Original article

Annals of Nuclear Medicine

, Volume 26, Issue 7, pp 527-534

Open Access This content is freely available online to anyone, anywhere at any time.

Superior prognostic utility of gross and metabolic tumor volume compared to standardized uptake value using PET/CT in head and neck squamous cell carcinoma patients treated with intensity-modulated radiotherapy

  • Paul B. RomesserAffiliated withDepartment of Radiation Oncology, Boston Medical Center, Boston University School of MedicineDepartment of Medicine, Memorial Sloan-Kettering Cancer Center
  • , Muhammad M. QureshiAffiliated withDepartment of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
  • , Bhartesh A. ShahAffiliated withDepartment of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
  • , Luke T. ChatburnAffiliated withDepartment of Radiology, Boston Medical Center, Boston University School of Medicine
  • , Scharukh JalisiAffiliated withDepartment of Otolaryngology, Boston Medical Center, Boston University School of Medicine
  • , Anand K. DevaiahAffiliated withDepartment of Otolaryngology, Boston Medical Center, Boston University School of Medicine
  • , Rathan M. SubramaniamAffiliated withDepartment of Radiation Oncology, Boston Medical Center, Boston University School of MedicineDepartment of Radiology, Boston Medical Center, Boston University School of Medicine
  • , Minh Tam TruongAffiliated withDepartment of Radiation Oncology, Boston Medical Center, Boston University School of MedicineDepartment of Radiology, Boston Medical Center, Boston University School of Medicine Email author 

Abstract

Objective

To compare the prognostic utility of the 2-[18F] fluoro-2-deoxy-d-glucose (FDG) maximum standardized uptake value (SUVmax), primary gross tumor volume (GTV), and FDG metabolic tumor volume (MTV) for disease control and survival in patients with head and neck squamous cell carcinoma (HNSCC) undergoing intensity-modulated radiotherapy (IMRT).

Methods

Between 2007 and 2011, 41 HNSCC patients who underwent a staging positron emission tomography with computed tomography and definitive IMRT were identified. Local (LC), nodal (NC), distant (DC), and overall (OC) control, overall survival (OS), and disease-free survival (DFS) were assessed using the Kaplan–Meier product-limit method.

Results

With a median follow-up of 24.2 months (range 2.7–56.3 months) local, nodal, and distant recurrences were recorded in 10, 5, and 7 patients, respectively. The median SUVmax, GTV, and MTV were 15.8, 22.2 cc, and 7.2 cc, respectively. SUVmax did not correlate with LC (p = 0.229) and OS (p = 0.661) when analyzed by median threshold. Patients with smaller GTVs (<22.2 cc) demonstrated improved 2-year actuarial LC rates of 100 versus 56.4 % (p = 0.001) and OS rates of 94.4 versus 65.9 % (p = 0.045). Similarly, a smaller MTV (<7.2 cc) correlated with improved 2-year actuarial LC rates of 100 versus 54.2 % (p < 0.001) and OS rates of 94.7 versus 64.2 % (p = 0.04). Smaller GTV and MTV correlated with improved NC, DC, OC, and DFS, as well.

Conclusion

GTV and MTV demonstrate superior prognostic utility as compared to SUVmax, with larger tumor volumes correlating with inferior local control and overall survival in HNSCC patients treated with definitive IMRT.

Keywords

Head and neck cancer PET/CT Standardized uptake value (SUV) Gross tumor volume (GTV) Metabolic tumor volume (MTV) Intensity-modulated radiotherapy (IMRT)