Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

Open Access 01-02-2018 | Original Article

The role of interim FDG PET-CT after induction chemotherapy as a predictor of concurrent chemoradiotherapy efficacy and prognosis for head and neck cancer

Authors: Ka-Rham Kim, Hyun-Jeong Shim, Jun-Eul Hwang, Sang-Hee Cho, Ik-Joo Chung, Ki Seong Park, Sae-Ryung Kang, Seong Young Kwon, Woong-Ki Chung, Woo Kyun Bae

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 2/2018

Abstract

Purpose

Induction chemotherapy (ICT) with docetaxel, cisplatin, and 5-fluorouracil (TPF) followed by concurrent chemoradiotherapy (CCRT) has the advantages of organ preservation and systemic control in head and neck cancer (HNC). Early prediction of CCRT efficacy may help identify patients who will benefit more from surgery than from CCRT. We investigated the role of interim 18-fluoro-2-deoxy-glucose positron emission tomography computed tomography (FDG PET-CT) after ICT to predict the efficacy of CCRT and clinical outcomes.

Methods

Tumor responses were retrospectively reviewed after CCRT based on the Response Evaluation Criteria in Solid Tumors. FDG PET-CT imaging was performed before and after three cycles of TPF. We examined the associations between the metabolic response (percentage decrease in the maximum standardized uptake value [SUVmax] and total metabolic tumor volume [MTV]) after ICT and complete response (CR) to CCRT, progression-free survival (PFS), and overall survival (OS).

Results

We studied 43 HNC patients with a median follow-up of 32.7 months. Lymph node (LN) SUVmax and total MTV decreases from baseline after ICT were greater in patients with a CR to CCRT than in non-CR patients (LN SUVmax, 88.8% vs. 62.5%, respectively; total MTV, 99.7% vs. 89.9%, respectively). Decreases in total MTV ≥ 78% and LN SUVmax ≥73% after ICT predicted CR to CCRT and longer OS and PFS.

Conclusions

Using interim FDG PET-CT to measure SUVmax and total MTV after three cycles of ICT may be a useful technique for identifying HNC patients who will benefit from CCRT and predicting survival outcomes.

Available only for authorised users

Pfister DG, Spencer S, Brizel DM, Burtness B, Busse PM, Caudell JJ, et al. Head and neck cancers, version 1.2015. J Natl Compr Cancer Netw. 2015;13(7):847–55. quiz 856 CrossRef

Argiris A, Haraf DJ, Kies MS, Vokes EE. Intensive concurrent chemoradiotherapy for head and neck cancer with 5-fluorouracil- and hydroxyurea-based regimens: reversing a pattern of failure. Oncologist. 2003;8(4):350–60.CrossRefPubMed

Lefebvre JL, Chevalier D, Luboinski B, Kirkpatrick A, Collette L, Sahmoud T. Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of cancer phase III trial. EORTC head and neck cancer cooperative group. J Natl Cancer Inst. 1996;88(13):890–9.CrossRefPubMed

Paccagnella A, Ghi MG, Loreggian L, Buffoli A, Koussis H, Mione CA, et al. Concomitant chemoradiotherapy versus induction docetaxel, cisplatin and 5-fluorouracil (TPF) followed by concomitant chemoradiotherapy in locally advanced head and neck cancer: a phase II randomized study. Ann Oncol. 2010;21(7):1515–22. https://doi.org/10.1093/annonc/mdp573.CrossRefPubMed

Hitt R, Lopez-Pousa A, Martinez-Trufero J, Escrig V, Carles J, Rizo A, et al. Phase III study comparing cisplatin plus fluorouracil to paclitaxel, cisplatin, and fluorouracil induction chemotherapy followed by chemoradiotherapy in locally advanced head and neck cancer. J Clin Oncol. 2005;23(34):8636–45. https://doi.org/10.1200/JCO.2004.00.1990.CrossRefPubMed

Posner MR, Hershock DM, Blajman CR, Mickiewicz E, Winquist E, Gorbounova V, et al. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med. 2007;357(17):1705–15. https://doi.org/10.1056/NEJMoa070956.CrossRefPubMed

Lorch JH, Goloubeva O, Haddad RI, Cullen K, Sarlis N, Tishler R, et al. Induction chemotherapy with cisplatin and fluorouracil alone or in combination with docetaxel in locally advanced squamous cell cancer of the head and neck: long-term results of the TAX 324 randomised phase 3 trial. Lancet Oncol. 2011;12(2):153–9. https://doi.org/10.1016/S1470-2045(10)70279-5.CrossRefPubMedPubMedCentral

Vermorken JB, Remenar E, van Herpen C, Gorlia T, Mesia R, Degardin M, et al. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med. 2007;357(17):1695–704. https://doi.org/10.1056/NEJMoa071028.CrossRefPubMed

Haddad R, O’Neill A, Rabinowits G, Tishler R, Khuri F, Adkins D, et al. Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial. Lancet Oncol. 2013;14(3):257–64. https://doi.org/10.1016/S1470-2045(13)70011-1.CrossRefPubMed

10.

