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Du M, Lin Q, Yan S, Gao X, Yang C, Li Z, Liao W, Yang A, Chen S. Clinicopathologic characteristics of HPV-associated head and neck squamous cell carcinoma in Southern China: long-term retrospective study of 400 cases. Ther Adv Med Oncol 2024; 16:17588359241242962. [PMID: 38617023 PMCID: PMC11010741 DOI: 10.1177/17588359241242962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Abstract
Background Human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) is an evolving and growing disease, especially in developing countries. However, the clinical characteristics of HPV-associated HNSCC in regard to HPV infection rates, patient features, and prognosis are under-reported in the Asian population. Methods In this study, we retrospectively enrolled a 400-case cohort of HNSCC with p16 immunochemistry and analyzed with long-term follow-up. We investigate the current HPV prevalence of HNSCC, unique HPV-associated patient clinical characteristics, and patient prognosis in the southern China population. Results HPV infection exhibited a 15% prevalence in all HNSCC cases, notably higher in oropharyngeal cases (30.7%), followed by oral cavity (11.8%), laryngeal (10.1%), and hypopharyngeal (2.5%). HPV status, gender, old age, and location of tumor were significantly associated with the patient's survival. Tonsil invasion was found more frequent in HPV-positive oropharyngeal HNSCC than in HPV-negative cases. HPV-associated HNSCC patients tend to possess stronger tobacco and alcohol habits, which were correlated to poor survival. HPV status's correlation with gender, age, and anatomical location is associated intricately with patient survival. The secondary primary tumor rate was found higher within the HPV-negative group, compared to the HPV-positive group (9.12% versus 1.67%). Conclusion Our study provided a current picture of HPV-associated HNSCC in the southern China population and elaborated the understanding of key factors that correlate to HNSCC prognosis. Our findings indicated a strong susceptibility of HPV-associated oropharyngeal HNSCC in the tonsil and the difference in secondary primary tumor rates associated with HPV status.
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Affiliation(s)
- Mingyuan Du
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Qiaohong Lin
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Shida Yan
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Xianlu Gao
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Chulin Yang
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Zhaoyang Li
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Wei Liao
- Department of Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Ankui Yang
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Shuwei Chen
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
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Cui M, Cheng J, Cheng H, Zhao M, Zhou D, Zhang M, Jia J, Luo L. Characteristics of human papillomavirus infection among oropharyngeal cancer patients: A systematic review and meta-analysis. Arch Oral Biol 2024; 157:105830. [PMID: 37924712 DOI: 10.1016/j.archoralbio.2023.105830] [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: 09/06/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE This study aimed to explore the characteristics of human papillomavirus (HPV) in oropharyngeal carcinoma (OPC), in order to provide a new theoretical basis for the prevention, treatment, and management of OPC. METHODS The electronic databases were searched available publications relevant to HPV infection and OPC. Studies were collected until July, 2023. The effect sizes were combined using R 4.2.2 software. Subgroup and sensitivity analyses were performed to explore the sources of heterogeneity. Funnel plot and Egger's test were used to assess the publication bias. RESULTS Seventy-one studies were included with 10,908 OPC patients. The pooled prevalence of HPV and HR-HPV infection was 44.22% and 43.94%, respectively. The genotypes of HR-HPV were HPV16 (37.24%), HPV33 (2.44%), HPV18 (1.64%), HPV35 (1.53%), and HPV58 (0.89%). The highest HPV infection was in North America (66.87%), Oceania (43.09%), and Europe (41.49%), lowest in Africa (4.89%). Females exhibited higher HPV infection (43.18% vs 34.59% in males). Top subsites of HPV infection was tonsil (45.78%), followed by base of tongue (36.66%). Infection was higher in OPC patients aged > 60 (38.15%) than < 60 (34.73%). The prevalence of HPV infection in stage I-II of OPC patients is higher than that in stage III-IV. CONCLUSIONS HPV genotyping (16, 18, 33, 35, 58) is a key factor in the prevention and treatment of OPC. Identifying tonsils, base of tongue, and soft palate as common subsites to improve early detection. Elderly women with high HPV infection require attention to risk management and health education for prevention.
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Affiliation(s)
- Meimei Cui
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China; Department of Pathology, Weifang Medical University, Weifang, China
| | - Jinling Cheng
- Digestive Department, Shandong Second Provincial General Hospital, Jinan, China
| | - Huijuan Cheng
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China
| | - Ming Zhao
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China; School of Public Health, Jiamusi University, Jiamusi, China
| | - Dan Zhou
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China; School of Public Health, Jiamusi University, Jiamusi, China
| | - Min Zhang
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China; School of Public Health, Jiamusi University, Jiamusi, China
| | - Jingjing Jia
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China; Department of Basic medicine, Jiamusi University, China
| | - Limei Luo
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China.
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Holgado A, León X, Quer M, Camacho V, Fernández A. Association between maximum standarised uptake value (SUV) and local control in patients with oropharyngeal carcinoma treated with radiotherapy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2023; 74:211-218. [PMID: 37149130 DOI: 10.1016/j.otoeng.2022.05.001] [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: 04/06/2022] [Accepted: 05/19/2022] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To analyse the prognostic ability of the maximum standardised uptake value (SUVmax) on local disease control in patients with oropharyngeal carcinoma treated with radiotherapy. MATERIAL AND METHODS Retrospective study of 105 patients with oropharyngeal carcinomas treated with radiotherapy, including chemo- and bio-radiotherapy, and who had a PET-CT scan prior to the start of treatment. RESULT Patients with a SUVmax value higher than 17.2 at the primary tumour site had a significantly higher risk of local recurrence. The 5-year local recurrence-free survival for patients with SUVmax less than or equal to 17.2 (n = 71) was 86.5% (95% CI 78.2-94.7 %), and for patients with SUVmax greater than 17.2 (n = 34) it was 55.8% (95% CI 36.0-75.6 %) (P = 0.0001). This difference in local control was maintained regardless of patients' HPV status. Specific survival was similarly lower for patients with a SUV greater than 17.2. The 5-year specific survival for patients with SUVmax greater than 17.2 was 39.5% (95% CI: 20.6-58.3 %), significantly shorter than that of patients with SUVmax equal to or less than 17.2, which was 77.3% (95% CI: 66.9-87.6 %) (P = 0.0001). CONCLUSIONS Patients with oropharyngeal carcinomas treated with radiotherapy with a SUVmax greater than 17.2 at the level of the primary tumour site had a significantly higher risk of local recurrence.
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Affiliation(s)
- Anna Holgado
- Servicio de Otorrinolaringología-->, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier León
- Servicio de Otorrinolaringología-->, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain; UVIC-->, Universitat Central de Catalunya, Vic, Spain.
| | - Miquel Quer
- Servicio de Otorrinolaringología-->, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Valle Camacho
- Servicio de Medicina Nuclear-->, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejando Fernández
- Servicio de Medicina Nuclear-->, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Lin Fracp P, Holloway L, Min Franzcr M, Lee Franzcr M, Fowler Franzcr A. Prognostic and predictive values of baseline and mid-treatment FDG-PET in oropharyngeal carcinoma treated with primary definitive (chemo)radiation and impact of HPV status: review of current literature and emerging roles. Radiother Oncol 2023; 184:109686. [PMID: 37142128 DOI: 10.1016/j.radonc.2023.109686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/16/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND PURPOSE This study provides a review of the literature assessing whether semiquantitative PET parameters acquired at baseline and/or during definitive (chemo)radiotherapy ("prePET" and "iPET") can predict survival outcomes in patients with oropharyngeal squamous cell carcinoma (OPC), and the impact of human papilloma virus (HPV) status. MATERIAL AND METHODS A literature search was carried out using PubMed and Embase between 2001 to 2021 in accordance with PRISMA. RESULTS The analysis included 22 FDG-PET/CT studies1-22, 19 pre-PET and 3 both pre-PET and iPET14,18,20,. The analysis involved 2646 patients, of which 1483 are HPV-positive (17 studies: 10 mixed and 7 HPV-positive only), 589 are HPV-negative, and 574 have unknown HPV status. Eighteen studies found significant correlations of survival outcomes with pre-PET parameters, most commonly primary or "Total" (combined primary and nodal) metabolic tumour volume and/or total lesional glycolysis. Two studies could not establish significant correlations and both employed SUVmax only. Two studies also could not establish significant correlations when taking into account of the HPV-positive population only. Because of the heterogeneity and lack of standardized methodology, no conclusions on optimal cut-off values can be drawn. Ten studies specifically evaluated HPV-positive patients: five showed positive correlation of pre-PET parameters and survival outcomes, but four of these studies did not include advanced T or N staging in multivariate analysis1,6,15,22, and two studies only showed positive correlations after excluding high risk patients with smoking history7 or adverse CT features22. Two studies found that prePET parameters predicted treatment outcomes only in HPV-negative but not HPV-positive patients10,16. Two studies found that iPET parameters could predict outcomes in HPV-positive patients but not prePET parameters14,18. CONCLUSION The current literature supports high pre-treatment metabolic burden prior to definitive (chemo)radiotherapy can predict poor treatment outcomes for HPV-negative OPC patients. Evidence is conflicting and currently does not support correlation in HPV-positive patients.
