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
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).
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.
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.
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.
- Posner, MR, Hershock, DM, Blajman, CR, Mickiewicz, E, Winquist, E, Gorbounova, V (2007) Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 357: pp. 1705-1715 CrossRef
- Vermorken, JB, Remenar, E, Herpen, C, Gorlia, T, Mesia, R, Degardin, M (2007) Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med 357: pp. 1695-1704 CrossRef
- Edge, SB, Byrd, DR, Compton, CC, Fritz, AG, Greene, FL, Trotti, A eds. (2010) AJCC cancer staging manual. Springer, Chicago
- Studer, G, Lutolf, UM, El-Bassiouni, M, Rousson, V, Glanzmann, C (2007) Volumetric staging (VS) is superior to TNM and AJCC staging in predicting outcome of head and neck cancer treated with IMRT. Acta Oncol 46: pp. 386-394 CrossRef
- Doweck, I, Denys, D, Robbins, KT (2002) Tumor volume predicts outcome for advanced head and neck cancer treated with targeted chemoradiotherapy. Laryngoscope 112: pp. 1742-1749 CrossRef
- Chen, MK, Chen, TH, Liu, JP, Chang, CC, Chie, WC (2004) Better prediction of prognosis for patients with nasopharyngeal carcinoma using primary tumor volume. Cancer 100: pp. 2160-2166 CrossRef
- Rothschild, S, Studer, G, Seifert, B, Huguenin, P, Glanzmann, C, Davis, JB (2007) PET/CT staging followed by intensity-modulated radiotherapy (IMRT) improves treatment outcome of locally advanced pharyngeal carcinoma: a matched-pair comparison. Radiat Oncol 2: pp. 22 CrossRef
- Subramaniam, RM, Truong, M, Peller, P, Sakai, O, Mercier, G (2010) Fluorodeoxyglucose-positron-emission tomography imaging of head and neck squamous cell cancer. AJNR Am J Neuroradiol 31: pp. 598-604 CrossRef
- Abgral, R, Querellou, S, Potard, G, Roux, PY, Duc-Pennec, A, Marianovski, R (2009) Does 18F-FDG PET/CT improve the detection of posttreatment recurrence of head and neck squamous cell carcinoma in patients negative for disease on clinical follow-up?. J Nucl Med 50: pp. 24-29 CrossRef
- Isles, MG, McConkey, C, Mehanna, HM (2008) A systematic review and meta-analysis of the role of positron emission tomography in the follow up of head and neck squamous cell carcinoma following radiotherapy or chemoradiotherapy. Clin Otolaryngol 33: pp. 210-222 CrossRef
- Imsande, HM, Davison, JM, Truong, MT, Devaiah, AK, Mercier, GA, Ozonoff, AJ (2011) Use of 18F-FDG PET/CT as a predictive biomarker of outcome in patients with head-and-neck non-squamous cell carcinoma. AJR Am J Roentgenol 197: pp. 976-980 CrossRef
- Chung, MK, Jeong, HS, Park, SG, Jang, JY, Son, YI, Choi, JY (2009) Metabolic tumor volume of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography predicts short-term outcome to radiotherapy with or without chemotherapy in pharyngeal cancer. Clin Cancer Res 15: pp. 5861-5868 CrossRef
- La, TH, Filion, EJ, Turnbull, BB, Chu, JN, Lee, P, Nguyen, K (2009) Metabolic tumor volume predicts for recurrence and death in head-and-neck cancer. Int J Radiat Oncol Biol Phys 74: pp. 1335-1341 CrossRef
- Machtay, M, Natwa, M, Andrel, J, Hyslop, T, Anne, PR, Lavarino, J (2009) Pretreatment FDG-PET standardized uptake value as a prognostic factor for outcome in head and neck cancer. Head Neck 31: pp. 195-201 CrossRef
- Torizuka, T, Tanizaki, Y, Kanno, T, Futatsubashi, M, Naitou, K, Ueda, Y (2009) Prognostic value of 18F-FDG PET in patients with head and neck squamous cell cancer. AJR Am J Roentgenol 192: pp. W156-W160 CrossRef
- Xie, P, Yue, JB, Zhao, HX, Sun, XD, Kong, L, Fu, Z (2010) Prognostic value of 18F-FDG PET–CT metabolic index for nasopharyngeal carcinoma. J Cancer Res Clin Oncol 136: pp. 883-889 CrossRef
- Xie, P, Yue, JB, Fu, Z, Feng, R, Yu, JM (2010) Prognostic value of 18F-FDG PET/CT before and after radiotherapy for locally advanced nasopharyngeal carcinoma. Ann Oncol 21: pp. 1078-1082 CrossRef