Cohen EE, Karrison T, Kocherginsky M, Huang CH, Agulnik M, Mittal BB et al. DeCIDE: a phase III randomized trial of docetaxel (D), cisplatin (P), 5-fluorouracil (F)(TPF) induction chemotherapy (IC) in patients with N2/N3 locally advanced squamous cell carcinoma of the head and neck (SCCHN). ASCO Annual Meeting Proceedings; 2012.

11.

Cremolini C, Loupakis F, Antoniotti C, Lonardi S, Masi G, Salvatore L, et al. Early tumor shrinkage and depth of response predict long-term outcome in metastatic colorectal cancer patients treated with first-line chemotherapy plus bevacizumab: results from phase III TRIBE trial by the Gruppo Oncologico del Nord Ovest. Ann Oncol. 2015;26(6):1188–94. https://doi.org/10.1093/annonc/mdv112.CrossRefPubMed

12.

Urba S, Wolf G, Eisbruch A, Worden F, Lee J, Bradford C, et al. Single-cycle induction chemotherapy selects patients with advanced laryngeal cancer for combined chemoradiation: a new treatment paradigm. J Clin Oncol. 2006;24(4):593–8. https://doi.org/10.1200/JCO.2005.01.2047.CrossRefPubMed

13.

Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324(24):1685–90. https://doi.org/10.1056/NEJM199106133242402.CrossRef

14.

Akagunduz OO, Savas R, Yalman D, Kocacelebi K, Esassolak M. Can adaptive threshold-based metabolic tumor volume (MTV) and lean body mass corrected standard uptake value (SUL) predict prognosis in head and neck cancer patients treated with definitive radiotherapy/chemoradiotherapy? Nucl Med Biol. 2015;42(11):899–904. https://doi.org/10.1016/j.nucmedbio.2015.06.007.CrossRefPubMed

15.

Schwartz DL, Harris J, Yao M, Rosenthal DI, Opanowski A, Levering A, et al. Metabolic tumor volume as a prognostic imaging-based biomarker for head-and-neck cancer: pilot results from radiation therapy oncology group protocol 0522. Int J Radiat Oncol Biol Phys. 2015;91(4):721–9. https://doi.org/10.1016/j.ijrobp.2014.12.023.CrossRefPubMedPubMedCentral

16.

Su M, Zhao L, Wei H, Lin R, Zhang X, Zou C. 18F-fluorodeoxyglucose positron emission tomography for predicting tumor response to radiochemotherapy in nasopharyngeal carcinoma. Strahlenther Onkol. 2015;191(8):642–8. https://doi.org/10.1007/s00066-015-0842-2.CrossRefPubMed

17.

Kikuchi M, Nakamoto Y, Shinohara S, Fujiwara K, Yamazaki H, Kanazawa Y, et al. Early evaluation of neoadjuvant chemotherapy response using FDG-PET/CT predicts survival prognosis in patients with head and neck squamous cell carcinoma. Int J Clin Oncol. 2013;18(3):402–10. https://doi.org/10.1007/s10147-012-0393-9.CrossRefPubMed

18.

Yen RF, Chen TH, Ting LL, Tzen KY, Pan MH, Hong RL. Early restaging whole-body (18)F-FDG PET during induction chemotherapy predicts clinical outcome in patients with locoregionally advanced nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging. 2005;32(10):1152–9. https://doi.org/10.1007/s00259-005-1837-5.CrossRefPubMed

19.

Abgral R, Le Roux PY, Keromnes N, Rousset J, Valette G, Gouders D, et al. Early prediction of survival following induction chemotherapy with DCF (docetaxel, cisplatin, 5-fluorouracil) using FDG PET/CT imaging in patients with locally advanced head and neck squamous cell carcinoma. Eur J Nucl Med Mol Imaging. 2012;39(12):1839–47. https://doi.org/10.1007/s00259-012-2213-x.CrossRefPubMed

20.

Yoon DH, Cho Y, Kim SY, Nam SY, Choi SH, Roh JL, et al. Usefulness of interim FDG-PET after induction chemotherapy in patients with locally advanced squamous cell carcinoma of the head and neck receiving sequential induction chemotherapy followed by concurrent chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2011;81(1):118–25. https://doi.org/10.1016/j.ijrobp.2010.04.034.CrossRefPubMed

21.

