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Published in: BMC Medical Imaging 1/2015

Open Access 01-12-2015 | Research article

Combined PET/CT-perfusion in patients with head and neck cancers might predict failure after radio-chemotherapy: a proof of concept study

Authors: Carsten Pietsch, Felipe de Galiza Barbosa, Martin W. Hüllner, Daniel T. Schmid, Stephan K. Haerle, Gerhard F. Huber, Gabriela Studer, Thomas F. Hany, Patrick Veit-Haibach

Published in: BMC Medical Imaging | Issue 1/2015

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Abstract

Background

[18F]FDG-PET/CT imaging is broadly used in head and neck cancer (HNSCC) patients. CT perfusion (CTP) is known to provide information about angiogenesis and blood-flow characteristics in tumors. The aim of this study was to evaluate the potential relationship of FDG-parameters and CTP-parameters in HNSCC preand post-therapy and the potential prognostic value of a combined PET/CT with CTP.

Methods

Thirteen patients with histologic proven HNSCC were prospectively included. All patients underwent a combined PET/CT with integrated CTP before and after therapy. Pre- and post-therapeutic data of CTP and PET of the tumors were compared. Differences were tested using Spearman’s rho test and Pearson’s correlation. A p-value of p <0.05 was considered statistically significant. Correlations were calculated using Pearson’s correlation. Bootstrap confidence intervals were calculated to test for additive confidence intervals.

Results

Three patients died due to malignancy recurrence, ten patients were free of recurrence until the end of the follow-up period. Patients with recurrent disease had significantly higher initial CTP-values compared to the recurrence-free patients: BFpre 267.4 (171.2)ml/100 mg/min, BVpre 40.9 (8.4)ml/100 mg and MTTpre 8.2 (6.1)sec. No higher SUVs initially but significantly higher TLG compared to patients without recurrence were found. Post-therapeutic PET-values differed significantly between the two groups: SUVmaxpost 6.0 (3.2), SUVmeanpost 3.6 (2.0) and TLG 21751.7 (29794.0).

