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Nuklearmedizin 2011; 50(04): 141-146
DOI: 10.3413/Nukmed-0367-10-11
Original article
Schattauer GmbH

Metabolic tumour volume

Prognostic value in locally advanced squamous cell carcinoma of the head and neckMetabolisches TumorvolumenPrognostische Bedeutung bei lokal fortgeschrittenen Platten - epithelkarzinomen im Kopf-Hals-Bereich
P. Deron
1   Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
,
K. Mertens
2   Department of Nuclear Medicine and Radiology, Ghent University Hospital, Ghent, Belgium
,
I. Goethals
2   Department of Nuclear Medicine and Radiology, Ghent University Hospital, Ghent, Belgium
,
S. Rottey
3   Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
,
F. Duprez
4   Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
,
W. De Neve
4   Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
,
H. Vermeersch
1   Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
,
C. Van de Wiele
2   Department of Nuclear Medicine and Radiology, Ghent University Hospital, Ghent, Belgium
› Author Affiliations
Further Information

Publication History

received: 06 November 2010

accepted in revised form: 01 March 2011

Publication Date:
28 December 2017 (online)

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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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 3 Argiris A, Karamouzis M, Raben D, Ferris R. Head and neck cancer. Lancet 2008; 371: 1695-1709.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    Search in Google Scholar
  • 11 Duvvuri U, Myers J. Cancer of the head and neck is the sixth common cancer worldwide. Curr Probl Surg 2009; 46: 114-117.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    Search in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    Thieme ConnectSearch in Google Scholar
  • 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.
    Search in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    Thieme ConnectSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar
  • 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.
    CrossrefSearch in Google Scholar