Young Adult
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Affiliation(s)
- Liam Welsh
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
- Clinical Research Fellow, Head and Neck Unit, Royal Marsden Hospital, Sutton, Surrey, SM2 5PT, UK.
| | - Rafal Panek
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Dualta McQuaid
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Alex Dunlop
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Maria Schmidt
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Angela Riddell
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Dow-Mu Koh
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Simon Doran
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Iain Murray
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Yong Du
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Sue Chua
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Vibeke Hansen
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Kee H Wong
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Jamie Dean
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Sarah Gulliford
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Shreerang Bhide
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Martin O Leach
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Christopher Nutting
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Kevin Harrington
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Kate Newbold
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
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Zhang B, Geng J, Nie F, Li X. Primary tumor standardized uptake value predicts survival in head and neck squamous cell carcinoma. Oncol Res Treat 2015; 38:45-8. [PMID: 25633888 DOI: 10.1159/000370331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/19/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether the pretreatment primary tumor standardized uptake value (SUV), as measured by positron emission tomography (PET), can add prognostic information for predicting survival in patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS 7 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 or a high SUV. Subsequently, we aggregated the individual RRs into a combined RR, using a fixed-effect model. Publication bias was assessed using a funnel plot. RESULTS The study included 7 clinical trials dedicated to HNSCC, involving 674 patients who underwent fluoro-2-deoxy-D-glucose-PET scanning before treatment. The combined RR from the 7 reports for the survival was 0.53 (95% confidence interval: 0.46-0.62). The funnel plot showed symmetrical distribution, indicating no evidence of any substantial publication bias. CONCLUSION Our meta-analysis indicates that patients with HNSCC who have a primary tumor with a high SUV have poor survival; this should be further confirmed in a meta-analysis based on individual patient data.
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Affiliation(s)
- Baitao Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Omami G, Tamimi D, Branstetter BF. Basic principles and applications of (18)F-FDG-PET/CT in oral and maxillofacial imaging: A pictorial essay. Imaging Sci Dent 2014; 44:325-32. [PMID: 25473642 PMCID: PMC4245476 DOI: 10.5624/isd.2014.44.4.325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/14/2014] [Accepted: 07/04/2014] [Indexed: 02/05/2023] Open
Abstract
A combination of positron emission tomography (PET) with 18F-labeled fluoro-2-deoxyglucose (18F-FDG) and computed tomography (18F-FDG-PET/CT) has increasingly become a widely used imaging modality for the diagnosis and management of head and neck cancer. On the basis of both recent literature and our professional experience, we present a set of principles with pictorial illustrations and clinical applications of FDG-PET/CT in the evaluation and management planning of squamous cell carcinoma of the oral cavity and oropharynx. We feel that this paper will be of interest and will aid the learning of oral and maxillofacial radiology trainees and practitioners.
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Affiliation(s)
- Galal Omami
- Department of Oral Diagnosis and Polyclinics, Faculty of Dentistry, The Hong Kong University, Hong Kong
| | | | - Barton F Branstetter
- Departments of Otolaryngology and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Joo YH, Yoo IR, Lee YS, Cho KJ, Park JO, Nam IC, Kim CS, Kim SY, Kim MS. Association between the standardized uptake value and high-risk HPV in hypopharyngeal squamous cell carcinoma. Acta Otolaryngol 2014; 134:1062-70. [PMID: 25220728 DOI: 10.3109/00016489.2014.905701] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Median (18)F-FDG PET/CT maximum standardized uptake values (SUV max) cut-off values of 7.9 or greater were associated with high-risk human papillomavirus (HPV) negativity in patients with hypopharyngeal squamous cell carcinoma (HPSCC). Furthermore, median (18)F-FDG PET/CT SUV max cut-off values of 7.9 or greater and high-risk HPV negativity were associated with adverse outcomes. OBJECTIVES We studied the association and the potential prognostic significance of (18)F-FDG PET/CT and high-risk HPV status in HPSCC. METHODS The medical records of 45 patients who underwent (18)F-FDG PET/CT for HPSCC before surgery were reviewed. High-risk HPV in situ hybridization was performed to detect HPV infection. RESULTS The median SUV max was 9.91 ± 4.91 (range 1.9-22.1) and the positive rate of high-risk HPV in situ hybridization was 11% (5 of 45). The SUV max values of negativity for the high-risk HPV subtypes (10.47 ± 4.87) and positivity (5.48 ± 2.45) were found to be significantly different (p = 0.030). The SUV max cut-off value for differentiating negativity for the high-risk HPV subtypes from positivity was 7.9, with a sensitivity of 65% and a specificity of 80%. The 5-year disease-specific survival rate (DSSR) in our cohort was 57%. Patients with an SUV max value higher than 7.9 (p = 0.005) and high-risk HPV negativity (p = 0.047) had decreased 5-year DSSR.