Conclusion

In our proof of concept study, combined PET/CT with integrated CTP might show complementary prognostic data pre- and post chemo-radiotherapy. CTP may be used to predict local tumor recurrence, while FDGPET/CT is still needed for whole-body staging.
Literature
2.
go back to reference Colevas AD. Chemotherapy options for patients with metastatic or recurrent squamous cell carcinoma of the head and neck. J Clin Oncol. 2006;24(17):2644–52.PubMedCrossRef Colevas AD. Chemotherapy options for patients with metastatic or recurrent squamous cell carcinoma of the head and neck. J Clin Oncol. 2006;24(17):2644–52.PubMedCrossRef
3.
go back to reference Forastiere A, Goepfert H, Goffinet D, Hong KW, Laramore G, Mittal B, et al. NCCN practice guidelines for head and neck cancer. National Comprehensive Cancer Network. Oncology (Williston Park). 1998;12(7A):39–147. Forastiere A, Goepfert H, Goffinet D, Hong KW, Laramore G, Mittal B, et al. NCCN practice guidelines for head and neck cancer. National Comprehensive Cancer Network. Oncology (Williston Park). 1998;12(7A):39–147.
4.
go back to reference Beyer T, Antoch G, Blodgett T, Freudenberg LF, Akhurst T, Mueller S. Dual-modality PET/CT imaging: the effect of respiratory motion on combined image quality in clinical oncology. Eur J Nucl Med Mol Imaging. 2003;30(4):588–96.PubMedCrossRef Beyer T, Antoch G, Blodgett T, Freudenberg LF, Akhurst T, Mueller S. Dual-modality PET/CT imaging: the effect of respiratory motion on combined image quality in clinical oncology. Eur J Nucl Med Mol Imaging. 2003;30(4):588–96.PubMedCrossRef
5.
go back to reference Steinkamp HJ, Keske U, Schedel J, Hosten N, Felix R. The spiral CT of cervical lymph node enlargements. The initial clinical results. Röfo. 1994;160(6):500–5.PubMed Steinkamp HJ, Keske U, Schedel J, Hosten N, Felix R. The spiral CT of cervical lymph node enlargements. The initial clinical results. Röfo. 1994;160(6):500–5.PubMed
6.
go back to reference Hoefling NL, McHugh JB, Light E, Kumar B, Walline H, Prince M, et al. Human papillomavirus, p16, and epidermal growth factor receptor biomarkers and CT perfusion values in head and neck squamous cell carcinoma. AJNR Am J Neuroradiol. 2013;34(5):1062–6. S1-2.PubMedPubMedCentralCrossRef Hoefling NL, McHugh JB, Light E, Kumar B, Walline H, Prince M, et al. Human papillomavirus, p16, and epidermal growth factor receptor biomarkers and CT perfusion values in head and neck squamous cell carcinoma. AJNR Am J Neuroradiol. 2013;34(5):1062–6. S1-2.PubMedPubMedCentralCrossRef
7.
go back to reference Jo SY, Wang PI, Nor JE, Bellile EL, Zhang Z, Worden FP, et al. CT perfusion can predict overexpression of CXCL8 (interleukin-8) in head and neck squamous cell carcinoma. AJNR Am J Neuroradiol. 2013;34(12):2338–42.PubMedPubMedCentralCrossRef Jo SY, Wang PI, Nor JE, Bellile EL, Zhang Z, Worden FP, et al. CT perfusion can predict overexpression of CXCL8 (interleukin-8) in head and neck squamous cell carcinoma. AJNR Am J Neuroradiol. 2013;34(12):2338–42.PubMedPubMedCentralCrossRef
8.
go back to reference Goerres GW, Schmid DT, Schuknecht B, Eyrich GK. Bone invasion in patients with oral cavity cancer: comparison of conventional CT with PET/CT and SPECT/CT. Radiology. 2005;237(1):281–7.PubMedCrossRef Goerres GW, Schmid DT, Schuknecht B, Eyrich GK. Bone invasion in patients with oral cavity cancer: comparison of conventional CT with PET/CT and SPECT/CT. Radiology. 2005;237(1):281–7.PubMedCrossRef
9.
go back to reference Tango T. Equivalence test and confidence interval for the difference in proportions for the paired-sample design. Stat Med. 1998;17(8):891–908.PubMedCrossRef Tango T. Equivalence test and confidence interval for the difference in proportions for the paired-sample design. Stat Med. 1998;17(8):891–908.PubMedCrossRef
10.
go back to reference Schoder H, Carlson DL, Kraus DH, Stambuk HE, Gonen M, Erdi YE, et al. 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med. 2006;47(5):755–62.PubMed Schoder H, Carlson DL, Kraus DH, Stambuk HE, Gonen M, Erdi YE, et al. 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med. 2006;47(5):755–62.PubMed
11.