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Affiliation(s)
- Peter Lin Fracp
- Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, NSW, Australia; School of Medicine, Western Sydney University, NSW, Australia.
| | - Lois Holloway
- South Western Sydney Clinical School, University of New South Wales, NSW, Australia; School of Medicine, Western Sydney University, NSW, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Myo Min Franzcr
- Department of Radiation Oncology, Sunshine Coast University Hospital, Queensland, Australia; Faculty of Science, Health, Education and Engineering, University of Sunshine Coast, Queensland, Australia
| | - Mark Lee Franzcr
- South Western Sydney Clinical School, University of New South Wales, NSW, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia
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Asociación entre el standarized uptake value (SUV) máximo y el control local en pacientes con carcinoma de orofaringe tratados con radioterapia. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Touska P, Connor S. Imaging of human papilloma virus associated oropharyngeal squamous cell carcinoma and its impact on diagnosis, prognostication, and response assessment. Br J Radiol 2022; 95:20220149. [PMID: 35687667 PMCID: PMC9815738 DOI: 10.1259/bjr.20220149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/22/2022] [Accepted: 06/07/2022] [Indexed: 01/13/2023] Open
Abstract
The clinical behaviour and outcomes of patients with oropharyngeal cancer (OPC) may be dichotomised according to their association with human papilloma virus (HPV) infection. Patients with HPV-associated disease (HPV+OPC) have a distinct demographic profile, clinical phenotype and demonstrate considerably better responses to chemoradiotherapy. This has led to a reappraisal of staging and treatment strategies for HPV+OPC, which are underpinned by radiological data. Structural modalities, such as CT and MRI can provide accurate staging information. These can be combined with ultrasound-guided tissue sampling and functional techniques (such as diffusion-weighted MRI and 18F-fludeoxyglucose positron emission tomography-CT) to monitor response to treatment, derive prognostic information, and to identify individuals who might benefit from intensification or deintensification strategies. Furthermore, advanced MRI techniques, such as intravoxel incoherent motion and perfusion MRI as well as application of artificial intelligence and radiomic techniques, have shown promise in treatment response monitoring and prognostication. The following review will consider the contemporary role and knowledge on imaging in HPV+OPC.
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Affiliation(s)
- Philip Touska
- Department of Radiology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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Noor A, Mair M, Cook L, Bolt H, Cheriyan S, Woods CM, Hopkins J, Ooi EH. Prognostic Value of
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F‐Fluoro‐Deoxyglucose‐Positron Emission Tomography Volumetric Parameters in Human Papillomavirus‐Related Oropharyngeal Squamous Cell Carcinoma. Laryngoscope 2022. [DOI: 10.1002/lary.30362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/15/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Anthony Noor
- Department of Otolaryngology, Head and Neck Surgery Flinders Medical Centre Bedford Park South Australia Australia
| | - Manish Mair
- Department of Otolaryngology, Head and Neck Surgery John Hunter Hospital Newcastle New South Wales Australia
| | - Lachlan Cook
- Department of Otolaryngology, Head and Neck Surgery Flinders Medical Centre Bedford Park South Australia Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health Flinders University Adelaide South Australia Australia
| | - Harrison Bolt
- Department of Otolaryngology, Head and Neck Surgery Flinders Medical Centre Bedford Park South Australia Australia
| | - Sanith Cheriyan
- Department of Otolaryngology, Head and Neck Surgery Flinders Medical Centre Bedford Park South Australia Australia
| | - Charmaine M. Woods
- Department of Otolaryngology, Head and Neck Surgery Flinders Medical Centre Bedford Park South Australia Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health Flinders University Adelaide South Australia Australia
| | - James Hopkins
- Department of Medical Imaging Flinders Medical Centre Bedford Park South Australia Australia
| | - Eng H. Ooi
- Department of Otolaryngology, Head and Neck Surgery Flinders Medical Centre Bedford Park South Australia Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health Flinders University Adelaide South Australia Australia
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Lv W, Xu H, Han X, Zhang H, Ma J, Rahmim A, Lu L. Context-Aware Saliency Guided Radiomics: Application to Prediction of Outcome and HPV-Status from Multi-Center PET/CT Images of Head and Neck Cancer. Cancers (Basel) 2022; 14:cancers14071674. [PMID: 35406449 PMCID: PMC8996849 DOI: 10.3390/cancers14071674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
Simple Summary This study investigated the ability of context-aware saliency-guided PET/CT radiomics in the prediction of outcome and HPV status for head and neck cancer. In total, 806 HNC patients (training vs. validation vs. external testing: 500 vs. 97 vs. 209) from 9 centers were collected from The Cancer Imaging Archive (TCIA). Saliency-guided radiomics showed enhanced performance for both outcome and HPV-status predictions relative to conventional radiomics. The radiomics-predicted HPV status also showed complementary prognostic value. This multi-center study highlights the feasibility of saliency-guided PET/CT radiomics in outcome predictions of head and neck cancer, confirming that certain regions are more relevant to tumor aggressiveness and prognosis. Abstract Purpose: This multi-center study aims to investigate the prognostic value of context-aware saliency-guided radiomics in 18F-FDG PET/CT images of head and neck cancer (HNC). Methods: 806 HNC patients (training vs. validation vs. external testing: 500 vs. 97 vs. 209) from 9 centers were collected from The Cancer Imaging Archive (TCIA). There were 100/384 and 60/123 oropharyngeal carcinoma (OPC) patients with human papillomavirus (HPV) status in training and testing cohorts, respectively. Six types of images were used for radiomics feature extraction and further model construction, namely (i) the original image (Origin), (ii) a context-aware saliency map (SalMap), (iii, iv) high- or low-saliency regions in the original image (highSal or lowSal), (v) a saliency-weighted image (SalxImg), and finally, (vi) a fused PET-CT image (FusedImg). Four outcomes were evaluated, i.e., recurrence-free survival (RFS), metastasis-free survival (MFS), overall survival (OS), and disease-free survival (DFS), respectively. Multivariate Cox analysis and logistic regression were adopted to construct radiomics scores for the prediction of outcome (Rad_Ocm) and HPV-status (Rad_HPV), respectively. Besides, the prognostic value of their integration (Rad_Ocm_HPV) was also investigated. Results: In the external testing cohort, compared with the Origin model, SalMap and SalxImg achieved the highest C-indices for RFS (0.621 vs. 0.559) and MFS (0.785 vs. 0.739) predictions, respectively, while FusedImg performed the best for both OS (0.685 vs. 0.659) and DFS (0.641 vs. 0.582) predictions. In the OPC HPV testing cohort, FusedImg showed higher AUC for HPV-status prediction compared with the Origin model (0.653 vs. 0.484). In the OPC testing cohort, compared with Rad_Ocm or Rad_HPV alone, Rad_Ocm_HPV performed the best for OS and DFS predictions with C-indices of 0.702 (p = 0.002) and 0.684 (p = 0.006), respectively. Conclusion: Saliency-guided radiomics showed enhanced performance for both outcome and HPV-status predictions relative to conventional radiomics. The radiomics-predicted HPV status also showed complementary prognostic value.
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Affiliation(s)
- Wenbing Lv
- School of Biomedical Engineering, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China; (W.L.); (H.X.); (X.H.); (J.M.)
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China
- Pazhou Lab, Guangzhou 510330, China
| | - Hui Xu
- School of Biomedical Engineering, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China; (W.L.); (H.X.); (X.H.); (J.M.)
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China
- Pazhou Lab, Guangzhou 510330, China
| | - Xu Han
- School of Biomedical Engineering, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China; (W.L.); (H.X.); (X.H.); (J.M.)
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China
- Pazhou Lab, Guangzhou 510330, China
| | - Hao Zhang
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China;
| | - Jianhua Ma
- School of Biomedical Engineering, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China; (W.L.); (H.X.); (X.H.); (J.M.)
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China
- Pazhou Lab, Guangzhou 510330, China
| | - Arman Rahmim
- Department of Integrative Oncology, BC Cancer Research Institute, 675 West 10th Avenue, Vancouver, BC V5Z 1L3, Canada;
- Department of Radiology, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 1Z1, Canada
- Department of Physics, University of British Columbia, 6224 Agricultural Road, Vancouver, BC V6T 1Z1, Canada
| | - Lijun Lu
- School of Biomedical Engineering, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China; (W.L.); (H.X.); (X.H.); (J.M.)