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FDG PET/CT imaging of oropharyngeal squamous cell carcinoma: characteristics of human papillomavirus-positive and -negative tumors. Clin Nucl Med 2014; 39:225-31. [PMID: 24152652 DOI: 10.1097/rlu.0000000000000255] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess differences in morphological and glycolytic characteristics of primary tumors and locoregional nodal disease between human papillomavirus (HPV)-positive and HPV-negative oropharyngeal head and neck squamous cell carcinoma. METHODS This was a retrospective analysis of 123 baseline FDG PET/CT scans from patients (aged 57.0 ± 10.6 years) with newly diagnosed oropharyngeal SCC between January 2003 and June 2012. There were 98 HPV-positive and 25 HPV-negative patients. SUVmax, SUVpeak, and SUVmean based on lean body mass, as well as RECIST (Response Evaluation Criteria In Solid Tumors) dimensions, metabolic tumor volume (gradient and threshold-segmentation methods) and total lesion glycolysis, were determined for primary and locoregional nodal disease. RESULTS Human papillomavirus-negative primary tumors were significantly larger as measured by RECIST longest diameter (P = 0.002) and slightly more heterogeneous as measured by the heterogeneity index (P = 0.07), higher SUVmax (P < 0.01), SUVpeak (P = 0.01), SUVmean (P = 0.01), metabolic tumor volume (P = 0.002), and total lesion glycolysis (P = 0.001), for both segmentation methods. Index parameters of HPV-positive nodal disease tend to be larger, but some with no statistical significance (P > 0.05). There was no significant difference in the metabolic parameters of primary tumor or nodal metastases for HPV-positive patients with and without smoking history. CONCLUSIONS Index morphologic and glycolytic parameters as measured in FDG PET/CT are significantly larger in HPV-negative as compared with HPV-positive primary oropharyngeal carcinoma. In contrast, the same parameters trended to be larger in HPV-positive regional nodal disease.
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Hoshikawa H, Yamamoto Y, Mori T, Kishino T, Fukumura T, Samukawa Y, Mori N, Nishiyama Y. Predictive value of SUV-based parameters derived from pre-treatment 18F-FLT PET/CT for short-term outcome with head and neck cancers. Ann Nucl Med 2014; 28:1020-6. [DOI: 10.1007/s12149-014-0902-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
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Kikuchi M, Koyasu S, Shinohara S, Usami Y, Imai Y, Hino M, Itoh K, Tona R, Kanazawa Y, Kishimoto I, Harada H, Naito Y. Prognostic value of pretreatment18F-fluorodeoxyglucose positron emission tomography/CT volume-based parameters in patients with oropharyngeal squamous cell carcinoma with known p16 and p53 status. Head Neck 2014; 37:1524-31. [DOI: 10.1002/hed.23784] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 05/02/2014] [Accepted: 05/28/2014] [Indexed: 01/19/2023] Open
Affiliation(s)
- Masahiro Kikuchi
- Department of Otolaryngology-Head and Neck Surgery; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Sho Koyasu
- Department of Diagnostic Imaging and Nuclear Medicine; Graduate School of Medicine, Kyoto University; Kobe City Japan
| | - Shogo Shinohara
- Department of Otolaryngology-Head and Neck Surgery; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Yu Usami
- Department of Clinical Laboratory; Osaka University Dental Hospital; Osaka Japan
| | - Yukihiro Imai
- Department of Clinical Pathology; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Megumu Hino
- Department of Radiology; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Kyo Itoh
- Department of Radiology; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Risa Tona
- Institute of Biomedical Research and Innovation; Kobe City Japan
| | - Yuji Kanazawa
- Department of Otolaryngology-Head and Neck Surgery; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Ippei Kishimoto
- Department of Otolaryngology-Head and Neck Surgery; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Hiroyuki Harada
- Department of Otolaryngology-Head and Neck Surgery; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Yasushi Naito
- Department of Otolaryngology-Head and Neck Surgery; Kobe City Medical Center General Hospital; Kobe City Japan
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Prognostic value of pretreatment 18F-FDG PET/CT parameters including visual evaluation in patients with head and neck squamous cell carcinoma. AJR Am J Roentgenol 2014; 202:851-8. [PMID: 24660716 DOI: 10.2214/ajr.13.11013] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether pretreatment quantitative and visual parameters seen on PET/CT using (18)F-FDG add prognostic information for clinical staging in patients with head and neck cancer. MATERIALS AND METHODS We enrolled 108 patients with histologically proven oral, oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinomas who underwent FDG PET/CT before treatment and, later, definitive therapy in our study. PET/CT parameters-maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and uptake pattern (sphere-shaped or ring-shaped)-were recorded. The prognostic value of these parameters was evaluated using univariate and multivariate Cox regression analyses. RESULTS In the univariate analysis, all of the FDG PET/CT parameters--SUVmax (> 10 g/mL) of the primary tumor, MTV (> 20 cm(3)), TLG (> 70 g), and uptake pattern (ring-shaped)--were significantly associated with negative effects on disease-specific survival (DSS) and disease-free survival (DFS). In the multivariate analysis, the MTV and uptake pattern remained associated with DSS after corrections for the Union for International Cancer Control (UICC) stage and definitive therapy (p = 0.023 and < 0.001, respectively). Another multivariate model that included MTV as a continuous variable, uptake pattern, and UICC stage showed that the uptake pattern remained significantly associated with DSS, whereas the association between DSS and MTV was not significant (p < 0.001 and = 0.332, respectively). CONCLUSION Our data indicate that the pretreatment PET/CT parameters had prognostic value. In particular, a qualitative factor, uptake pattern, provided better prognostic information to the clinical staging of head and neck squamous cell carcinomas than the other PET/CT parameters.
