FDG uptake after intraarterial chemotherapy in head and neck cancer

N. Döbert; A. F. Kovács; C. Menzel; K. Engels; W. T. Kranert; F. Grünwald

doi:10.1055/s-0038-1625123

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2006; 45(06): 243-247
DOI: 10.1055/s-0038-1625123

Originalarbeiten – Original Articles

Schattauer GmbH

FDG uptake after intraarterial chemotherapy in head and neck cancer

FDG-Aufnahme nach intraarterieller Chemotherapie bei Kopf-Hals-Tumoren

N. Döbert

¹Department of Nuclear Medicine

⁴Gemeinschaftspraxis Nuklearmedizin, Darmstadt, Germany

,

A. F. Kovács

²Department of Maxillofacial Plastic Surgery

,

C. Menzel

¹Department of Nuclear Medicine

,

K. Engels

³Senckenberg Department of Pathology, University Hospital Frankfurt am Main

,

W. T. Kranert

¹Department of Nuclear Medicine

,

F. Grünwald

¹Department of Nuclear Medicine

› Author Affiliations

Abstract

Summary

Aim: The intraarterial chemotherapy (i.a. CHT) using high dose cisplatin combined with systemic neutralization in patients with head and neck cancer (HNSCC) is used to reduce the tumor volume preoperatively. Aim of the study is the evaluation of the influence of i.a. CHT on the metabolism of fluor-18-deoxyglucose (FDG) in the primary and lymph nodes (LN). The value of FDG positron emission tomography (PET) preoperative and as follow-up method after i.a. CHT is examined. Patients, methods: Altogether 16 patients with HNSCC underwent two preoperative FDG PET examinations: the baseline examination one week before and the follow-up three weeks after i.a. CHT. The SUVmax values of the primary and the LN and LN metastases were evaluated and compared with each other and the histopathology. Results: The SUVmax value of the primary decreased after i.a. CHT significantly from a median (25^th percentile/ 75^th percentile) of 6.4 (4.1/ 7.8) to 3.6 (2.4/ 6.7) (p = 0.01). In 11 out of 16 patients cervical LN metastases were detected. The cervical LN metastases showed a decrease of the SUVmax value from 3.6 (2.3/ 4.8) in the pretreatment examination to 2.3 (1.7/ 3.6) after i.a. CHT (p = 0.008). Only in one patient with LN metastases the SUVmax of the nodes increased. The histopathologically measured size of the LN metastases ranged from 2 to 30 mm. Non malignant LN did not reveal a significant SUVmax decrease after i.a. CHT (p = 0.13). Conclusions: As expected, primaries of HNSCC showed a significant reduction of SUV after i.a. CHT. Compared to the primary the SUVmax decrease in LN metastases was less, but also significant. Since cytotoxic levels of cisplatin do not occur systemic, postinflammatory reactions of the LN or a lymphatic drainage of the chemotherapeutic drug into the LN could be an explanation. PET for staging of HNSCC must thus be performed prior to i.a. CHT.

Zusammenfassung

Die intraarterielle Chemotherapie (i.a. CHT) mit hochdosiertem Cisplatin kombiniert mit systemischer Neutralisation bei Patienten mit Kopf-Hals-Tumoren (HNSCC) wird präoperativ zur Verkleinerung des Tumorvolumens eingesetzt. Ziel der Studie ist die Evaluierung des Einflusses der i.a.- CHT auf den Stoffwechsel vom Fluor-18-Desoxyglukose (FDG) des Primarius und der zervikalen Lymphknoten (LKs) und damit die Beurteilung der Wertigkeit der Positronenemissionstomographie (PET) präoperativ und in der Verlaufskontrolle nach Chemotherapie. Patienten, Methoden: Insgesamt wurden 16 Patienten mit HNSCC zweimal präoperativ mit FDG-PET untersucht: Die Basisuntersuchung erfolgte eine Woche vor, die Verlaufskontrolle drei Wochen nach i.a. CHT. Es wurden maximale standardisierte Uptake-Werte (SUVmax) des Primarius und der LKs/ LK-Filiae gemessen und miteinander sowie mit dem histopathologischen Befund verglichen. Ergebnisse: Der SUVmax des Primarius nahm nach i.a. CHT signifikant von einem Median (25. Perzentile/ 75. Perzentile) von 6,4 (4,1/ 7,8) auf 3,6 (2,4/ 6,7) ab (p = 0,01). Von den insgesamt 16 Patienten wiesen 11 Patienten zervikale LK-Filiae auf. Der SUVmax der zervikalen LK-Metastasen nahm von 3,6 (2,3/ 4,8) in der Ausgangsuntersuchung auf 2,3 (1,7/ 3,6) nach i.a. CHT ab (p = 0,008). Nur bei einem Patienten mit LKMetastasierung stieg der SUVmax der LK-Filiae an. Der histopathologisch gemessene Durchmesser der LK-Metastasen lag zwischen 2 und 30 mm. Die histopathologisch nicht als maligne eingestuften LKs wiesen keinen signifikanten SUVmax- Abfall nach i.a. CHT auf (p = 0,13). Schlussfolgerung: Erwartungsgemäß wiesen die Primarii der HNSCC einen signifikanten SUV-Abfall nach i.a. CHT auf. Im Vergleich zum Primarius zeigten LK-Metastasen einen geringeren, aber auch signifikanten SUVmax-Abfall. Da zytotoxische Levels nicht systemisch erreicht werden, könnten postentzündliche Reaktionen der LKs oder ein lokoregionärer Lymphabfluss eine Erklärung dafür sein. PET zum Staging des HNSCC sollte daher vor i.a. CHT erfolgen.

Keywords

FDG-PET - squamous cell carcinoma of the head and neck - intraarterial chemotherapy - cervical lymph nodes - metastases - standardized uptake value

Schlüsselwörter

FDG-PET - Plattenepithelkarzinom der Kopf-Hals-Region - intraarterielle Chemotherapie - zervikale Lymphknoten - zervikale Lymphknotenmetastasen - standardisierter Uptake- Wert

Full Text

References

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