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, 1023 Shatai Road, Guangzhou 510515, China
- Pazhou Lab, Guangzhou 510330, China
- Correspondence: ; Tel.: +86-020-62789116
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Cegla P, Currie G, Wróblewska JP, Cholewiński W, Kaźmierska J, Marszałek A, Kubiak A, Golusinski P, Golusiński W, Majchrzak E. Influence of Semiquantitative [18F]FDG PET and Hematological Parameters on Survival in HNSCC Patients Using Neural Network Analysis. Pharmaceuticals (Basel) 2022; 15:ph15020224. [PMID: 35215335 PMCID: PMC8875232 DOI: 10.3390/ph15020224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/02/2022] [Accepted: 02/09/2022] [Indexed: 02/08/2023] Open
Abstract
The aim of this study is to assess the influence of semiquantitative PET-derived parameters as well as hematological parameters in overall survival in HNSCC patients using neural network analysis. Retrospective analysis was performed on 106 previously untreated HNSCC patients. Several PET-derived parameters (SUVmax, SUVmean, TotalSUV, MTV, TLG, TLRmax, TLRmean, TLRTLG, and HI) for primary tumor and lymph node with highest activity were assessed. Additionally, hematological parameters (LEU, LEU%, NEU, NEU%, MON, MON%, PLT, PLT%, NRL, and LMR) were also assessed. Patients were divided according to the diagnosis into the good and bad group. The data were evaluated using an artificial neural network (Neural Analyzer version 2.9.5) and conventional statistic. Statistically significant differences in PET-derived parameters in 5-year survival rate between group of patients with worse prognosis and good prognosis were shown in primary tumor SUVmax (10.0 vs. 7.7; p = 0.040), SUVmean (5.4 vs. 4.4; p = 0.047), MTV (23.2 vs. 14.5; p = 0.010), and TLG (155.0 vs. 87.5; p = 0.05), and mean liver TLG (27.8 vs. 30.4; p = 0.031), TLRmax (3.8 vs. 2.6; p = 0.019), TLRmean (2.8 vs. 1.9; p = 0.018), and in TLRTLG (5.6 vs. 2.3; p = 0.042). From hematological parameters, only LMR showed significant differences (2.5 vs. 3.2; p = 0.009). Final neural network showed that for ages above 60, primary tumors SUVmax, TotalSUV, MTV, TLG, TLRmax, and TLRmean over (9.7, 2255, 20.6, 145, 3.6, 2.6, respectively) are associated with worse survival. Our study shows that the neural network could serve as a supplement to PET-derived parameters and is helpful in finding prognostic parameters for overall survival in HNSCC.
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Affiliation(s)
- Paulina Cegla
- Department of Nuclear Medicine, Greater Poland Cancer Center, 61-866 Poznan, Poland;
- Correspondence:
| | - Geoffrey Currie
- School of Dentistry and Health Science, Charles Sturt University, Wagga Wagga 2678, Australia;
| | - Joanna P. Wróblewska
- Department of Oncologic Pathology and Prophylaxis, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (J.P.W.); (A.M.)
- Department of Tumor Pathology, Greater Poland Cancer Centre, 61-866 Poznan, Poland
| | - Witold Cholewiński
- Department of Nuclear Medicine, Greater Poland Cancer Center, 61-866 Poznan, Poland;
- Department of Electroradiology, Poznan University of Medical Science, 61-701 Poznan, Poland;
| | - Joanna Kaźmierska
- Department of Electroradiology, Poznan University of Medical Science, 61-701 Poznan, Poland;
- 2nd Radiotherapy Department, Greater Poland Cancer Center, 61-866 Poznan, Poland
| | - Andrzej Marszałek
- Department of Oncologic Pathology and Prophylaxis, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (J.P.W.); (A.M.)
- Department of Tumor Pathology, Greater Poland Cancer Centre, 61-866 Poznan, Poland
| | - Anna Kubiak
- Greater Poland Cancer Registry, Greater Poland Cancer Centre, 61-866 Poznan, Poland;
| | - Pawel Golusinski
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora, 65-046 Zielona Góra, Poland;
| | - Wojciech Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Center, 61-866 Poznan, Poland; (W.G.); (E.M.)
| | - Ewa Majchrzak
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Center, 61-866 Poznan, Poland; (W.G.); (E.M.)
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Lin P, Min M, Lai K, Lee M, Holloway L, Xuan W, Bray V, Fowler A, Lee CS, Yong J. Mid-treatment Fluorodeoxyglucose Positron Emission Tomography in Human Papillomavirus-related Oropharyngeal Squamous Cell Carcinoma Treated with Primary Radiotherapy: Nodal Metabolic Response Rate can Predict Treatment Outcomes. Clin Oncol (R Coll Radiol) 2021; 33:e586-e598. [PMID: 34373179 DOI: 10.1016/j.clon.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 06/05/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
AIMS To evaluate whether biomarkers derived from fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) performed prior to (prePET) and during the third week (interim PET; iPET) of radiotherapy can predict treatment outcomes in human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPC). MATERIALS AND METHODS This retrospective analysis included 46 patients with newly diagnosed OPC treated with definitive (chemo)radiation and all patients had confirmed positive HPV status (HPV+OPC) based on p16 immunohistochemistry. The maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV) and total lesional glycolysis (TLG) of primary, index node (node with the highest TLG) and total lymph nodes and their median percentage (≥50%) reductions in iPET were analysed, and correlated with 5-year Kaplan-Meier and multivariable analyses (smoking, T4, N2b-3 and AJCC stage IV), including local failure-free survival, regional failure-free survival, locoregional failure-free survival (LRFFS), distant metastatic failure-free survival (DMFFS), disease-free survival (DFS) and overall survival. RESULTS There was no association of outcomes with prePET parameters observed on multivariate analysis. A complete metabolic response of primary tumour was seen in 13 patients; the negative predictive value for local failure was 100%. More than a 50% reduction in total nodal MTV provided the best predictor of outcomes, including LRFFS (88% versus 47.1%, P = 0.006, hazard ratio = 0.153) and DFS (78.2% versus 41.2%, P = 0.01, hazard ratio = 0.234). More than a 50% reduction in index node TLG was inversely related to DMFFS: a better nodal response was associated with a higher incidence of distant metastatic failure (66.7% versus 100%, P = 0.009, hazard ratio = 3.0). CONCLUSION The reduction (≥50%) of volumetric nodal metabolic burden can potentially identify a subgroup of HPV+OPC patients at low risk of locoregional failure but inversely at higher risk of distant metastatic failure and may have a role in individualised adaptive radiotherapy and systemic therapy.
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Affiliation(s)
- P Lin
- Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia.
| | - M Min
- Department of Radiation Oncology, Sunshine Coast University Hospital, Queensland, Australia; Faculty of Science, Health, Education and Engineering, University of Sunshine Coast, Queensland, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - K Lai
- Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia
| | - M Lee
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - L Holloway
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia; Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - W Xuan
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - V Bray
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - A Fowler
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - C S Lee
- South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia; School of Medicine, Western Sydney University, New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia; Central Clinical School, University of Sydney, New South Wales, Australia
| | - J Yong
- Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia
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11
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Rosen BS, Wilkie JR, Sun Y, Ibrahim M, Casper KA, Miller JE, Chotchutipan T, Stucken CL, Bradford C, Prince MEP, Rosko AJ, Malloy KM, McLean SA, Chinn SB, Shuman AG, Spector ME, Swiecicki PL, Worden FP, Shah JL, Schonewolf CA, Chapman CH, Eisbruch A, Mierzwa ML. CT and FDG-PET radiologic biomarkers in p16+ oropharyngeal squamous cell carcinoma patients treated with definitive chemoradiotherapy. Radiother Oncol 2020; 155:174-181. [PMID: 33069764 DOI: 10.1016/j.radonc.2020.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess associations between imaging biomarkers from standard of care pre-treatment CT and FDG-PET scans and locoregional (LR) and distant metastatic (DM) recurrences in patients with p16+ oropharyngeal squamous cell carcinoma (OPSCC) treated with definitive chemoradiotherapy (CRT). METHODS An institutional database from a single NCI-designated cancer center identified 266 patients with p16+ OPSCC treated with definitive CRT in our department from 2005 to 2016 with evaluable pre-treatment FDG-PET scans. Quantitative SUV metrics and qualitative imaging metrics were determined from FDG-PET and CT scans, while clinical characteristics were abstracted from the medical record. Associations between clinical/imaging features and time to LR (TTLRF) or DM (TTDMF) failure and overall survival (OS) were assessed using univariable Cox regression and penalized stepwise regression for multivariable analyses (MVA). RESULTS There were 27 LR and 32 DM recurrences as incident failures. Imaging biomarkers were significantly associated with TTLRF, TTDMF and OS. FDG-PET metrics outperformed CT and clinical metrics for TTLRF, with metabolic tumor volume being the only significant feature selected on MVA: C-index = 0.68 (p = 0.01). Radiographic extranodal extension (rENE), positive retropharyngeal nodes (RPN+), and clinical stage were significant on MVA for TTDMF: C-index = 0.84 (p < 0.001). rENE, group stage, and RPN+ were significant on MVA for OS: C-index = 0.77 (p < 0.001). CONCLUSIONS In the largest study to date of uniformly treated patients with CRT to evaluate both pretreatment CT and FDG-PET, radiographic biomarkers were significantly associated with TTLRF, TTDMF and OS among patients with p16+ OPSCC treated with CRT. CT metrics performed best to predict TTDMF, while FDG-PET metrics showed improved prediction for LRRFS. These metrics may help identify candidates for treatment intensification or de-escalation of therapy. STATEMENT OF TRANSLATIONAL RELEVANCE Pre-treatment imaging features from standard-of-care PET/CT imaging show promise for predicting long-term outcomes following HPV-associated oropharynx cancer (HPV-OPC) therapy. This study comprehensively characterizes qualitative and quantitative pre-treatment imaging metrics associated with time to pattern-specific failure in a cohort of 266 patients treated uniformly with definitive chemoradiation. Multivariate analysis (MVA) for time to locoregional failure (TTLRF), time to distant metastatic failure (TTDMF), and overall survival (OS) was performed. FDG-PET metrics outperformed CT and clinical metrics for TTLRF. CT radiographic extranodal extension, positive retropharyngeal nodes, and stage strongly predicted TTDMF (combined C-index = 0.84, log rank p < 0.001). Number of smoking pack-years complemented clinical and imaging features only in patients without radiographic extranodal extension or positive retropharyngeal nodes. Time to pattern-specific failure is important for guiding treatment de-escalation strategies, which intend to reduce treatment-related toxicity in patients with relatively long expected survival times. This study suggests that PET/CT features should play a crucial role in future de-escalation trials and management of HPV-OPC patients.