go back to reference Veit-Haibach P, Schmid D, Strobel K, Soyka JD, Schaefer NG, Haerle SK, et al. Combined PET/CT-perfusion in patients with head and neck cancers. Eur Radiol. 2013;23(1):163–73.PubMedCrossRef Veit-Haibach P, Schmid D, Strobel K, Soyka JD, Schaefer NG, Haerle SK, et al. Combined PET/CT-perfusion in patients with head and neck cancers. Eur Radiol. 2013;23(1):163–73.PubMedCrossRef
12.
go back to reference Ash L, Teknos TN, Gandhi D, Patel S, Mukherji SK. Head and neck squamous cell carcinoma: CT perfusion can help noninvasively predict intratumoral microvessel density. Radiology. 2009;251(2):422–8.PubMedCrossRef Ash L, Teknos TN, Gandhi D, Patel S, Mukherji SK. Head and neck squamous cell carcinoma: CT perfusion can help noninvasively predict intratumoral microvessel density. Radiology. 2009;251(2):422–8.PubMedCrossRef
13.
go back to reference Hermans R, Meijerink M, Van den Bogaert W, Rijnders A, Weltens C, Lambin P. Tumor perfusion rate determined noninvasively by dynamic computed tomography predicts outcome in head-and-neck cancer after radiotherapy. Int J Radiat Oncol Biol Phys. 2003;57(5):1351–6.PubMedCrossRef Hermans R, Meijerink M, Van den Bogaert W, Rijnders A, Weltens C, Lambin P. Tumor perfusion rate determined noninvasively by dynamic computed tomography predicts outcome in head-and-neck cancer after radiotherapy. Int J Radiat Oncol Biol Phys. 2003;57(5):1351–6.PubMedCrossRef
14.
go back to reference Zima A, Carlos R, Gandhi D, Case I, Teknos T, Mukherji SK. Can pretreatment CT perfusion predict response of advanced squamous cell carcinoma of the upper aerodigestive tract treated with induction chemotherapy? AJNR Am J Neuroradiol. 2007;28(2):328–34.PubMed Zima A, Carlos R, Gandhi D, Case I, Teknos T, Mukherji SK. Can pretreatment CT perfusion predict response of advanced squamous cell carcinoma of the upper aerodigestive tract treated with induction chemotherapy? AJNR Am J Neuroradiol. 2007;28(2):328–34.PubMed
15.
go back to reference Truong MT, Saito N, Ozonoff A, Wang J, Lee R, Qureshi MM, et al. Prediction of locoregional control in head and neck squamous cell carcinoma with serial CT perfusion during radiotherapy. AJNR Am J Neuroradiol. 2011;32(7):1195–201.PubMedCrossRef Truong MT, Saito N, Ozonoff A, Wang J, Lee R, Qureshi MM, et al. Prediction of locoregional control in head and neck squamous cell carcinoma with serial CT perfusion during radiotherapy. AJNR Am J Neuroradiol. 2011;32(7):1195–201.PubMedCrossRef
16.
go back to reference Cao Y, Popovtzer A, Li D, Chepeha DB, Moyer JS, Prince ME, et al. Early prediction of outcome in advanced head-and-neck cancer based on tumor blood volume alterations during therapy: a prospective study. Int J Radiat Oncol Biol Phys. 2008;72(5):1287–90.PubMedPubMedCentralCrossRef Cao Y, Popovtzer A, Li D, Chepeha DB, Moyer JS, Prince ME, et al. Early prediction of outcome in advanced head-and-neck cancer based on tumor blood volume alterations during therapy: a prospective study. Int J Radiat Oncol Biol Phys. 2008;72(5):1287–90.PubMedPubMedCentralCrossRef
17.
go back to reference Ul-Hassan F, Simo R, Guerrero-Urbano T, Oakley R, Jeannon JP, Cook GJ. Can 18F-FDG PET/CT reliably assess response to primary treatment of head and neck cancer? Clin Nucl Med. 2013;38(4):263–5.PubMedCrossRef Ul-Hassan F, Simo R, Guerrero-Urbano T, Oakley R, Jeannon JP, Cook GJ. Can 18F-FDG PET/CT reliably assess response to primary treatment of head and neck cancer? Clin Nucl Med. 2013;38(4):263–5.PubMedCrossRef
18.
go back to reference Vainshtein JM, Spector ME, Stenmark MH, Bradford CR, Wolf GT, Worden FP, et al. Reliability of post-chemoradiotherapy F-18-FDG PET/CT for prediction of locoregional failure in human papillomavirus-associated oropharyngeal cancer. Oral Oncol. 2013. Vainshtein JM, Spector ME, Stenmark MH, Bradford CR, Wolf GT, Worden FP, et al. Reliability of post-chemoradiotherapy F-18-FDG PET/CT for prediction of locoregional failure in human papillomavirus-associated oropharyngeal cancer. Oral Oncol. 2013.
19.
20.
go back to reference Picchio M, Kirienko M, Mapelli P, Dell’Oca I, Villa E, Gallivanone F, et al. Predictive value of pre-therapy (18)F-FDG PET/CT for the outcome of (18)F-FDG PET-guided radiotherapy in patients with head and neck cancer. Eur J Nucl Med Mol Imaging. 2014;41(1):21–31.PubMedCrossRef Picchio M, Kirienko M, Mapelli P, Dell’Oca I, Villa E, Gallivanone F, et al. Predictive value of pre-therapy (18)F-FDG PET/CT for the outcome of (18)F-FDG PET-guided radiotherapy in patients with head and neck cancer. Eur J Nucl Med Mol Imaging. 2014;41(1):21–31.PubMedCrossRef
