Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-04-2014 | Original Article

Prognostic value of volumetric parameters measured by ¹⁸F-FDG PET/CT in patients with head and neck squamous cell carcinoma

Authors: Ronan Abgral, Nathalie Keromnes, Philippe Robin, Pierre-Yves Le Roux, David Bourhis, Xavier Palard, Jean Rousset, Gérald Valette, Rémi Marianowski, Pierre-Yves Salaün

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 4/2014

Abstract

Purpose

The objective of this study was to investigate the value of metabolic tumour volume (MTV) assessed with ¹⁸F-FDG PET/CT in predicting event-free survival (EFS) and overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC), and particularly to compare it with more conventional parameters such as maximum standardized uptake value (SUVmax).

Methods

Patients referred to our department for ¹⁸F-FDG PET/CT for staging of HNSCC were prospectively included between February 2009 and March 2011. Each patient was scanned using a Philips Gemini PET/CT system at 1 h after injection. The MTV was calculated semiautomatically for the primary site using methods based on SUV with various thresholds: 3-D contour around voxels equal to or greater than 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0, 6.5 and 7.0 times SUV, or more than 30 %, 40 % and 50 % of SUVmax. ROC analysis was used to test the statistical significance of the differences among the calculated MTVs. EFS and OS were determined using the Kaplan-Meier method and compared with MTV in univariate and multivariate analyses, including the usual prognostic factors: age, sex, primary site, treatment, SCC histologic grade, AJCC stage, TNM classification, tumour SUVmax and SUVpeak.

Results

The study included 80 consecutive patients (70 men, 10 women; mean age 62.4 ± 9.0 years). ROC analysis revealed that pretreatment MTV using a threshold of 5.0 times SUV (MTV5.0) was the best parameter to predict recurrence and death after treatment. In univariate analysis, MTV5.0 >4.9 ml was predictive of poor EFS (p < 0.0001) and poor OS (p < 0.0001). In multivariate, MTV5.0 persisted as an independent predictive factor for EFS (p = 0.011) and OS (p = 0.010), while SUVmax became nonsignificant (p = 0.277 for EFS, p = 0.975 for OS).

Conclusion

Our results suggest that MTV measured by ¹⁸F-FDG PET/CT has independent prognostic value of in patients with HNSCC, stronger than SUVmax.

Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.PubMedCrossRef

Ang KK, Trotti A, Brown BW, Garden AS, Foote RL, Morrison WH, et al. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001;51:571–8.PubMedCrossRef

Leemans CR, Tiwari R, Nauta JJ, van der Waal I, Snow GB. Recurrence at the primary site in head and neck cancer and the significance of neck lymph node metastases as a prognostic factor. Cancer. 1994;73:187–90.PubMedCrossRef

Salaün PY, Abgral R, Querellou S, Couturier O, Valette G, Bizais Y, et al. Does 18fluoro-fluorodeoxyglucose positron emission tomography improve recurrence detection in patients cured of head and neck squamous cell carcinoma with negative clinical follow up? Head Neck. 2007;29:1115–20.PubMedCrossRef

Abgral R, Querellou S, Potard G, Le Roux PY, Le Duc-Pennec A, Marianowski R, et al. Does 18F-FDG PET/CT improve the detection of posttreatment recurrence of head and neck squamous cell carcinoma in patients negative for disease on clinical follow-up? J Nucl Med. 2009;50:24–9.PubMedCrossRef

Cojocariu OM, Huguet F, Lefevre M, Périé S. Prognosis and predictive factors in head-and-neck cancers. Bull Cancer. 2009;96:369–78.PubMed

Chiesa F, Mauri S, Tradati N, Calabreses L, Giugliano G, Ansarin M, et al. Surfing prognostic factors in head and neck cancer at the millennium. Oral Oncol. 1999;35:590–6.PubMedCrossRef

Phelps ME, Huang SC, Hoffman EJ, Sokoloff L, Kuhl DE. Tomographic measurement of local cerebral glucose metabolic rate in humans with (18-F)2-fluoro-2-deoxy-D-glucose: validation of method. Ann Neurol. 1979;6:371–88.PubMedCrossRef

Fletcher JW, Djulbegovic B, Soares HP, Siegel BA, Lowe VJ, Lyman GH, et al. Recommendations on the use of 18F-FDG PET in oncology. J Nucl Med. 2008;49:480–508.PubMedCrossRef

10.

Bourguet P, Blanc-Vincent MP, Boneu A, Bosquet L, Chauffert B, Corone C, et al. Summary of the Standards, Options and Recommendations for the use of positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose (FDP-PET scanning) in oncology (2002). Br J Cancer. 2003;89:84–91.CrossRef

11.