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Jeong J, Setton JS, Lee NY, Oh JH, Deasy JO. Estimate of the impact of FDG-avidity on the dose required for head and neck radiotherapy local control. Radiother Oncol 2014; 111:340-7. [PMID: 24833560 PMCID: PMC4822492 DOI: 10.1016/j.radonc.2014.03.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/14/2014] [Accepted: 03/22/2014] [Indexed: 11/29/2022]
Abstract
Background and purpose Although FDG-avid tumors are recognized as a potential target for dose escalation, there is no clear basis for selecting a boost dose to counter this apparent radioresistance. Using a novel analysis method, based on the new concept of an outcome-equivalent dose, we estimate the extra dose required to equalize local control between FDG-avid and non-avid head and neck tumors. Materials and methods Based on a literature review, five reports of head and neck cancer (423 patients in total), along with an internal validation dataset from our institution (135 oropharynx patients), were used in this analysis. To compensate for the heterogeneity among multi-institutional patient cohorts and corresponding treatment techniques, local control data of the cohorts were fit to a single dose–response curve with a clinically representative steepness (γ50 = 2), thereby defining an ‘outcome-equivalent dose’ (OED) for each institutional cohort. Separate dose–response curves were then determined for the FDG-avid and FDG-non-avid patient cohorts, and the ratio of TD50 (tumor dose required for 50% of control) values between the high- and low-FDG-uptake groups (TD50,high/TD50,low) was estimated, resulting in an estimated metabolic dose-modifying factor (mDMF) due to FDG-avidity. Results For individual datasets, the estimated mDMFs were found to be in the range of 1.07–1.62, decreasing if the assumed slope (γ50) increased. Weighted logistic regression for the six datasets resulted in a mDMF of 1.19 [95% CI: 1.04–1.34] for a γ50 value of 2, which translates to a needed dose increase of about 1.5 Gy per unit increase in the maximum standardized uptake value (SUVm) of FDG-PET [95% CI: 0.3–2.7]. Assumptions of lower or higher γ50 values (1.5 or 2.5) resulted in slightly different mDMFs: 1.26 or 1.15, respectively. A validation analysis with seven additional datasets, based on relaxed criteria, was consistent with the estimated mDMF. Conclusions We introduced a novel outcome-equivalent dose analysis method to estimate the dose– response modifying effect of FDG uptake variation. To reach equal response rates, FDG-avid tumors are likely to require 10% to 30% more dose than FDG-non-avid tumors. These estimates provide a rational starting point for selecting IMRT boosts for FDG-avid tumors. However, independent tests and refinements of the estimated dose-modifying effect, using high-quality prospective clinical trial data, are needed.
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Affiliation(s)
- Jeho Jeong
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Jeremy S Setton
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, USA.