21.
go back to reference Albo D, Granick MS, Jhala N, Atkinson B, Solomon MP. The relationship of angiogenesis to biological activity in human squamous cell carcinomas of the head and neck. Ann Plast Surg. 1994;32(6):588–94.PubMedCrossRef Albo D, Granick MS, Jhala N, Atkinson B, Solomon MP. The relationship of angiogenesis to biological activity in human squamous cell carcinomas of the head and neck. Ann Plast Surg. 1994;32(6):588–94.PubMedCrossRef
22.
go back to reference Gandhi D, Chepeha DB, Miller T, Carlos RC, Bradford CR, Karamchandani R, et al. Correlation between initial and early follow-up CT perfusion parameters with endoscopic tumor response in patients with advanced squamous cell carcinomas of the oropharynx treated with organ-preservation therapy. AJNR Am J Neuroradiol. 2006;27(1):101–6.PubMed Gandhi D, Chepeha DB, Miller T, Carlos RC, Bradford CR, Karamchandani R, et al. Correlation between initial and early follow-up CT perfusion parameters with endoscopic tumor response in patients with advanced squamous cell carcinomas of the oropharynx treated with organ-preservation therapy. AJNR Am J Neuroradiol. 2006;27(1):101–6.PubMed
23.
go back to reference Guenzel T, Franzen A, Wiegand S, Kraetschmer S, Jahn JL, Mironczuk R, et al. The Value of PET Compared to MRI in malignant head and neck tumors. Anticancer Res. 2013;33(3):1141–6.PubMed Guenzel T, Franzen A, Wiegand S, Kraetschmer S, Jahn JL, Mironczuk R, et al. The Value of PET Compared to MRI in malignant head and neck tumors. Anticancer Res. 2013;33(3):1141–6.PubMed
24.
go back to reference Hustinx R, Lucignani G. PET/CT in head and neck cancer: an update. Eur J Nucl Med Mol Imaging. 2010;37(3):645–51.PubMedCrossRef Hustinx R, Lucignani G. PET/CT in head and neck cancer: an update. Eur J Nucl Med Mol Imaging. 2010;37(3):645–51.PubMedCrossRef
25.
go back to reference Kambadakone AR, Sahani DV. Body perfusion CT: technique, clinical applications, and advances. Radiol Clin North Am. 2009;47(1):161–78.PubMedCrossRef Kambadakone AR, Sahani DV. Body perfusion CT: technique, clinical applications, and advances. Radiol Clin North Am. 2009;47(1):161–78.PubMedCrossRef
26.
go back to reference Rumboldt Z, Al-Okaili R, Deveikis JP. Perfusion CT for head and neck tumors: pilot study. AJNR Am J Neuroradiol. 2005;26(5):1178–85.PubMed Rumboldt Z, Al-Okaili R, Deveikis JP. Perfusion CT for head and neck tumors: pilot study. AJNR Am J Neuroradiol. 2005;26(5):1178–85.PubMed
27.
go back to reference Hirasawa S, Tsushima Y, Takei H, Hirasawa H, Taketomi-Takahashi A, Takano A, et al. Inverse correlation between tumor perfusion and glucose uptake in human head and neck tumors. Acad Radiol. 2007;14(3):312–8.PubMedCrossRef Hirasawa S, Tsushima Y, Takei H, Hirasawa H, Taketomi-Takahashi A, Takano A, et al. Inverse correlation between tumor perfusion and glucose uptake in human head and neck tumors. Acad Radiol. 2007;14(3):312–8.PubMedCrossRef
28.
go back to reference Preda L, Calloni SF, Moscatelli ME, Cossu Rocca M, Bellomi M. Role of CT perfusion in monitoring and prediction of response to therapy of head and neck squamous cell carcinoma. BioMed Res Int. 2014;2014:917150.PubMedPubMedCentralCrossRef Preda L, Calloni SF, Moscatelli ME, Cossu Rocca M, Bellomi M. Role of CT perfusion in monitoring and prediction of response to therapy of head and neck squamous cell carcinoma. BioMed Res Int. 2014;2014:917150.PubMedPubMedCentralCrossRef
Metadata
Title
Combined PET/CT-perfusion in patients with head and neck cancers might predict failure after radio-chemotherapy: a proof of concept study
Authors
Carsten Pietsch
Felipe de Galiza Barbosa
Martin W. Hüllner
Daniel T. Schmid
Stephan K. Haerle
Gerhard F. Huber
Gabriela Studer
Thomas F. Hany
Patrick Veit-Haibach
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Medical Imaging / Issue 1/2015
Electronic ISSN: 1471-2342
DOI
https://doi.org/10.1186/s12880-015-0102-z

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