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Affiliation(s)
- Benjamin S Rosen
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, United States.
| | - Joel R Wilkie
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, United States
| | - Yilun Sun
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, United States; Department of Biostatistics, University of Michigan, Ann Arbor, MI, Uninet States
| | - Mohannad Ibrahim
- Department of Radiology, Division of Neuroradiology, Michigan Medicine, Ann Arbor, United States
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, United States
| | - Jessa E Miller
- Department of Head and Neck Surgery, UCLA, Los Angeles, United States
| | - Thong Chotchutipan
- Department of Radiation Oncology, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, United States
| | - Carol Bradford
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, United States
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, United States
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, United States
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, United States
| | - Scott A McLean
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, United States
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, United States
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, United States
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, United States
| | - Paul L Swiecicki
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, United States; U.S. Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, United States
| | - Francis P Worden
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, United States
| | - Jennifer L Shah
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, United States
| | | | - Christina H Chapman
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, United States; U.S. Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, United States
| | - Avraham Eisbruch
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, United States
| | - Michelle L Mierzwa
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, United States
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12
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PET/CT radiomics signature of human papilloma virus association in oropharyngeal squamous cell carcinoma. Eur J Nucl Med Mol Imaging 2020; 47:2978-2991. [DOI: 10.1007/s00259-020-04839-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/24/2020] [Indexed: 01/02/2023]
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13
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Moan JM, Amdal CD, Malinen E, Svestad JG, Bogsrud TV, Dale E. The prognostic role of 18F-fluorodeoxyglucose PET in head and neck cancer depends on HPV status. Radiother Oncol 2019; 140:54-61. [DOI: 10.1016/j.radonc.2019.05.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 11/25/2022]
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14
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Gouw ZAR, La Fontaine MD, van Kranen S, van de Kamer JB, Vogel WV, van Werkhoven E, Sonke JJ, Al-Mamgani A. The Prognostic Value of Baseline 18F-FDG PET/CT in Human Papillomavirus–Positive Versus Human Papillomavirus–Negative Patients With Oropharyngeal Cancer. Clin Nucl Med 2019; 44:e323-e328. [DOI: 10.1097/rlu.0000000000002531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Yang F, Yin Y, Li P, Zhang X, Chen D, Liu Y, Wang J, Guo L. Prevalence of human papillomavirus type-18 in head and neck cancer among the Chinese population: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2019; 98:e14551. [PMID: 30813166 PMCID: PMC6408054 DOI: 10.1097/md.0000000000014551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND China has a high burden of head and neck cancer globally and oncogenic human papillomavirus (HPV) has been hypothesized as a risk factor for head and neck cancer, but research was absent for establishing HPV prevalence in China. We aimed to conduct a meta-analysis to estimate the high-risk HPV-18 prevalence of head and neck cancer in the Chinese population. METHODS This meta-analysis was reported following the guideline of PRISMA. The reports on HPV and head and neck cancer in a Chinese population published between Jan 1, 2006 and May 31, 2018 were retrieved via CNKI/WANFANG/MEDLINE/EMBASE/COCHRANE databases. A random-effect model was used to calculate pooled prevalence and corresponding 95% confidence intervals. RESULTS A total of 1881 head and neck cancer cases from 19 studies were included in this meta-analysis. Overall, the pooled HPV-18 prevalence among head and neck cancer cases was 6.0% (4.1%-7.9%) in China, 31.2% (13.0%-49.4%) in laryngeal cancer, 7.2% (3.9%-10.5%) in oral cancer and 0.6% (0.0%-1.3%) in oropharyngeal cancer, 18.7% (6.2%-31.2%) in fresh or frozen biopsies and 4.3% (2.5%-6.1%) in paraffin-embedded fixed biopsies, 29.5% (15.6%-43.3%) by E6/E7 region and 3.9% (0.5%-7.4%) by L1 region of HPV gene. The highest HPV-18 prevalence was found in Central China. CONCLUSIONS High prevalence of HPV-18 was found in the samples of Chinese head and neck cancers. Prophylactic HPV-vaccination may reduce the burden of HPV-related head and neck cancer in China.
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Affiliation(s)
- Funa Yang
- Nursing Department, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou
| | - Yulin Yin
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Peng Li
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou
| | - Xiaojun Zhang
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou
| | - Defeng Chen
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou
| | - Yang Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Jian Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Lanwei Guo
- Henan Office for Cancer Control and Research
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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16
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Chotchutipan T, Rosen BS, Hawkins PG, Lee JY, Saripalli AL, Thakkar D, Eisbruch A, El Naqa I, Mierzwa ML. Volumetric 18 F-FDG-PET parameters as predictors of locoregional failure in low-risk HPV-related oropharyngeal cancer after definitive chemoradiation therapy. Head Neck 2018; 41:366-373. [PMID: 30548704 DOI: 10.1002/hed.25505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/16/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We sought to investigate the prognostic value of volumetric positron emission tomography (PET) parameters in patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) and a ≤10 pack-year smoking history treated with chemoradiation. METHODS A total of 142 patients were included. Maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of the primary tumor, involved regional lymph nodes, and total lesion were calculated. Cox proportional hazard modeling was used to evaluate associations of clinical and PET parameters with locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), and overall survival (OS). RESULTS On univariate analysis, volumetric PET parameters were significantly associated with all endpoints, and 8th edition American Joint Committee on Cancer/Union Internationale Contre le Cancer staging was significantly associated with DMFS and OS. On multivariate analysis, total lesion TLG was significantly associated with LRFFS, while staging was most significantly prognostic for DMFS and OS. CONCLUSION Volumetric PET parameters are uniquely prognostic of LRFFS in low-risk HPV-related OPSCC and may be useful for directing de-intensification strategies.
