Metabolic tumour volume

Summary

Purpose: Evaluate the predictive and prognostic value of semi-quantitative FDG-PET variables derived from pretreatment FDG-PET images in patients suffering from locally advanced squamous cell carcinoma of the head and neck (SCCHN), treated by means of concomitant radiochemotherapy. Patients, methods: 40 patients with newly diagnosed SCCHN that were treated with concomitant radiochemotherapy underwent FDG-PET/CT for treatment planning; 18 patients had neck dissection prior to their baseline scan and to receiving radiochemotherapy. FDG-PET images were used to calculate metabolic tumour volumes using region growing and a threshold of 50% (MTV₅₀) of primary lesions and involved lymph nodes as well as the mean and maximum standard uptake value (SUVmean and SUVmax) of the primary tumours. Results: Neither SUVmean nor SUVmax values of the primary tumour were significantly different between responders and non-responders whereas MTV₅₀ values of the primary tumour proved significantly higher in non-responders. SUVmean, SUVmax and MTV₅₀ of the primary tumour were not predictive for overall or disease free survival. Contrariwise, dichotomized summed MTV₅₀ values (cut-off ≥ 31 cm³) of the primary tumour and involved lymph nodes in patients that didn’t have neck dissection prior to radiochemotherapy were predictive for disease free and overall survival in both univariate and multivariate analysis (p ≤ 0.05). Conclusion: Summed MTV₅₀ values of both the primary tumour and involved lymph nodes provided independent prognostic information on disease free and overall survival.

Zusammenfassung

Ziel: Beurteilung der prädiktiven und prognostischen Bedeutung semi-quantitativer FDG-PETVariablen, abgeleitet von prätherapeutischen FDG-PET-Aufnahmen bei Patienten mit lokal fortgeschrittenen Plattenepithelkarzinomen des Kopf-Hals-Bereichs (SCCHN), die mit einer kombinierten Radiochemotherapie behandelt wurden. Patienten, Methoden: Bei 40 Patienten mit neu diagnostizierten SCCHN, die mit kombinierter Radiochemotherapie behandelt wurden, wurde zur Therapieplanung eine FDG-PET/CT durchgeführt; bei 18 Patienten war vor dem Baseline-Scan und vor Beginn der Radiochemotherapie eine Neck-Dissection erfolgt. Anhand der FDG-PET/CT-Aufnahmen wurden die metabolischen Tumor volumina der Primärläsionen und der befallenen Lymphknoten mittels regionalen Wachstums und einer 50%-Schwelle (MTV₅₀) sowie des mittleren und maximalen Standard Uptake Value (SUVmean und SUVmax) der Primärtumore berechnet. Ergebnisse: Weder für die SUVmean- noch die SUVmax- Werte der Primärtumore bestanden signifikante Unterschiede zwischen Respondern und Non-Respondern, wohingegen sich die MTV₅₀-Werte der Primärtumore bei Non-Respondern als signifikant hoher erwiesen. SUVmean, SUVmax und MTV₅₀ der Primärtumore erlaubten keine Vorhersage für das gesamte oder das krankheitsfreie Überleben. Die dichotomisierten Summenwerte von MTV₅₀ (Cutoff ≥ 31 cm³) des Primärtumors und der befallenen Lymphknoten bei Patienten ohne Neck-Dissection waren hingegen vor der Radiochemotherapie sowohl in der univariaten als auch in der multivariaten Analyse für das krankheitsfreie Überleben und das Gesamtüberleben (p ≤ 0,05) prädiktiv. Schlussfolgerung: Die Summe der MTV₅₀-Werte aus Primärtumor und befallenen Lymphknoten liefert unabhängige prognostische Informationen zum krankheitsfreien Überleben und zum Gesamtüberleben.

