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Post-treatment PET/CT and p16 status for predicting treatment outcomes in locally advanced head and neck cancer after definitive radiation

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To retrospectively review post-treatment (post-tx) FDG-PET/CT scans in patients with advanced head and neck squamous cell carcinoma (HNSCC) and known p16 status, treated with definitive (chemo)radiation (RT).

Methods

A total of 108 eligible patients had N2A or greater HNSCC treated with chemoRT from August 1, 2008, to February 28, 2015, with post-tx PET/CT within 6 months after RT. Kaplan–Meier curves, log-rank statistics, and Cox proportional hazards regression were used for statistical analysis.

Results

Median follow-up was 2.38 years. Sixty-eight (63.0%) patients had p16+ and 40 (37.0%) had p16− status. Two-year overall survival and recurrence-free survival were 93.4% and 77.8%, respectively. The negative predictive value (NPV) of PET/CT for local recurrence (LR) was 100%. The NPV for regional recurrence (RR) was 96.5% for all patients, 100% for p16+ patients, and 88.5% for p16− patients. The positive predictive value (PPV) of PET/CT for recurrence was 77.3% for all patients, 50.0% for p16+, and 78.6% for p16−. The PPV for LR was 72.7% for all patients, 50.0% for p16+ patients, and 72.7% for p16− patients. The PPV for RR was 50.0% for all patients, 33% for p16+, and 66.6% for p16−. Post-tx PET/CT and p16 status were independent predictors of recurrence-free survival (p < 0.01).

Conclusions

Post-tx PET/CT predicts treatment outcomes in both p16 + and p16− patients, and does so independently of p16 status. P16− patients with negative PET have a 10% risk of nodal recurrence, and closer follow-up in these patients is warranted.

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Authors and Affiliations

  1. Department of Radiation Oncology, Case Western Reserve University and University Hospitals, 11100 Euclid Avenue, Cleveland, OH, 44114, USA

    Musaddiq J. Awan, Mitchell Machtay & Min Yao

  2. Department of Otolaryngology and Head and Neck Surgery, University Hospitals, Cleveland, OH, USA

    Pierre Lavertu, Chad Zender, Rod Rezaee & Nicole Fowler

  3. Department of Medical Oncology, University Hospitals, Cleveland, OH, USA

    Lilit Karapetyan & Michael Gibson

  4. Department of Pathology, University Hospitals, Cleveland, OH, USA

    Jay Wasman

  5. Department of Nuclear Medicine and Radiology, University Hospitals, Cleveland, OH, USA

    Peter Faulhaber

Authors
  1. Musaddiq J. Awan
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  2. Pierre Lavertu
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  3. Chad Zender
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  4. Rod Rezaee
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  5. Nicole Fowler
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  6. Lilit Karapetyan
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  7. Michael Gibson
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  8. Jay Wasman
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  9. Peter Faulhaber
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  10. Mitchell Machtay
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  11. Min Yao
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Corresponding author

Correspondence to Musaddiq J. Awan.

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Funding

This study was not funded by any entity.

Conflict of interest

Mitchell Machtay is a consultant for Bristol-Myers, AbbVie, and Novocure. All other authors declare that they have no conflict of interest.

Ethical approval

This is a retrospective, minimal-risk study. Institutional review board approval was obtained for retrospective review of patient charts. This was performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

This article was partially presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting in September 2016

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Awan, M.J., Lavertu, P., Zender, C. et al. Post-treatment PET/CT and p16 status for predicting treatment outcomes in locally advanced head and neck cancer after definitive radiation. Eur J Nucl Med Mol Imaging 44, 988–997 (2017). https://doi.org/10.1007/s00259-016-3612-1

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  • DOI: https://doi.org/10.1007/s00259-016-3612-1

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