Halfpenny W, Hain SF, Biassoni L, Maisey MN, Sherman JA, McGurk M. FDG-PET. A possible prognostic factor in head and neck cancer. Br J Cancer. 2002;86:512–6.PubMedCentralPubMedCrossRef

12.

Allal AS, Dulguerov P, Allaoua M, Haengelli CA, el El-Ghazi A, Lehmann W, 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 or without chemotherapy. J Clin Oncol. 2002;20:1398–404.PubMedCrossRef

13.

Querellou S, Abgral R, le Roux PY, Nowak E, Valette G, Potard G, et al. Prognostic value of fluorine-18 fluorodeoxyglucose positron-emission tomography imaging in patients with head and neck squamous cell carcinoma. Head Neck. 2012;34:462–8.PubMedCrossRef

14.

Dibble EH, Alvarez AC, Truong MT, Mercier G, Cook EF, Subramaniam RM. 18F-FDG metabolic tumor volume and total lesion glycolytic activity of oral cavity and oropharyngeal squamous cell cancer: adding value to clinical staging. J Nucl Med. 2012;53:709–15.PubMedCrossRef

15.

Moon SH, Hyun SH, Choi JY. Prognostic significance of volume-based PET parameters in cancer patients. Korean J Radiol. 2013;14:1–12.PubMedCentralPubMedCrossRef

16.

Zhu D, Ma T, Niu Z, Zheng J, Han A, Zhao S, et al. Prognostic significance of metabolic parameters measured by (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with small cell lung cancer. Lung Cancer. 2001;73:332–7.CrossRef

17.

Hyun SH, Choi JY, Shim YM, Kim K, Lee SJ, Cho YS, et al. Prognostic value of metabolic tumor volume measured by 18F-fluorodeoxyglucose positron emission tomography in patients with oesophageal carcinoma. Ann Surg Oncol. 2010;17:115–22.PubMedCrossRef

18.

Chung HH, Kwon HW, Kang KW, Park NH, Song YS, Chung JK, et al. Prognostic value of preoperative metabolic tumor volume and total lesion glycolysis in patients with epithelial ovarian cancer. Ann Surg Oncol. 2012;19:1966–72.PubMedCrossRef

19.

Tang C, Murphy JD, Khong B, La TH, Kong C, Fischbein NJ, et al. Validation that metabolic tumor volume predicts outcome in head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2012;83:1514–20.PubMedCentralPubMedCrossRef

20.

Van de Wiele C, Kruse V, Smeets P, Sathekge M, Maes A. Predictive and prognostic value of metabolic tumour volume and total lesion glycolysis in solid tumours. Eur J Nucl Med Mol Imaging. 2013;40:290–301.PubMedCrossRef

21.

Chu KP, Murphy JD, La TH, Krakow TE, Iagaru A, Graves EE, et al. Prognostic value of metabolic tumor volume and velocity in predicting head-and-neck cancer outcomes. Int J Radiat Oncol Biol Phys. 2012;83:1521–7.PubMedCentralPubMedCrossRef

22.

La TH, Fillion EJ, Turnbull BB, Chu JN, Lee P, Nguyen K, et al. Metabolic tumor volume predicts for recurrence and death in head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2009;74:1335–41.PubMedCentralPubMedCrossRef

23.

Choi KH, Yoo LR, Han EJ, Kim YS, Kim GW, Na SJ, et al. Prognostic value of metabolic tumor volume measured by 18F-FDG PET/CT in locally advanced head and neck squamous cell carcinomas treated by surgery. Nucl Med Mol Imaging. 2011;47:43–51.CrossRef

24.

Moon SH, Choi JY, Lee HJ, Son YI, Baek CH, Ahn YC, et al. Prognostic value of 18F-FDG PET/CT in patients with squamous cell carcinoma of the tonsil: comparison of volume-based metabolic parameters. Head Neck. 2013;35:15–22.PubMedCrossRef

25.

Kao CH, Lin SC, Hsieh TC, Yen KY, Yang SN, Wang YC, et al. Use of pretreatment metabolic tumor volumes to predict the outcome of pharyngeal cancer treated by definitive radiotherapy. Eur J Nucl Med Mol Imaging. 2012;39:1297–305.PubMedCrossRef

26.

Lim R, Eaton A, Lee NY, Setton J, Ohri N, Rao S, et al. 18F-FDG PET/CT metabolic tumor volume and total lesion glycolysis predict outcome in oropharyngeal squamous cell carcinoma. J Nucl Med. 2012;53:1506–13.PubMedCrossRef

27.

