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18F‐ FDG PET – CT performed before and during radiation therapy of head and neck squamous cell carcinoma: Are they independent or complementary to each other?
Author(s) -
Min Myo,
Lin Peter,
Lee Mark,
Shon Ivan Ho,
Lin Michael,
Forstner Dion,
Tieu Minh Thi,
Chicco Andrew,
Bray Victoria,
Fowler Allan
Publication year - 2016
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.12439
Subject(s) - medicine , univariate analysis , nuclear medicine , radiation therapy , head and neck squamous cell carcinoma , head and neck cancer , oncology , multivariate analysis
The aims of this study are to evaluate the prognostic value of metabolic parameters derived from 18 F‐ FDG PET ‐ CT performed before definitive radiation therapy ( RT ) (pre PET ) in patients with mucosal primary head and neck squamous cell carcinoma ( MPHNSCC ) and to assess the additive prognostic values of FDG PET ‐ CT performed during RT ( iPET ). Methods One hundred patients with MPHNSCC treated with radical RT underwent staging pre PET and iPET performed during the third week of treatment. The maximum standardized uptake value ( SUV max ), metabolic tumour volume ( MTV ) and total lesional glycolysis ( TLG ) of primary tumour were analysed for both pre PET and iPET , and results were correlated with loco‐regional recurrence‐free survival ( LRFS ), disease‐free survival ( DFS ), metastatic failure‐free survival ( MFFS ) and overall survival ( OS ), using Kaplan–Meier analysis. Optimal cut‐offs ( OC ) for pre PET and iPET were derived from Receiver Operating Characteristic curves. Patients with metabolic parameters above/below the individual OC of pre PET as well as iPET (i.e. combined pre PET and iPET (com PET )) were evaluated against their outcomes. Results Median age was 61 years (range 39–81), median follow‐up of 20 months (range 4–70, mean 27), and AJCC 7th Edition clinical stage II , III and IV were 8, 24 and 68 patients respectively. Metabolic values below individual OC in com PET were found to be associated with statistically significant improvements ( P < 0.05) in DFS , LRFS and OS . In addition, patients with SUV max above the OC in com PET were associated with worse MFFS ( P = 0.011) and confirmed on both univariate ( P = 0.019) and multivariate analyses ( P = 0.04). Conclusion Addition of iPET significantly improves the prognostic values of all three metabolic parameters and can potentially be used in future adaptive local and systemic therapy trials.