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Affiliation(s)
- Thong Chotchutipan
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, US.,Department of Radiation Oncology, Chulabhorn Hospital, HRH Princess Chulabhorn, College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Benjamin S Rosen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, US
| | - Peter G Hawkins
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, US
| | - Jae Y Lee
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, US.,Princeton Radiation Oncology, Princeton, New Jersey, US
| | - Anjali L Saripalli
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, US
| | - Dharmesh Thakkar
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, US
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, US
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, US
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, US
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17
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Guo L, Yang F, Yin Y, Liu S, Li P, Zhang X, Chen D, Liu Y, Wang J, Wang K, Zhu Y, Lv Q, Wang X, Sun X. Prevalence of Human Papillomavirus Type-16 in Head and Neck Cancer Among the Chinese Population: A Meta-Analysis. Front Oncol 2018; 8:619. [PMID: 30619756 PMCID: PMC6299118 DOI: 10.3389/fonc.2018.00619] [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: 09/12/2018] [Accepted: 11/29/2018] [Indexed: 12/11/2022] Open
Abstract
Background: The burden of head and neck cancer in China is heavier, and studies have shown that it may be associated with HPV infection, especially high-risk HPV. Objectives: We aimed to conduct a meta-analysis to estimate the high-risk HPV-16 prevalence of head and neck cancer in the Chinese population. Methods: The reports on HPV and head and neck cancer in a Chinese population published between Jan 1, 2006 and Oct 23, 2018 were retrieved via WANFANG/CNKI/MEDLINE/EMBASE databases. The pooled prevalence and corresponding 95% confidence intervals was calculated by a random-effect model. Results: The meta-analysis included a total of 2,896 head and neck cancer cases from 28 studies. Overall, the pooled HPV-16 prevalence among head and neck cancer cases was 24.7% (20.2-29.3%) in China, 31.6% (21.7-41.5%) in oropharyngeal cancer, 28.5% (18.2-38.7%) in laryngeal cancer and 14.9% (10.1-19.7%) in oral cancer, 25.3% (14.8-35.8%) in fresh or frozen biopsies and 25.0% (19.5-30.5%) in paraffin-embedded fixed biopsies, 36.5% (17.9-55.1%) by E6/E7 region and 14.3% (6.4-22.1%) by L1 region of HPV gene. The highest HPV-16 prevalence was found in Central China. Conclusions: High prevalence of HPV-16 was found in the samples of Chinese head and neck cancers. Preventive HPV-vaccination may reduce the burden of HPV-related head and neck cancer in China.
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Affiliation(s)
- Lanwei Guo
- Henan Office for Cancer Control and Research, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.,Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Funa Yang
- Nursing Department, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yulin Yin
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuzheng Liu
- Henan Office for Cancer Control and Research, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Peng Li
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Xiaojun Zhang
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Defeng Chen
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yang Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiming Zhu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Lv
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyu Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xibin Sun
- Henan Office for Cancer Control and Research, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
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18
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Survival for HPV-positive oropharyngeal squamous cell carcinoma with surgical versus non-surgical treatment approach: A systematic review and meta-analysis. Oral Oncol 2018; 86:121-131. [DOI: 10.1016/j.oraloncology.2018.09.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 02/07/2023]
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19
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Radiomic Profiling of Head and Neck Cancer: 18F-FDG PET Texture Analysis as Predictor of Patient Survival. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:3574310. [PMID: 30363632 PMCID: PMC6180924 DOI: 10.1155/2018/3574310] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/26/2018] [Indexed: 02/07/2023]
Abstract
Background and Purpose The accurate prediction of prognosis and pattern of failure is crucial for optimizing treatment strategies for patients with cancer, and early evidence suggests that image texture analysis has great potential in predicting outcome both in terms of local control and treatment toxicity. The aim of this study was to assess the value of pretreatment 18F-FDG PET texture analysis for the prediction of treatment failure in primary head and neck squamous cell carcinoma (HNSCC) treated with concurrent chemoradiation therapy. Methods We performed a retrospective analysis of 90 patients diagnosed with primary HNSCC treated between January 2010 and June 2017 with concurrent chemo-radiotherapy. All patients underwent 18F-FDG PET/CT before treatment. 18F-FDG PET/CT texture features of the whole primary tumor were measured using an open-source texture analysis package. Least absolute shrinkage and selection operator (LASSO) was employed to select the features that are associated the most with clinical outcome, as progression-free survival and overall survival. We performed a univariate and multivariate analysis between all the relevant texture parameters and local failure, adjusting for age, sex, smoking, primary tumor site, and primary tumor stage. Harrell c-index was employed to score the predictive power of the multivariate cox regression models. Results Twenty patients (22.2%) developed local failure, whereas the remaining 70 (77.8%) achieved durable local control. Multivariate analysis revealed that one feature, defined as low-intensity long-run emphasis (LILRE), was a significant predictor of outcome regardless of clinical variables (hazard ratio < 0.001, P=0.001).The multivariate model based on imaging biomarkers resulted superior in predicting local failure with a c-index of 0.76 against 0.65 of the model based on clinical variables alone. Conclusion LILRE, evaluated on pretreatment 18F-FDG PET/CT, is associated with higher local failure in patients with HNSCC treated with chemoradiotherapy. Using texture analysis in addition to clinical variables may be useful in predicting local control.
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20
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Han M, Lee S, Lee D, Kim S, Choi J. Correlation of human papilloma virus status with quantitative perfusion/diffusion/metabolic imaging parameters in the oral cavity and oropharyngeal squamous cell carcinoma: comparison of primary tumour sites and metastatic lymph nodes. Clin Radiol 2018; 73:757.e21-757.e27. [DOI: 10.1016/j.crad.2018.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 04/11/2018] [Indexed: 12/26/2022]
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21
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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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22
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Mucientes J, Calles L, Rodríguez B, Mitjavila M. Parameters of metabolic quantification in clinical practice. Is it now time to include them in reports? Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Lewis JS, Beadle B, Bishop JA, Chernock RD, Colasacco C, Lacchetti C, Moncur JT, Rocco JW, Schwartz MR, Seethala RR, Thomas NE, Westra WH, Faquin WC. Human Papillomavirus Testing in Head and Neck Carcinomas: Guideline From the College of American Pathologists. Arch Pathol Lab Med 2018; 142:559-597. [PMID: 29251996 DOI: 10.5858/arpa.2017-0286-cp] [Citation(s) in RCA: 329] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context Human papillomavirus (HPV) is a major cause of oropharyngeal squamous cell carcinomas, and HPV (and/or surrogate marker p16) status has emerged as a prognostic marker that significantly impacts clinical management. There is no current consensus on when to test oropharyngeal squamous cell carcinomas for HPV/p16 or on which tests to choose. Objective To develop evidence-based recommendations for the testing, application, interpretation, and reporting of HPV and surrogate marker tests in head and neck carcinomas. Design The College of American Pathologists convened a panel of experts in head and neck and molecular pathology, as well as surgical, medical, and radiation oncology, to develop recommendations. A systematic review of the literature was conducted to address 6 key questions. Final recommendations were derived from strength of evidence, open comment period feedback, and expert panel consensus. Results The major recommendations include (1) testing newly diagnosed oropharyngeal squamous cell carcinoma patients for high-risk HPV, either from the primary tumor or from cervical nodal metastases, using p16 immunohistochemistry with a 70% nuclear and cytoplasmic staining cutoff, and (2) not routinely testing nonsquamous oropharyngeal carcinomas or nonoropharyngeal carcinomas for HPV. Pathologists are to report tumors as HPV positive or p16 positive. Guidelines are provided for testing cytologic samples and handling of locoregional and distant recurrence specimens. Conclusions Based on the systematic review and on expert panel consensus, high-risk HPV testing is recommended for all new oropharyngeal squamous cell carcinoma patients, but not routinely recommended for other head and neck carcinomas.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - William C Faquin
- From the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Lewis); the Department of Radiation Oncology, Stanford University Medical Center, Palo Alto, California (Dr Beadle); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Drs Bishop and Westra); the Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri (Dr Chernock); Surveys, the College of American Pathologists, Northfield, Illinois (Mss Colasacco and Thomas); Policy and Advocacy, American Society of Clinical Oncology, Alexandria, Virginia (Ms Lacchetti); the Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Moncur); the Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexler Medical Center, Columbus (Dr Rocco); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Schwartz); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Seethala); and the Department of Pathology, Massachusetts General Hospital, Boston (Dr Faquin)
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24
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Mucientes J, Calles L, Rodríguez B, Mitjavila M. Parameters of metabolic quantification in clinical practice. Is it now time to include them in reports? Rev Esp Med Nucl Imagen Mol 2018; 37:264-270. [PMID: 29358053 DOI: 10.1016/j.remn.2017.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/07/2017] [Accepted: 12/13/2017] [Indexed: 12/16/2022]
Abstract
Qualitative techniques have traditionally been the standard for the diagnostic assessment with 18F-FDG PET studies. Since the introduction of the technique, quantitative parameters have been sought, more accurate and with better diagnostic precision, that may offer relevant information of the behavior, aggressiveness or prognosis of tumors. Nowadays, more and more studies with high quality evidence show the utility of other metabolic parameters different from the SUV maximum, which despite being widely used in clinical practice is controversial and many physicians still do not know its real meaning. The objective of this paper has been to review the key concepts of these metabolic parameters that could be relevant in normal practice in the future. It has been seen that there is more evidence in the complete evaluation of the metabolism of a lesion, through volumetric parameters that more adequately reflect the patient's tumor burden. Basically, these parameters calculate the volume of tumor that fulfills certain characteristics. A software available in the majority of the workstations has been used for this purpose and it has allowed to calculate these volumes using more or less complex criteria. The simplest threshold-based segmentation methods are available in most equipments, they are easy to calculate and they have been shown in many studies to have an important prognostic significance.