- Mukherji, SK, O’Brien, SM, Gerstle, RJ, Weissler, M, Shockley, W, Stone, JA (2000) The ability of tumor volume to predict local control in surgically treated squamous cell carcinoma of the supraglottic larynx. Head Neck 22: pp. 282-287 CrossRef
- Mendenhall, WM, Parsons, JT, Mancuso, AA, Pameijer, FJ, Stringer, SP, Cassisi, NJ (1997) Definitive radiotherapy for T3 squamous cell carcinoma of the glottic larynx. J Clin Oncol 15: pp. 2394-2402
- Mukherji, SK, Mancuso, AA, Mendenhall, W, Kotzur, IM, Kubilis, P (1995) Can pretreatment CT predict local control of T2 glottic carcinomas treated with radiation therapy alone?. AJNR Am J Neuroradiol 16: pp. 655-662
- Lee, WR, Mancuso, AA, Saleh, EM, Mendenhall, WM, Parsons, JT, Million, RR (1993) Can pretreatment computed tomography findings predict local control in T3 squamous cell carcinoma of the glottic larynx treated with radiotherapy alone?. Int J Radiat Oncol Biol Phys 25: pp. 683-687 CrossRef
- Strongin, A, Yovino, S, Taylor, R, Wolf, J, Cullen, K, Zimrin, A (2012) Primary tumor volume is an important predictor of clinical outcomes among patients with locally advanced squamous cell cancer of the head and neck treated with definitive chemoradiotherapy. Int J Radiat Oncol Biol Phys. 82: pp. 1823-1830 CrossRef
- Lok, BH, Setton, J, Caria, N, Romanyshyn, J, Wolden, SL, Zelefsky, MJ (2012) Intensity-modulated radiation therapy in oropharyngeal carcinoma: effect of tumor volume on clinical outcomes. Int J Radiat Oncol Biol Phys. 82: pp. 1851-1857 CrossRef
- AJCC. Cancer staging manual. New York: Springer; 2002.
- Dibble E, Lara Alvarex A, Truong M, Mercier G, Cook E, Subramaniam RM. Metabolic tumor volume and total glycolytic activty of oral cavity and oropharyngeal squamous cell cancer: adding value to clinical staging. J Nucl Med. 2012;53(5):709–15.
- Werner-Wasik, M, Nelson, AD, Choi, W, Arai, Y, Faulhaber, PF, Kang, P (2012) What is the best way to contour lung tumors on PET scans? Multiobserver validation of a gradient-based method using a NSCLC digital PET phantom. Int J Radiat Oncol Biol Phys 82: pp. 1164-1171 CrossRef
- Kaplan, EL, Meier, P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53: pp. 25 CrossRef
- Schwartz DL, Rajendran J, Yueh B, et al. FDG-PET prediction of head and neck squamous cell cancer outcomes. Arch Otolaryngol Head Neck Surg 2004;130:1361–67.
- Kinahan, PE, Doot, RK, Wanner-Roybal, M, Bidaut, LM, Armato, SG, Meyer, CR (2009) PET/CT assessment of response to therapy: tumor change measurement, truth data, and error. Transl Oncol 2: pp. 223-230
- Fahey, FH, Kinahan, PE, Doot, RK, Kocak, M, Thurston, H, Poussaint, TY (2010) Variability in PET quantitation within a multicenter consortium. Med Phys 37: pp. 3660-3666 CrossRef
- Brasse, D, Kinahan, PE, Lartizien, C, Comtat, C, Casey, M, Michel, C (2005) Correction methods for random coincidences in fully 3D whole-body PET: impact on data and image quality. J Nucl Med 46: pp. 859-867
- Ford, EC, Kinahan, PE, Hanlon, L, Alessio, A, Rajendran, J, Schwartz, DL (2006) Tumor delineation using PET in head and neck cancers: threshold contouring and lesion volumes. Med Phys 33: pp. 4280-4288 CrossRef
- 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
Annals of Nuclear Medicine
Volume 26, Issue 7 , pp 527-534
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Head and neck cancer
- Standardized uptake value (SUV)
- Gross tumor volume (GTV)
- Metabolic tumor volume (MTV)
- Intensity-modulated radiotherapy (IMRT)
- Industry Sectors
- Author Affiliations
- 1. Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, 830 Harrison Ave, Moakley Building LL 238, Boston, MA, 02118, USA
- 2. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
- 3. Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- 4. Department of Otolaryngology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA