Early FDG PET at 10 or 20 Gy under chemoradiotherapy is prognostic for locoregional control and overall survival in patients with head and neck cancer
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Our study aimed to explore the optimal timing as well as the most appropriate prognostic parameter of 18F-fluorodeoxyglucose positron emission tomography (FDG PET) during chemoradiotherapy (CRT) for an early prediction of outcome for patients with head and neck squamous cell carcinoma (HNSCC).
Serial PET data (before and three times during CRT) of 37 patients with advanced stage HNSCC, receiving combined CRT between 2005 and 2009, were evaluated. The maximum standardized uptake value (SUVmax), the average SUV (SUVmean) and the gross tumour volume determined by FDG PET (GTV PET), based on a source to background algorithm, were analysed. Stratified actuarial analysis was performed for overall survival (OS), disease-free survival (DFS) and locoregional control (LRC). The median follow-up time was 26 months (range 8–50).
For all patients, OS was 51%, DFS 44% and LRC 55% after 2 years. The 2-year OS (88%) and 2-year LRC (88%) were higher for patients whose SUVmax of the primary tumour decreased 50% or more from the beginning (0 Gy) to week 1 or 2 (10 or 20 Gy) of CRT (ΔSUVmax10/20 ≥ 50%) than for patients with ΔSUVmax20 < 50% (2-year OS = 38%; p = 0.02; 2-year LRC 40%; p = 0.06). A pretreatment GTV PET below the median of 10.2 ml predicted a better 2-year OS (34% for GTV PET ≥ 10.2 ml vs 83% for GTV PET < 10.2 ml; p = 0.02).
The decrease of SUVmax from before (0 Gy) to week 1 or 2 (10 or 20 Gy) of CRT is a potential prognostic marker for patients with HNSCC. Because GTV PET depends on the applied method of analysis, we suggest the use of SUVmax, especially ΔSUVmax10/20, for an early estimation of therapy outcome. Confirmatory studies are warranted.
KeywordsFDG PET Head and neck cancer Outcome Prognostic marker Chemoradiotherapy
This work was supported by the 6th framework EU-project ‘BioCare’, proposal #505785 and by the German Federal Ministry of Education and Research (BMBF 03ZIK342).
Conflicts of interest
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