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Affiliation(s)
- J Mucientes
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España.
| | - L Calles
- Servicio de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - B Rodríguez
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - M Mitjavila
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
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25
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Yeh CH, Lin G, Wang JJ, Lin CY, Tsai SY, Lin YC, Wu YM, Ko SF, Wang HM, Chan SC, Yen TC, Liao CT, Ng SH. Predictive value of 1H MR spectroscopy and 18F-FDG PET/CT for local control of advanced oropharyngeal and hypopharyngeal squamous cell carcinoma receiving chemoradiotherapy: a prospective study. Oncotarget 2017; 8:115513-115525. [PMID: 29383178 PMCID: PMC5777790 DOI: 10.18632/oncotarget.23306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 12/05/2017] [Indexed: 01/30/2023] Open
Abstract
Purpose To determine whether pretreatment in vivo 1H magnetic resonance (MR) spectroscopy at 3 Tesla (T) and 18F-FDG PET/CT can offer predictive power regarding the local control of oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) patients. Materials and Methods 1H MR spectroscopy was performed in addition to conventional MR imaging before definitive chemoradiotherapy in 58 patients with advanced OHSCC. The relationship of local control with the 1H MR spectroscopy and 18F-FDG PET/CT parameters was analyzed. Results With a median follow-up of 17.6 months, 13 (22.4%) patients exhibited local failure; whereas the remaining 45 achieved local control. Kaplan-Meier analysis identified age > 60 years, creatine level on MRS ≦ 6.02 mM, glutamine and glutamate (Glx) level on MRS > 3.31 mM, and total lesion glycolysis (TLG) on 18F-FDG PET/CT > 217.18 g/mL × mL as significant adverse predictors for 2-year local control. Multivariate Cox regression analysis showed that age (p=0.017), Glx level on MRS (p=0.021), and TLG on 18F-FDG PET/CT (p=0.028) retained their independent prognostic significance. A scoring system was constructed based on the sum of these three factors. We found that patients with scores of 2-3 had significantly poorer local control rates than patients with scores of 0-1 (33.3% versus 86.8%, p=0.003). Conclusion We conclude that Glx on 1H MR spectroscopy at 3 T was the independent prognostic factor for local control of OHSCC patients treated with chemoradiotherapy, and its combination with age and TLG may help identify a subgroup of patients at high risk for developing local failure.
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Affiliation(s)
- Chih-Hua Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan.,Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan.,Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan.,Clinical Phenome Center and Imaging Core Lab, Institute for Radiological Research, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Jiun-Jie Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Yueh Tsai
- Graduate Institute of Applied Physics, National Chengchi University, Taipei, Taiwan
| | - Yu-Chun Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan.,Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ming Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan.,Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Sheung-Fat Ko
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Chieh Chan
- Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Nuclear Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Nuclear Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan.,Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
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26
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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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Rath TJ, Narayanan S, Hughes MA, Ferris RL, Chiosea SI, Branstetter BF. Solid Lymph Nodes as an Imaging Biomarker for Risk Stratification in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma. AJNR Am J Neuroradiol 2017; 38:1405-1410. [PMID: 28450437 DOI: 10.3174/ajnr.a5177] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/07/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Human papillomavirus-related oropharyngeal squamous cell carcinoma is associated with cystic lymph nodes on CT and has a favorable prognosis. A subset of patients with aggressive disease experience treatment failure. Our aim was to determine whether the extent of cystic lymph node burden on staging CT can serve as an imaging biomarker to predict treatment failure in human papillomavirus-related oropharyngeal squamous cell carcinoma. MATERIALS AND METHODS We identified patients with human papilloma virus-related oropharyngeal squamous cell carcinoma and staging neck CTs. Demographic and clinical variables were recorded. We retrospectively classified the metastatic lymph node burden on CT as cystic or solid and assessed radiologic extracapsular spread. Biopsy, subsequent imaging, or clinical follow-up was the reference standard for treatment failure. The primary end point was disease-free survival. Cox proportional hazard regression analyses of clinical, demographic, and anatomic variables for treatment failure were performed. RESULTS One hundred eighty-three patients were included with a mean follow-up of 38 months. In univariate analysis, the following variables had a statistically significant association with treatment failure: solid-versus-cystic lymph nodes, clinical T-stage, clinical N-stage, and radiologic evidence of extracapsular spread. The multivariate Cox proportional hazard model resulted in a model that included solid-versus-cystic lymph nodes, T-stage, and radiologic evidence of extracapsular spread as independent predictors of treatment failure. Patients with cystic nodal metastasis at staging had significantly better disease-free survival than patients with solid lymph nodes. CONCLUSIONS In human papilloma virus-related oropharyngeal squamous cell carcinoma, patients with solid lymph node metastases are at higher risk for treatment failure with worse disease-free survival. Solid lymph nodes may serve as an imaging biomarker to tailor individual treatment regimens.
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Affiliation(s)
- T J Rath
- From the Departments of Radiology (T.J.R., M.A.H., B.F.B.) .,Otolaryngology (T.J.R., M.A.H., R.L.F., B.F.B.)
| | - S Narayanan
- Department of Radiology (S.N.), Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - M A Hughes
- From the Departments of Radiology (T.J.R., M.A.H., B.F.B.).,Otolaryngology (T.J.R., M.A.H., R.L.F., B.F.B.)
| | - R L Ferris
- Otolaryngology (T.J.R., M.A.H., R.L.F., B.F.B.)
| | - S I Chiosea
- Pathology (S.I.C.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - B F Branstetter
- From the Departments of Radiology (T.J.R., M.A.H., B.F.B.).,Otolaryngology (T.J.R., M.A.H., R.L.F., B.F.B.)
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28
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Mena E, Thippsandra S, Yanamadala A, Redy S, Pattanayak P, Subramaniam RM. Molecular Imaging and Precision Medicine in Head and Neck Cancer. PET Clin 2016; 12:7-25. [PMID: 27863568 DOI: 10.1016/j.cpet.2016.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The concept of using tumor genomic profiling information has revolutionized personalized cancer treatment. Head and neck (HN) cancer management is being influenced by recent discoveries of activating mutations in epidermal growth factor receptor and related targeted therapies with tyrosine kinase inhibitors, targeted therapies for Kristen Rat Sarcoma, and MET proto-oncogenes. Molecular imaging using PET plays an important role in assessing the biologic behavior of HN cancer with the goal of delivering individualized cancer treatment. This review summarizes recent genomic discoveries in HN cancer and their implications for functional PET imaging in assessing response to targeted therapies, and drug resistance mechanisms.
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Affiliation(s)
- Esther Mena
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Shwetha Thippsandra
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Anusha Yanamadala
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Siddaling Redy
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Puskar Pattanayak
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Rathan M Subramaniam
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA; Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9096, USA; Department of Biomedical Engineering, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8896, USA; Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8896, USA.
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Cammaroto G, Quartuccio N, Sindoni A, Di Mauro F, Caobelli F. The role of PET/CT in the management of patients affected by head and neck tumors: a review of the literature. Eur Arch Otorhinolaryngol 2016; 273:1961-73. [PMID: 25971995 DOI: 10.1007/s00405-015-3651-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/06/2015] [Indexed: 02/07/2023]
Abstract
The management of head and neck tumor (HNSCC) has been changing over the years, especially due to the aid of imaging techniques that help physicians to attain a correct diagnosis. These techniques represent a valuable tool to help tailor treatment and during follow-up of patients affected by malignancies. The aim of this review is to summarize the results of the most recent and relevant studies about the use of PET imaging in HNSCCs. This review is divided into six chapters: (1) The role of PET/CT in the pre-treatment phase; (2) PET/CT and radiotherapy planning; (3) PET/CT in the post-treatment setting; (4) PET/CT and SUVmax for prediction of prognosis; (5) miscellanea on the utility of PET in specific HNSCCs; (6) non-FDG PET tracers used in HNSCC. Promising results have been obtained so far. Despite the encouraging outcomes, more investigations are needed to warrant the value of this technique, especially in the pre-treatment setting.