Lee SC, Shores CG, Weissler MC. Salvage surgery after failed primary concomitant chemoradiation. Curr Opin Otolaryngol Head Neck Surg. 2008;16(2):135–40. https://doi.org/10.1097/MOO.0b013e3282f495b6.CrossRefPubMed

22.

Ko EC, Genden EM, Misiukiewicz K, Som PM, Kostakoglu L, Chen CT, et al. Toxicity profile and clinical outcomes in locally advanced head and neck cancer patients treated with induction chemotherapy prior to concurrent chemoradiation. Oncol Rep. 2012;27(2):467–74. https://doi.org/10.3892/or.2011.1512.PubMed

23.

Mehanna H, Wong WL, McConkey CC, Rahman JK, Robinson M, Hartley AG, et al. PET-CT surveillance versus neck dissection in advanced head and neck cancer. N Engl J Med. 2016;374(15):1444–54. https://doi.org/10.1056/NEJMoa1514493.CrossRefPubMed

24.

Moeller BJ, Rana V, Cannon BA, Williams MD, Sturgis EM, Ginsberg LE, et al. Prospective risk-adjusted [18F]Fluorodeoxyglucose positron emission tomography and computed tomography assessment of radiation response in head and neck cancer. J Clin Oncol. 2009;27(15):2509–15. https://doi.org/10.1200/JCO.2008.19.3300.CrossRefPubMedPubMedCentral

25.

Semrau S, Haderlein M, Schmidt D, Lell M, Wolf W, Waldfahrer F, et al. Single-cycle induction chemotherapy followed by chemoradiotherapy or surgery in patients with head and neck cancer: what are the best predictors of remission and prognosis? Cancer. 2015;121(8):1214–22. https://doi.org/10.1002/cncr.29188.CrossRefPubMed

26.

Kikuchi M, Shinohara S, Nakamoto Y, Usami Y, Fujiwara K, Adachi T, et al. Sequential FDG-PET/CT after neoadjuvant chemotherapy is a predictor of histopathologic response in patients with head and neck squamous cell carcinoma. Mol Imaging Biol. 2011;13(2):368–77. https://doi.org/10.1007/s11307-010-0364-3.CrossRefPubMed

27.

Weber WA, Wieder H. Monitoring chemotherapy and radiotherapy of solid tumors. Eur J Nucl Med Mol Imaging. 2006;33(Suppl 1):27–37. https://doi.org/10.1007/s00259-006-0133-3.CrossRefPubMed

28.

Schoder H, Fury M, Lee N, Kraus D. PET monitoring of therapy response in head and neck squamous cell carcinoma. J Nucl Med. 2009;50(Suppl 1):74S–88S. https://doi.org/10.2967/jnumed.108.057208.CrossRefPubMed

29.

Brun E, Kjellen E, Tennvall J, Ohlsson T, Sandell A, Perfekt R, et al. FDG PET studies during treatment: prediction of therapy outcome in head and neck squamous cell carcinoma. Head Neck. 2002;24(2):127–35.CrossRefPubMed

Title: The role of interim FDG PET-CT after induction chemotherapy as a predictor of concurrent chemoradiotherapy efficacy and prognosis for head and neck cancer
Authors: Ka-Rham Kim
Hyun-Jeong Shim
Jun-Eul Hwang
Sang-Hee Cho
Ik-Joo Chung
Ki Seong Park
Sae-Ryung Kang
Seong Young Kwon
Woong-Ki Chung
Woo Kyun Bae
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 2/2018
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-017-3836-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The role of interim FDG PET-CT after induction chemotherapy as a predictor of concurrent chemoradiotherapy efficacy and prognosis for head and neck cancer

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2018

Invited editorial for the paper by Silvoniemi et al. “Repeatability of tumor hypoxia imaging using [18F]EF5 PET/CT in head and neck cancer.” in this issue of EJNMMI

Validation of the mIBG skeletal SIOPEN scoring method in two independent high-risk neuroblastoma populations: the SIOPEN/HR-NBL1 and COG-A3973 trials

Delayed response after repeated 177Lu-PSMA-617 radioligand therapy in patients with metastatic castration resistant prostate cancer

68Ga-PSMA 11 ligand PET imaging in patients with biochemical recurrence after radical prostatectomy – diagnostic performance and impact on therapeutic decision-making

The prognostic value of 18F–FDG PET/CT prior to liver transplantation for nonresectable colorectal liver metastases

Patterns of bone tracer uptake on SPECT-CT in symptomatic and asymptomatic patients with primary total hip arthroplasty