Keywords

Locally advanced SCCHN - FDG-PET - prognosis

Schlüsselwörter

Lokal fortgeschrittenes SCCHN - FDG-PET - Prognose

• References

• 1 Allal A, Dulguerov P, Allaoua M. et al. Standardized uptake value of 2-(¹⁸F) fluoro-2-deoxy-D-glucose in predicting outcome in head and neck carcinomas treated by radiotherapy with and without chemotherapy. J Clin Oncol 2002; 20: 1398-1404.
• 2 Allal A, Slosman D, Kebdani T. et al. Prediction of outcome in head-and-neck cancer patients using standardized uptake value of 2-(¹⁸F) fluoro-2-deoxy-D-glucose. Int J Radiat Oncol Biol Phys 2004; 59: 1295-1300.
• 3 Argiris A, Karamouzis M, Raben D, Ferris R. Head and neck cancer. Lancet 2008; 371: 1695-1709.
• 4 Brun E, Kjellén E, Tennvall J. et al. FDG PET studies during treatment: prediction of therapy outcome in head and neck squamous cell carcinoma. Head Neck 2002; 24: 127-135.
• 5 Byers R, Clayman G, Guillamondequi O. et al. Resection of advanced cervical metastasis prior to definitive radiotherapy for squamous carcinomas of the upper aerodigestive tract. Head Neck 1992; 14: 133-138.
• 6 Ciernik I, Dizendorf E, Baumert B. et al. Radiation treatment planning with an integrated positron emission and computer tomography (PET/CT): A feasability study. Int J Radiat Oncol Biol Phys 2003; 57: 853-863.
• 7 Cooper J, Porter K, Mallin K. National Cancer Database report on cancer of the head and neck: 10-year update. Head Neck 2009; 31: 748-758.
• 8 Dequanter D, Lothaire P, Awada A. et al. Does clinical and radiological response predict complete tumor control in N2-N3 squamous cell head and neck cancer after non-operative management of the neck?. Acta Otolaryngol 2006; 126: 1225-1228.
• 9 Doweck I, Denys D, Robbins K. Tumor volume predicts outcome for advanced head and neck cancer treated with targeted chemotherapy. Laryngoscope 2002; 112: 1742-1749.
• 10 Duprez F, De Neve W, De Gersem W. et al. Adaptive dose painting by numbers for head-and-neck cancer. IJRBOP. 2010: 1-11.
• 11 Duvvuri U, Myers J. Cancer of the head and neck is the sixth common cancer worldwide. Curr Probl Surg 2009; 46: 114-117.
• 12 Frank D, Hu K, Culliney B. et al. Planned neck dissection after concomitant radiochemotherapy for advanced head and neck cancer. Laryngoscope 2005; 115: 1015-1020.
• 13 Grabenbauer G, Steininger H, Meyer M. et al. Nodal CT density and tumor volume as prognostic factors after radiation therapy of stage III/IV head and neck cancer. Radiother Oncol 1998; 47: 175-183.
• 14 Halfpenny W, Hain S, Biassoni L. et al. FDG-PET. A possible prognostic factor in head and neck cancer. Br J Cancer 2002; 86: 512-516.
• 15 Kitagawa Y, Sano K, Nishizawa S. et al. FDG-PET for prediction of tumour aggressiveness and response to intra-arterial chemotherapy and radiotherapy in head and neck cancer. Eur J Nucl Med 2003; 30: 63-71.
• 16 Knegjens J, Hauptman M, Pameijer F. et al. Tumor volume as outcome predictor in chemoradiation for advanced head and neck cancer. Head Neck 2011; 33: 375-382.
• 17 La T, Filion E, Turnbull B. et al. Metabolic tumor volume predicts for recurrence and death in head-and-neck cancer. Int J Radiat Oncol Biol Phys 2009; 74: 1335-1341.
• 18 Linecker A, Kermer C, Sulzbacher I. et al. Uptake of ¹⁸F-FLT and ¹⁸F-FDG in primary head and neck cancer correlates with survival. Nuklearmedizin 2008; 47: 80-85.
• 19 Minn H, Lapela M, Klemi P. et al. Prediction of survival with fluorine-18-fluoro-deoxyglucose and PET in head and neck cancer. J Nucl Med 1997; 38: 1907-1911.
• 20 Pignon J, le Maître A, Maillard E, Bourhis J. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17346 patients. Radiother Oncol 2009; 92: 4-14.
• 21 Plataniotis G, Theofanopoulou M, Kalogera-Fountzila A. et al. Prognostic impact of tumor volumetry in patients with locally advanced head-and-neck cancer (non-nasopharyngeal) treated by radiotherapy alone or combined with radiochemotherapy in a randomized trial. Int J Radiat Oncol Biol Phys 2004; 59: 1018-1026.
• 22 Schmidt M, Schmalenbach M, Jungehülsing M. et al. ¹⁸F-FDG PET for detecting recurrent head and neck cancer, local lymph node involvement and distant metastases. Comparison of qualitative visual and semiquantitative analysis. Nuklearmedizin 2004; 43: 91-101.
• 23 Smeele L, Leemans C, Reid C. et al. Neck dissection for advanced lymph node metastasis before definitive radiotherapy for primary carcinoma of the head and neck. Laryngoscope 2000; 110: 1210-1214.
• 24 Suzuki H, Hasegawa Y, Terada A. et al. FDG-PET predicts survival and distant metastasis in oral squamous cell carcinoma. Oral Oncology 2009; 45: 569-573.
• 25 Torizuka T, Tanizaki Y, Kanno T. et al. Prognostic value of ¹⁸F-FDG PET in patients with head and neck squamous cell cancer. Am J Roentgenol 2009; 192: W156-W160.
• 26 Vermeersch H, Loose D, Ham H. et al. Nuclear medicine imaging for the assessment of primary and recurrent head and neck carcinoma using routinely available tracers. Eur J Nucl Med 2003; 30: 1689-1700.
• 27 Vernon M, Maheshwari M, Schultz C. et al. Clinical outcomes of patients receiving integrated PET/CT-guided radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 2008; 70: 678-684.
• 28 Xie P, Yue J, Zhao H. et al. Prognostic value of ¹⁸F-FDG PET-CT metabolic index for nasopharyngeal carcinoma. J Cancer Res Clin Oncol 2010; 136: 883-889.