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Affiliation(s)
- Giovanni Cammaroto
- Department of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Natale Quartuccio
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Alessandro Sindoni
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Francesca Di Mauro
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
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30
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Kim KH, Lee J, Chang JS, Lee CG, Yun M, Choi EC, Kim SH, Keum KC. Prognostic value of FDG-PET volumetric parameters in patients with p16-positive oropharyngeal squamous cell carcinoma who received curative resection followed by postoperative radiotherapy or chemoradiotherapy. Head Neck 2016; 38:1515-24. [DOI: 10.1002/hed.24465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Jeongshim Lee
- Department of Radiation Oncology, Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Republic of Korea
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31
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Ng SH, Liao CT, Lin CY, Chan SC, Lin YC, Yen TC, Chang JTC, Ko SF, Fan KH, Wang HM, Yang LY, Wang JJ. Dynamic contrast-enhanced MRI, diffusion-weighted MRI and 18F-FDG PET/CT for the prediction of survival in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiation. Eur Radiol 2016; 26:4162-4172. [PMID: 26911889 DOI: 10.1007/s00330-016-4276-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We prospectively investigated the roles of pretreatment dynamic contrast-enhanced MR imaging (DCE-MRI), diffusion-weighted MR imaging (DWI) and 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG PET)/CT for predicting survival of oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC) patients treated with chemoradiation. METHODS Patients with histologically proven OHSCC and neck nodal metastases scheduled for chemoradiation were eligible. Clinical variables as well as DCE-MRI-, DWI- and 18F-FDG PET/CT-derived parameters of the primary tumours and metastatic neck nodes were analysed in relation to 3-year progression-free survival (PFS) and overall survival (OS) rates. RESULTS Eighty-six patients were available for analysis. Multivariate analysis identified the efflux rate constant (K ep)-tumour < 3.79 min-1 (P = 0.001), relative volume of extracellular extravascular space (V e)-node < 0.23 (P = 0.004) and SUVmax-tumour > 19.44 (P = 0.025) as independent risk factors for both PFS and OS. A scoring system based upon the sum of each of the three imaging parameters allowed stratification of our patients into three groups (patients with 0/1 factor, patients with 2 factors and patients with 3 factors, respectively) with distinct PFS (3-year rates = 72 %, 38 % and 0 %, P < 0.0001) and OS (3-year rates = 81 %, 46 % and 20 %, P < 0.0001). CONCLUSIONS K ep-tumour, V e-node and SUVmax-tumour were independent prognosticators for OHSCC treated with chemoradiation. Their combination helped survival stratification. KEY POINTS • K ep -tumour, V e -node and SUV max -tumour are independent predictors of survival rates. • The combination of these three prognosticators may help stratification of survival. • MRI and FDG-PET/CT play complementary roles in prognostication of head and neck cancer.
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Affiliation(s)
- Shu-Hang Ng
- Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, 259 Wen Hua 1st Road, Kueishan, Taoyuan, 333, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Sheng-Chieh Chan
- Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Yu-Chun Lin
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, 259 Wen Hua 1st Road, Kueishan, Taoyuan, 333, Taiwan
| | - Tzu-Chen Yen
- Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Sheung-Fat Ko
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Biostatistics and Informatics Unit, Chang Gung Memorial Hospital, Chang Gung University, Kueishan, Taoyuan, Taiwan
| | - Jiun-Jie Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung Memorial Hospital, Chang Gung University, 259 Wen Hua 1st Road, Kueishan, Taoyuan, 333, Taiwan.
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan.
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University / Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
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32
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18F-FDG PET/CT quantification in head and neck squamous cell cancer: principles, technical issues and clinical applications. Eur J Nucl Med Mol Imaging 2016; 43:1360-75. [DOI: 10.1007/s00259-015-3294-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/14/2015] [Indexed: 01/28/2023]
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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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18F-FDG PET/CT as a semiquantitative imaging marker in HPV-p16-positive oropharyngeal squamous cell cancers. Nucl Med Commun 2015; 36:16-20. [DOI: 10.1097/mnm.0000000000000208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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35
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Cheng NM, Fang YHD, Lee LY, Chang JTC, Tsan DL, Ng SH, Wang HM, Liao CT, Yang LY, Hsu CH, Yen TC. Zone-size nonuniformity of 18F-FDG PET regional textural features predicts survival in patients with oropharyngeal cancer. Eur J Nucl Med Mol Imaging 2014; 42:419-28. [PMID: 25339524 DOI: 10.1007/s00259-014-2933-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/02/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE The question as to whether the regional textural features extracted from PET images predict prognosis in oropharyngeal squamous cell carcinoma (OPSCC) remains open. In this study, we investigated the prognostic impact of regional heterogeneity in patients with T3/T4 OPSCC. METHODS We retrospectively reviewed the records of 88 patients with T3 or T4 OPSCC who had completed primary therapy. Progression-free survival (PFS) and disease-specific survival (DSS) were the main outcome measures. In an exploratory analysis, a standardized uptake value of 2.5 (SUV 2.5) was taken as the cut-off value for the detection of tumour boundaries. A fixed threshold at 42 % of the maximum SUV (SUVmax 42 %) and an adaptive threshold method were then used for validation. Regional textural features were extracted from pretreatment (18)F-FDG PET/CT images using the grey-level run length encoding method and grey-level size zone matrix. The prognostic significance of PET textural features was examined using receiver operating characteristic (ROC) curves and Cox regression analysis. RESULTS Zone-size nonuniformity (ZSNU) was identified as an independent predictor of PFS and DSS. Its prognostic impact was confirmed using both the SUVmax 42 % and the adaptive threshold segmentation methods. Based on (1) total lesion glycolysis, (2) uniformity (a local scale texture parameter), and (3) ZSNU, we devised a prognostic stratification system that allowed the identification of four distinct risk groups. The model combining the three prognostic parameters showed a higher predictive value than each variable alone. CONCLUSION ZSNU is an independent predictor of outcome in patients with advanced T-stage OPSCC, and may improve their prognostic stratification.
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Affiliation(s)
- Nai-Ming Cheng
- Departments of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taiyuan, Taiwan
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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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Rasmussen JH, Vogelius IR, Fischer BM, Friborg J, Aznar MC, Persson GF, Håkansson K, Kristensen CA, Bentzen SM, Specht L. Prognostic value of 18F-fludeoxyglucose uptake in 287 patients with head and neck squamous cell carcinoma. Head Neck 2014; 37:1274-81. [DOI: 10.1002/hed.23745] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/05/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jacob H. Rasmussen
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Ivan R. Vogelius
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Barbara M. Fischer
- PET and Cyclotron Unit; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Jeppe Friborg
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Marianne C. Aznar
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Gitte F. Persson
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Katrin Håkansson
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Claus A. Kristensen
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Søren M. Bentzen
- Division of Biostatistics and Bioinformatics; University of Maryland Greenebaum Cancer Center, and Department of Epidemiology and Public Health, University of Maryland School of Medicine; Baltimore Maryland
| | - Lena Specht
- Department of Oncology; Section of Radiotherapy, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
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Hanamoto A, Tatsumi M, Takenaka Y, Hamasaki T, Yasui T, Nakahara S, Yamamoto Y, Seo Y, Isohashi F, Ogawa K, Hatazawa J, Inohara H. Volumetric PET/CT parameters predict local response of head and neck squamous cell carcinoma to chemoradiotherapy. Cancer Med 2014; 3:1368-76. [PMID: 25045041 PMCID: PMC4302687 DOI: 10.1002/cam4.295] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/09/2014] [Accepted: 06/09/2014] [Indexed: 11/25/2022] Open
Abstract
It is not well established whether pretreatment 18F-FDG PET/CT can predict local response of head and neck squamous cell carcinoma (HNSCC) to chemoradiotherapy (CRT). We examined 118 patients: 11 with nasopharyngeal cancer (NPC), 30 with oropharyngeal cancer (OPC), and 77 with laryngohypopharyngeal cancer (LHC) who had completed CRT. PET/CT parameters of primary tumor, including metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum and mean standardized uptake value (SUVmax and SUVmean), were correlated with local response, according to primary site and human papillomavirus (HPV) status. Receiver-operating characteristic analyses were made to access predictive values of the PET/CT parameters, while logistic regression analyses were used to identify independent predictors. Area under the curve (AUC) of the PET/CT parameters ranged from 0.53 to 0.63 in NPC and from 0.50 to 0.54 in OPC. HPV-negative OPC showed AUC ranging from 0.51 to 0.58, while all of HPV-positive OPCs showed complete response. In contrast, AUC ranged from 0.71 to 0.90 in LHC. Moreover, AUCs of MTV and TLG were significantly higher than those of SUVmax and SUVmean (P < 0.01). After multivariate analysis, high MTV >25.0 mL and high TLG >144.8 g remained as independent, significant predictors of incomplete response compared with low MTV (odds ratio [OR], 13.4; 95% confidence interval [CI], 2.5–72.9; P = 0.003) and low TLG (OR, 12.8; 95% CI, 2.4–67.9; P = 0.003), respectively. In conclusion, predictive efficacy of pretreatment 18F-FDG PET/CT varies with different primary sites and chosen parameters. Local response of LHC is highly predictable by volume-based PET/CT parameters.
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Affiliation(s)
- Atsushi Hanamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka, Japan
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Hasbek Z, Yucel B, Salk I, Turgut B, Erselcan T, Babacan NA, Kacan T. Potential impact of atelectasis and primary tumor glycolysis on F-18 FDG PET/CT on survival in lung cancer patients. Asian Pac J Cancer Prev 2014; 15:4085-9. [PMID: 24935601 DOI: 10.7314/apjcp.2014.15.9.4085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atelectasis is an important prognostic factor that can cause pleuritic chest pain, coughing or dyspnea, and even may be a cause of death. In this study, we aimed to investigate the potential impact of atelectasis and PET parameters on survival and the relation between atelectasis and PET parameters. MATERIALS AND METHODS The study consisted of patients with lung cancer with or without atelectasis who underwent (18)F-FDG PET/CT examination before receiving any treatment. (18)F-FDG PET/CT derived parameters including tumor size, SUVmax, SUVmean, MTV, total lesion glycosis (TLG), SUV mean of atelectasis area, atelectasis volume, and histological and TNM stage were considered as potential prognostic factors for overall survival. RESULTS Fifty consecutive lung cancer patients (22 patients with atelectasis and 28 patients without atelectasis, median age of 65 years) were evaluated in the present study. There was no relationship between tumor size and presence or absence of atelectasis, nor between presence/absence of atelectasis and TLG of primary tumors. The overall one-year survival rate was 83% and median survival was 20 months (n=22) in the presence of atelectasis; the overall one-year survival rate was 65.7% (n=28) and median survival was 16 months (p=0.138) in the absence of atelectasis. With respect to PFS; the one-year survival rate of AT+ patients was 81.8% and median survival was 19 months; the one-year survival rate of AT- patients was 64.3% and median survival was 16 months (p=0.159). According to univariate analysis, MTV, TLG and tumor size were significant risk factors for PFS and OS (p<0.05). However, SUVmax was not a significant factor for PFS and OS (p>0.05). CONCLUSIONS The present study suggested that total lesion glycolysis and metabolic tumor volume were important predictors of survival in lung cancer patients, in contrast to SUVmax. In addition, having a segmental lung atelectasis seems not to be a significant factor on survival.
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Affiliation(s)
- Zekiye Hasbek
- Department of Nuclear Medicine, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey E-mail :
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Tan S, Zhang H, Zhang Y, Chen W, D'Souza WD, Lu W. Predicting pathologic tumor response to chemoradiotherapy with histogram distances characterizing longitudinal changes in 18F-FDG uptake patterns. Med Phys 2014; 40:101707. [PMID: 24089897 DOI: 10.1118/1.4820445] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE A family of fluorine-18 ((18)F)-fluorodeoxyglucose ((18)F-FDG) positron-emission tomography (PET) features based on histogram distances is proposed for predicting pathologic tumor response to neoadjuvant chemoradiotherapy (CRT). These features describe the longitudinal change of FDG uptake distribution within a tumor. METHODS Twenty patients with esophageal cancer treated with CRT plus surgery were included in this study. All patients underwent PET/CT scans before (pre-) and after (post-) CRT. The two scans were first rigidly registered, and the original tumor sites were then manually delineated on the pre-PET/CT by an experienced nuclear medicine physician. Two histograms representing the FDG uptake distribution were extracted from the pre- and the registered post-PET images, respectively, both within the delineated tumor. Distances between the two histograms quantify longitudinal changes in FDG uptake distribution resulting from CRT, and thus are potential predictors of tumor response. A total of 19 histogram distances were examined and compared to both traditional PET response measures and Haralick texture features. Receiver operating characteristic analyses and Mann-Whitney U test were performed to assess their predictive ability. RESULTS Among all tested histogram distances, seven bin-to-bin and seven crossbin distances outperformed traditional PET response measures using maximum standardized uptake value (AUC = 0.70) or total lesion glycolysis (AUC = 0.80). The seven bin-to-bin distances were: L(2) distance (AUC = 0.84), χ(2) distance (AUC = 0.83), intersection distance (AUC = 0.82), cosine distance (AUC = 0.83), squared Euclidean distance (AUC = 0.83), L(1) distance (AUC = 0.82), and Jeffrey distance (AUC = 0.82). The seven crossbin distances were: quadratic-chi distance (AUC = 0.89), earth mover distance (AUC = 0.86), fast earth mover distance (AUC = 0.86), diffusion distance (AUC = 0.88), Kolmogorov-Smirnov distance (AUC = 0.88), quadratic form distance (AUC = 0.87), and match distance (AUC = 0.84). These crossbin histogram distance features showed slightly higher prediction accuracy than texture features on post-PET images. CONCLUSIONS The results suggest that longitudinal patterns in (18)F-FDG uptake characterized using histogram distances provide useful information for predicting the pathologic response of esophageal cancer to CRT.
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Affiliation(s)
- Shan Tan
- Key Laboratory of Image Processing and Intelligent Control of Ministry of Education of China, School of Automation, Huazhong University of Science and Technology, Wuhan 430074, China and Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201
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Subramaniam RM, Alluri KC, Tahari AK, Aygun N, Quon H. PET/CT Imaging and Human Papilloma Virus–Positive Oropharyngeal Squamous Cell Cancer: Evolving Clinical Imaging Paradigm. J Nucl Med 2014; 55:431-8. [DOI: 10.2967/jnumed.113.125542] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Cheng NM, Fang YHD, Chang JTC, Huang CG, Tsan DL, Ng SH, Wang HM, Lin CY, Liao CT, Yen TC. Textural features of pretreatment 18F-FDG PET/CT images: prognostic significance in patients with advanced T-stage oropharyngeal squamous cell carcinoma. J Nucl Med 2013; 54:1703-9. [PMID: 24042030 DOI: 10.2967/jnumed.112.119289] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Previous studies have shown that total lesion glycolysis (TLG) may serve as a prognostic indicator in oropharyngeal squamous cell carcinoma (OPSCC). We sought to investigate whether the textural features of pretreatment (18)F-FDG PET/CT images can provide any additional prognostic information over TLG and clinical staging in patients with advanced T-stage OPSCC. METHODS We retrospectively analyzed the pretreatment (18)F-FDG PET/CT images of 70 patients with advanced T-stage OPSCC who had completed concurrent chemoradiotherapy, bioradiotherapy, or radiotherapy with curative intent. All of the patients had data on human papillomavirus (HPV) infection and were followed up for at least 24 mo or until death. A standardized uptake value (SUV) of 2.5 was taken as a cutoff for tumor boundary. The textural features of pretreatment (18)F-FDG PET/CT images were extracted from histogram analysis (SUV variance and SUV entropy), normalized gray-level cooccurrence matrix (uniformity, entropy, dissimilarity, contrast, homogeneity, inverse different moment, and correlation), and neighborhood gray-tone difference matrix (coarseness, contrast, busyness, complexity, and strength). Receiver-operating-characteristic curves were used to identify the optimal cutoff values for the textural features and TLG. RESULTS Thirteen patients were HPV-positive. Multivariate Cox regression analysis showed that age, tumor TLG, and uniformity were independently associated with progression-free survival (PFS) and disease-specific survival (DSS). TLG, uniformity, and HPV positivity were significantly associated with overall survival (OS). A prognostic scoring system based on TLG and uniformity was derived. Patients who presented with TLG > 121.9 g and uniformity ≤ 0.138 experienced significantly worse PFS, DSS, and OS rates than those without (P < 0.001, < 0.001, and 0.002, respectively). Patients with TLG > 121.9 g or uniformity ≤ 0.138 were further divided according to age, and different PFS and DSS were observed. CONCLUSION Uniformity extracted from the normalized gray-level cooccurrence matrix represents an independent prognostic predictor in patients with advanced T-stage OPSCC. A scoring system was developed and may serve as a risk-stratification strategy for guiding therapy.
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Affiliation(s)
- Nai-Ming Cheng
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Paidpally V, Chirindel A, Lam S, Agrawal N, Quon H, Subramaniam RM. FDG-PET/CT imaging biomarkers in head and neck squamous cell carcinoma. ACTA ACUST UNITED AC 2012; 4:633-647. [PMID: 23482696 DOI: 10.2217/iim.12.60] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article discusses the value of 18F-fluoro-2-deoxyglucose PET/CT imaging biomarkers in head and neck squamous cell carcinoma. 18F-fluoro-2-deoxyglucose PET/CT is valuable at baseline staging, radiotherapy planning, therapy response assessment and in the follow-up of patients with head and neck squamous cell carcinoma. Maximum and peak standardized uptake value (SUVmax and SUVpeak), metabolic tumor volume and total lesion glycolysis are the common 18F-fluoro-2-deoxyglucose quantitative parameters that have been studied, along with qualitative assessments. These parameters will be evaluated with respect to their established or potential role as noninvasive biomarkers for patient risk stratification, treatment response and survival outcome.
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Affiliation(s)
- Vasavi Paidpally
- Russel H Morgan Department of Radiology & Radiology Science, Johns Hopkins Medical Institutions, 601 North Caroline Street/JHOC 3235, Baltimore, MD 21287, USA
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