Top

Published in:

Open Access 01-12-2016 | Research article

Predictive and prognostic value of PET/CT imaging post-chemoradiotherapy and clinical decision-making consequences in locally advanced head & neck squamous cell carcinoma: a retrospective study

Authors: Ryul Kim, Chan-Young Ock, Bhumsuk Keam, Tae Min Kim, Jin Ho Kim, Jin Chul Paeng, Seong Keun Kwon, J. Hun Hah, Tack-Kyun Kwon, Dong-Wan Kim, Hong-Gyun Wu, Myung-Whun Sung, Dae Seog Heo

Published in: BMC Cancer | Issue 1/2016

Abstract

Background

The accuracy of ¹⁸F-fluorodeoxygluocose positron emission tomography/computed tomography (PET/CT) in predicting immediate failure after radical chemoradiotherapy (CRT) for HNSCC is poorly characterized at present. The purpose of this study was to examine PET/CT as a predictive and prognostic gauge of immediate failure after CRT and determine the impact of these studies on clinical decision making in terms of salvage surgery.

Methods

Medical records of 78 consecutive patients receiving radical CRT for locally advanced HNSCC were reviewed, analyzing PET/CTs done before and 3 months after CRT. Immediate failure was defined as residual disease or locoregional and/or systemic relapse within 6 months after CRT.

Results

Maximum standard uptake value (SUV) of post CRT PET/CT (postSUVmax) was found optimal for predicting immediate failure at a cutpoint of 4.4. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 90.0 %, 83.8 %, 98.3 %, and 45.0 %, respectively. Of 78 patients studied, postSUVmax ≥4.4 prevailed in 20 (25.6 %), with postSUVmax <4.4 in 58 (74.4 %). At postSUVmax ≥4.4 (vs. postSUVmax <4.4) OS was poorer by comparison (3-year OS: 56.9 vs. 87.7 %; P = 0.005), as was progression-free survival (3-year PFS: 42.9 vs. 81.1 %; P < 0.001). At postSUVmax ≥4.4, OS with and without immediate salvage surgery did not differ significantly (3-year OS: 60.0 vs. 55.6 %; Log-rank P = 0.913).

Conclusion

Post CRT PET/CT imaging has prognostic value in terms of OS and PFS and is useful in predicting immediate therapeutic failure, given its high NPV. However, OS was not significantly altered by early salvage surgery done on the basis of post CRT PET/CT findings.

Available only for authorised users

Ferlay J, Parkin DM, Steliarova-Foucher E. Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer. 2010;46(4):765–81. doi:10.1016/j.ejca.2009.12.014.CrossRefPubMed

Lee JC, Kim JS, Lee JH, Nam SY, Choi SH, Lee SW, et al. F-18 FDG-PET as a routine surveillance tool for the detection of recurrent head and neck squamous cell carcinoma. Oral Oncol. 2007;43(7):686–92. doi:10.1016/j.oraloncology.2006.08.006.CrossRefPubMed

Ryan WR, Fee Jr WE, Le QT, Pinto HA. Positron-emission tomography for surveillance of head and neck cancer. Laryngoscope. 2005;115(4):645–50. doi:10.1097/01.mlg.0000161345.23128.d4.CrossRefPubMed

Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. New Engl J Medicine. 2008;359(11):1116–27. doi:10.1056/NEJMoa0802656.CrossRef

Kim G, Kim YS, Han EJ, Yoo Ie R, Song JH, Lee SN, et al. FDG-PET/CT as prognostic factor and surveillance tool for postoperative radiation recurrence in locally advanced head and neck cancer. Radiat Oncol J. 2011;29(4):243–51. doi:10.3857/roj.2011.29.4.243.PubMedCentralCrossRefPubMed

Paidpally V, Chirindel A, Lam S, Agrawal N, Quon H, Subramaniam RM. FDG-PET/CT imaging biomarkers in head and neck squamous cell carcinoma. Imaging Med. 2012;4(6):633–47. doi:10.2217/iim.12.60.PubMedCentralCrossRefPubMed

Mandapathil M, Roessler M, Werner JA, Silver CE, Rinaldo A, Ferlito A. Salvage surgery for head and neck squamous cell carcinoma. Eur Arch Oto Rhino Laryngol. 2014;271(7):1845–50. doi:10.1007/s00405-014-3043-1.CrossRef

Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47. doi:10.1016/j.ejca.2008.10.026.CrossRefPubMed

Ock C-Y, Keam B, Lim Y, Kim TM, Lee S-H, Kwon SK et al. Effect of induction chemotherapy on survival in locally advanced head and neck squamous cell carcinoma treated with concurrent chemoradiotherapy: Single center experience. Head Neck. 2014;n/a-n/a. doi:10.1002/hed.23891.

10.