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Refining risk stratification for locoregional failure after chemoradiotherapy in human papillomavirus-associated oropharyngeal cancer. Oral Oncol 2014; 50:513-9. [PMID: 24565983 DOI: 10.1016/j.oraloncology.2014.02.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/30/2014] [Accepted: 02/03/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND To determine whether the addition of molecular and imaging biomarkers to established clinical risk factors could help predict locoregional failure (LRF) after chemoradiation in human papillomavirus (HPV)-related (+) oropharyngeal cancer (OPC) and improve patient selection for locoregional treatment de-intensification. METHODS HPV status was determined for 198 consecutive patients with stage III/IV OPC treated with definitive chemoradiation from 5/2003 to 10/2010. The impact of pre-therapy epidermal growth factor receptor (EGFR) overexpression; imaging biomarkers including primary tumor and nodal maximum standardized uptake values on FDG-PET, gross tumor volumes, and matted nodes; and clinical factors on LRF (including residual disease at adjuvant neck dissection) was assessed. RESULTS Primary tumors were HPV+ in 184 patients and HPV-negative in 14. EGFR overexpression was related to HPV-negative status and was univariately associated with LRF in the overall population, but was neither retained in the multivariate model after adjustment for HPV status, nor associated with LRF in HPV+ patients. Similarly, imaging biomarkers were univariately associated with LRF, but correlated with T-stage and/or N-stage and did not remain predictive in HPV+ patients after adjustment for T4- and N3-stages, which were the only significant predictors of LRF on multivariate analysis. Among HPV+ patients with non-T4- or N3-stages, only minimal smoking was associated with decreased LRF. CONCLUSIONS The prognostic impact of EGFR overexpression and imaging biomarkers on LRF was predominantly related to their association with HPV-negative status and T- or N-stage, respectively. Among HPV+ OPC patients treated with uniform chemoradiation, only T4-stage, N3-stage, and smoking contributed to risk-stratification for LRF.
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Zhao K, Yang SY, Zhou SH, Dong MJ, Bao YY, Yao HT. Fluorodeoxyglucose uptake in laryngeal carcinoma is associated with the expression of glucose transporter-1 and hypoxia-inducible-factor-1α and the phosphoinositide 3-kinase/protein kinase B pathway. Oncol Lett 2014; 7:984-990. [PMID: 24944654 PMCID: PMC3961369 DOI: 10.3892/ol.2014.1877] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 01/23/2014] [Indexed: 12/28/2022] Open
Abstract
High fluorodeoxyglucose (FDG) uptake by human carcinomas, including head and neck cancers, is associated with a poor prognosis. Glucose transporter-1 (Glut-1) is believed to be an intrinsic marker of hypoxia in malignant tumors. The expression of hypoxia-inducible factor-1α (HIF-1α) and correlated target genes, including Glut-1, is regulated by the phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) pathway. However, it remains unclear whether the PI3K/Akt signaling pathway is involved in regulating FDG uptake directly. In the present study, 24 consecutive patients with laryngeal carcinoma were examined pre-operatively and the standardized uptake values (SUV) of the laryngeal carcinomas were determined. Glut-1, HIF-1α, PI3K and phosphorylated-Akt (p-Akt) expression was detected by immunohistochemical staining of paraffin sections from the tumor specimens. Associations among SUVmax, Glut-1, HIF-1α, PI3K and p-Akt protein expression and the other clinical parameters were analyzed. The univariate analyses revealed a significantly shorter survival time along with higher HIF-1α (P=0.018) and PI3K (P=0.008) expression, but the survival time was not significantly correlated with Glut-1 or p-Akt expression. The multivariate analysis demonstrated that higher SUVmax (P=0.043) and PI3K expression (P=0.012) were significantly correlated with a poor survival time. Spearman’s rank analysis showed significant correlations between SUVmax and HIF-1α (r=0.577; P=0.003), PI3K (r=1.0; P<0.0001) and p-Akt (r=0.577; P=0.003) expression. PI3K was associated with poorly- and moderately-differentiated laryngeal carcinoma (P=0.012). In conclusion, a high SUVmax indicates a poor prognosis for laryngeal carcinoma. Also, a high SUVmax may be associated with the increased expression of Glut-1, HIF-1α, PI3K and p-Akt.
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Affiliation(s)
- Kui Zhao
- Department of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Shu-Ye Yang
- Department of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Meng Jie Dong
- Department of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Yang-Yang Bao
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Hong-Tian Yao
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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Pérez Romasanta LA, García Velloso MJ, López Medina A. Functional imaging in radiation therapy planning for head and neck cancer. Rep Pract Oncol Radiother 2013; 18:376-82. [PMID: 24416582 PMCID: PMC3863200 DOI: 10.1016/j.rpor.2013.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 10/16/2013] [Accepted: 10/16/2013] [Indexed: 11/22/2022] Open
Abstract
Functional imaging and its application to radiotherapy (RT) is a rapidly expanding field with new modalities and techniques constantly developing and evolving. As technologies improve, it will be important to pay attention to their implementation. This review describes the main achievements in the field of head and neck cancer (HNC) with particular remarks on the unsolved problems.
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Affiliation(s)
- Luis A. Pérez Romasanta
- Radiation Oncology, Hospital Universitario de Salamanca, Ps. San Vicente 58, 37007 Salamanca, Spain
| | | | - Antonio López Medina
- Medical Physics Department and Radiological Protection, Galaria – Hospital do Meixoeiro – Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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