Chung MK, Jeong HS, Park SG, Jang JY, Son YI, Choi JY, et al. Metabolic tumor volume of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography predicts short-term outcome to radiotherapy with or without chemotherapy in pharyngeal cancer. Clin Cancer Res. 2009;15:5861–8.PubMedCrossRef

28.

Seol YM, Kwon YM, Kwon BR, Choi YJ, Shin HJ, Chung JS, et al. Measurement of tumor volume by PET to evaluate prognosis in patients with head and neck cancer treated by chemo-radiation therapy. Acta Oncol. 2010;49:201–8.PubMedCrossRef

29.

Kim K, Kim SJ, Kim IJ, Kim YS, Pak K, Kim H. Prognostic value of volumetric parameters measured by F-18 FDG PET/CT in surgically resected non-small-cell lung cancer. Nucl Med Commun. 2012;33:613–20.PubMedCrossRef

30.

Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, et al., editors. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010. p. 29–62.

31.

Sobin LH, Gospodarowicz MK, Wittekind C, editors. TNM Classification of Malignant Tumours. 7th ed. New York: Wiley-Liss; 2009.

32.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers, V.2.2008. Available at: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed 20 Nov 2008.

33.

Vanderhoek M, Perlman SB, Jeraj R. Impact of the definition of peak standardized uptake value on quantification of treatment response. J Nucl Med. 2012;53:4–11.PubMedCentralPubMedCrossRef

34.

Higgins KA, Hoang JK, Roach MC, Chino J, Yoo DS, Turkington TG, et al. Analysis of pretreatment FDG-PET SUV parameters in head-and-neck cancer: tumor SUVmean has superior prognostic value. Int J Radiat Oncol Biol Phys. 2012;82:548–53.PubMedCrossRef

35.

Schwartz DL, Ford E, Rajendran J, Yueh B, Coltrera MD, Virgin J, et al. FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2005;61:129–36.PubMedCrossRef

36.

Wanet M, Lee JA, Weynand B, de Bast M, Poncelet A, Lacroix V, et al. Gradient-based delineation of the primary GTV on FDG-PET in non-small cell lung cancer: a comparison with threshold-based approaches, CT and surgical specimens. Radiother Oncol. 2011;98:117–25.PubMedCrossRef

37.

Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363:24–35.PubMedCentralPubMedCrossRef

38.

Abgral R, Le Roux PY, Rousset J, Querellou S, Valette G, Nowak E, et al. Prognostic value of dual time point 18FDG PET-CT imaging in patients with head and neck squamous cell carcinoma. Nucl Med Commun. 2013;34:551–6.PubMedCrossRef

39.

Satoh Y, Nambu A, Onishi H, Sawada E, Tominaga L, Kuriyama K, et al. Value of dual time point F-18 FDG-PET/CT imaging for the evaluation of prognosis and risk factors for recurrence in patients with stage I non-small cell lung cancer treated with stereotactic body radiation therapy. Eur J Radiol. 2012;81:3530–4.PubMedCrossRef

40.

Abe Y, Tamura K, Sakata I, Ishida J, Ozeki Y, Tamura A, et al. Clinical implications of 18F-fluorodeoxyglucose positron emission tomography/computed tomography at delayed phase for diagnosis and prognosis of malignant pleural mesothelioma. Oncol Rep. 2012;27:333–8.PubMed

Title: Prognostic value of volumetric parameters measured by 18F-FDG PET/CT in patients with head and neck squamous cell carcinoma
Authors: Ronan Abgral
Nathalie Keromnes
Philippe Robin
Pierre-Yves Le Roux
David Bourhis
Xavier Palard
Jean Rousset
Gérald Valette
Rémi Marianowski
Pierre-Yves Salaün
Publication date: 01-04-2014
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 4/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-013-2618-1

At a glance: The STEP trials

Springer Medicine

Prognostic value of volumetric parameters measured by ¹⁸F-FDG PET/CT in patients with head and neck squamous cell carcinoma

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2014

John Tsiouris, Pina C. Sanelli, Joseph P. Comunale: Case-Based Brain Imaging, 2nd Edition

Amyloid imaging in depression: a predictor of Alzheimer’s disease?

Nuclear imaging in proliferative angiopathy

Comparative evaluation of CT-based and respiratory-gated PET/CT-based planning target volume (PTV) in the definition of radiation treatment planning in lung cancer: preliminary results

Differentiation of HIV-associated lymphoma from HIV-reactive adenopathy using quantitative FDG-PET and symmetry

Image acquisition and interpretation criteria for 99mTc-HMPAO-labelled white blood cell scintigraphy: results of a multicentre study