Network NCC. Clinical practice guidelines in oncology: head and neck cancers, version 1.2015. National Comprehensive Cancer Network website.

11.

Young H, Baum R, Cremerius U, Herholz K, Hoekstra O, Lammertsma AA, et al. Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group. Eur J Cancer. 1999;35(13):1773–82.CrossRefPubMed

12.

Zenda S, Onozawa Y, Boku N, Iida Y, Ebihara M, Onitsuka T. Single-agent docetaxel in patients with platinum-refractory metastatic or recurrent squamous cell carcinoma of the head and neck (SCCHN). Jpn J Clin Oncol. 2007;37(7):477–81. doi:10.1093/jjco/hym059.CrossRefPubMed

13.

Schisterman EF, Perkins NJ, Liu A, Bondell H. Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples. Epidemiology. 2005;16(1):73–81.CrossRefPubMed

14.

Gupta T, Master Z, Kannan S, Agarwal JP, Ghsoh-Laskar S, Rangarajan V, et al. Diagnostic performance of post-treatment FDG PET or FDG PET/CT imaging in head and neck cancer: a systematic review and meta-analysis. Eur J Nuclear Med Mol Imaging. 2011;38(11):2083–95. doi:10.1007/s00259-011-1893-y.CrossRef

15.

Schoder H, Fury M, Lee N, Kraus D. PET monitoring of therapy response in head and neck squamous cell carcinoma. J Nuclear Med. 2009;50 Suppl 1:74s–88s. doi:10.2967/jnumed.108.057208.CrossRef

16.

Kubota K, Yokoyama J, Yamaguchi K, Ono S, Qureshy A, Itoh M, et al. FDG-PET delayed imaging for the detection of head and neck cancer recurrence after radio-chemotherapy: comparison with MRI/CT. Eur J Nuclear Med Mol Imaging. 2004;31(4):590–5. doi:10.1007/s00259-003-1408-6.CrossRef

17.

Ceulemans G, Voordeckers M, Farrag A, Verdries D, Storme G, Everaert H. Can 18-FDG-PET during radiotherapy replace post-therapy scanning for detection/demonstration of tumor response in head-and-neck cancer? Int J Radiat Oncol Biol Phys. 2011;81(4):938–42. doi:10.1016/j.ijrobp.2010.07.019.CrossRefPubMed

18.

Kitagawa Y, Sadato N, Azuma H, Ogasawara T, Yoshida M, Ishii Y, et al. FDG PET to evaluate combined intra-arterial chemotherapy and radiotherapy of head and neck neoplasms. J Nuclear Med. 1999;40(7):1132–7.

19.

Mori M, Tsukuda M, Horiuchi C, Matsuda H, Taguchi T, Takahashi M, et al. Efficacy of fluoro-2-deoxy-D-glucose positron emission tomography to evaluate responses to concurrent chemoradiotherapy for head and neck squamous cell carcinoma. Auris Nasus Larynx. 2011;38(6):724–9. doi:10.1016/j.anl.2011.04.013.CrossRefPubMed

20.

Sherriff JM, Ogunremi B, Colley S, Sanghera P, Hartley A. The role of positron emission tomography/CT imaging in head and neck cancer patients after radical chemoradiotherapy. Br J Radiol. 2012;85(1019):e1120–6. doi:10.1259/bjr/20976707.PubMedCentralCrossRefPubMed

21.

Ong SC, Schoder H, Lee NY, Patel SG, Carlson D, Fury M, et al. Clinical utility of 18F-FDG PET/CT in assessing the neck after concurrent chemoradiotherapy for Locoregional advanced head and neck cancer. J Nuclear Med. 2008;49(4):532–40. doi:10.2967/jnumed.107.044792.CrossRef

22.

Yao M, Smith RB, Graham MM, Hoffman HT, Tan H, Funk GF, et al. The role of FDG PET in management of neck metastasis from head-and-neck cancer after definitive radiation treatment. Int J Radiat Oncol Biol Phys. 2005;63(4):991–9. doi:10.1016/j.ijrobp.2005.03.066.CrossRefPubMed

23.

Chen AY, Vilaseca I, Hudgins PA, Schuster D, Halkar R. PET-CT vs contrast-enhanced CT: what is the role for each after chemoradiation for advanced oropharyngeal cancer? Head Neck. 2006;28(6):487–95. doi:10.1002/hed.20362.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. doi:10.1200/jco.2008.19.3300.PubMedCentralCrossRefPubMed

25.

Zundel MT, Michel MA, Schultz CJ, Maheshwari M, Wong SJ, Campbell BH, et al. Comparison of physical examination and fluorodeoxyglucose positron emission tomography/computed tomography 4–6 months after radiotherapy to assess residual head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2011;81(5):e825–32. doi:10.1016/j.ijrobp.2010.11.072.CrossRefPubMed

26.

Porceddu SV, Jarmolowski E, Hicks RJ, Ware R, Weih L, Rischin D, et al. Utility of positron emission tomography for the detection of disease in residual neck nodes after (chemo)radiotherapy in head and neck cancer. Head Neck. 2005;27(3):175–81. doi:10.1002/hed.20130.CrossRefPubMed

27.

Lonneux M, Lawson G, Ide C, Bausart R, Remacle M, Pauwels S. Positron emission tomography with fluorodeoxyglucose for suspected head and neck tumor recurrence in the symptomatic patient. Laryngoscope. 2000;110(9):1493–7. doi:10.1097/00005537-200009000-00016.CrossRefPubMed

28.

Loo SW, Geropantas K, Beadsmoore C, Montgomery PQ, Martin WM, Roques TW. Neck dissection can be avoided after sequential chemoradiotherapy and negative post-treatment positron emission tomography-computed tomography in N2 head and neck squamous cell carcinoma. Clin Oncol. 2011;23(8):512–7. doi:10.1016/j.clon.2011.03.008.CrossRef

29.

Nayak JV, Walvekar RR, Andrade RS, Daamen N, Lai SY, Argiris A, et al. Deferring planned neck dissection following chemoradiation for stage IV head and neck cancer: the utility of PET-CT. Laryngoscope. 2007;117(12):2129–34. doi:10.1097/MLG.0b013e318149e6bc.CrossRefPubMed

30.

Bachar GY, Goh C, Goldstein DP, O'Sullivan B, Irish JC. Long-term outcome analysis after surgical salvage for recurrent tonsil carcinoma following radical radiotherapy. Eur Arch Oto Rhino Laryngol. 2010;267(2):295–301. doi:10.1007/s00405-009-1070-0.CrossRef

31.

Goodwin Jr WJ. Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means? Laryngoscope. 2000;110(3 Pt 2 Suppl 93):1–18. doi:10.1097/00005537-200003001-00001.CrossRefPubMed

32.

Sewnaik A, Keereweer S, Al-Mamgani A, Baatenburg de Jong RJ, Wieringa MH, Meeuwis CA, et al. High complication risk of salvage surgery after chemoradiation failures. Acta Oto Laryngol. 2012;132(1):96–100. doi:10.3109/00016489.2011.617779.CrossRef

33.

Aarts MC, Rovers MM, Grau C, Grolman W, van der Heijden GJ. Salvage laryngectomy after primary radiotherapy: what are prognostic factors for the development of pharyngocutaneous fistulae? Otolaryngol Head Neck Surg. 2011;144(1):5–9. doi:10.1177/0194599810390914.CrossRefPubMed

34.

Chepeha DB, Sacco AG, Oxford LE, Karamchandani R, Miller TH, Teknos TN, et al. Advanced squamous cell carcinoma of the oropharynx: efficacy of positron emission tomography and computed tomography for determining primary tumor response during induction chemotherapy. Head Neck. 2009;31(4):452–60. doi:10.1002/hed.21006.CrossRefPubMed

35.

McCollum AD, Burrell SC, Haddad RI, Norris CM, Tishler RB, Case MA, et al. Positron emission tomography with 18F-fluorodeoxyglucose to predict pathologic response after induction chemotherapy and definitive chemoradiotherapy in head and neck cancer. Head Neck. 2004;26(10):890–6. doi:10.1002/hed.20080.CrossRefPubMed

Title: Predictive and prognostic value of PET/CT imaging post-chemoradiotherapy and clinical decision-making consequences in locally advanced head & neck squamous cell carcinoma: a retrospective study
Authors: Ryul Kim
Chan-Young Ock
Bhumsuk Keam
Tae Min Kim
Jin Ho Kim
Jin Chul Paeng
Seong Keun Kwon
J. Hun Hah
Tack-Kyun Kwon
Dong-Wan Kim
Hong-Gyun Wu
Myung-Whun Sung
Dae Seog Heo
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Cancer / Issue 1/2016
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-016-2147-y

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2016

Bicyclol induces cell cycle arrest and autophagy in HepG2 human hepatocellular carcinoma cells through the PI3K/AKT and Ras/Raf/MEK/ERK pathways

Statin use and breast cancer survival: a nationwide cohort study in Scotland

3D culture of Her2+ breast cancer cells promotes AKT to MAPK switching and a loss of therapeutic response

Correlation of KIT and PDGFRA mutational status with clinical benefit in patients with gastrointestinal stromal tumor treated with sunitinib in a worldwide treatment-use trial

The dual specificity phosphatase 2 gene is hypermethylated in human cancer and regulated by epigenetic mechanisms

Survival and prognostic factors in patients with stable and unstable spinal bone metastases from solid tumors: a retrospective analysis of 915 cases

Keynote webinar | Spotlight on antibody–drug conjugates in cancer