Nodal parameters of FDG PET/CT performed during radiotherapy for locally advanced mucosal primary head and neck squamous cell carcinoma can predict treatment outcomes: SUVmean and response rate are useful imaging biomarkers

  • Peter LinEmail author
  • Myo Min
  • Mark Lee
  • Lois Holloway
  • Dion Forstner
  • Victoria Bray
  • Allan Fowler
Original Article



To evaluate the prognostic utility of nodal metabolic parameters derived from FDG PET/CT performed before radiotherapy (prePET) and during the third week of radiotherapy (iPET) in patients with mucosal primary head and neck squamous cell carcinoma (MPHNSCC).


This analysis included 75 patients with newly diagnosed locally advanced node-positive MPHNSCC treated with radical radiotherapy and concurrent systemic therapy who underwent prePET and iPET: N1 11 patients, N2a 38, N2b 12, N2c 9, N3 5. The median follow-up was 28 months (9 – 70 months). The maximum and mean standardized uptake values (SUVmax and SUVmean), metabolic tumour volume (MTV) and total lesional glycolysis (TLG) of the index lymph node (node with the highest TLG) and the combined total lymph nodes, and their percentage reductions on iPET were determined, and the results were correlated with 3-year Kaplan-Meier locoregional, regional and distant metastatic failure-free survival (FFS), disease-free survival (DFS) and overall survival (OS). Optimal cut-off values were derived from receiver operating characteristic curves. Cox regression univariate and multivariate analyses with clinical covariates were performed.


Based on assessment of residual nodal metabolic burden during treatment, the iPET index node SUVmean (optimal cut-off value 2.95 g/ml) and the total node SUVmean (optimal cut-off value 3.25) were the best independent predictors of outcome in the multivariate analysis: index node SUVmean for DFS and OS p = 0.033 and 0.003, respectively, and the total node SUVmean for locoregional FFS, DFS and OS p = 0.028, 0.025 and 0.014, respectively. Based on the assessment of response rates during treatment, a reduction of more than 50 % in the total node TLG was the best biomarker for locoregional and regional FFS, DFS and OS in the multivariate analysis (p = 0.001, 0.016, 0.001 and 0.004, respectively), and reduction in the total node MTV for locoregional FFS, DFS and OS (p = 0.026, 0.003 and 0.014, respectively). There were no significant correlations between oncological outcomes and prePET nodal parameters.


We demonstrated that the index node and total node SUVmean on iPET and a reduction of more than 50 % in MTV and TLG are useful imaging biomarkers, and can potentially identify those patients with MPHNSCC who have a high risk of locoregional metastatic failure and death.


Mucosal primary head and neck squamous cell carcinoma FDG PET/CT Positron emission tomography Radiotherapy Imaging biomarkers 


Compliance with ethical standards



Conflicts of interest


Ethical approval

This study was approved by the local research ethics committee (Sydney South West Area Health Service Human Research Ethics Committee). For this type of study, formal consent is not required.

Supplementary material

259_2016_3584_MOESM1_ESM.docx (30 kb)
ESM 1 (DOCX 30 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Peter Lin
    • 1
    • 2
    • 3
    Email author
  • Myo Min
    • 2
    • 4
    • 5
  • Mark Lee
    • 2
    • 4
  • Lois Holloway
    • 2
    • 3
    • 4
    • 5
  • Dion Forstner
    • 2
    • 4
    • 5
  • Victoria Bray
    • 4
  • Allan Fowler
    • 4
  1. 1.Department of Nuclear Medicine and PETLiverpool HospitalLiverpool BCAustralia
  2. 2.South Western Sydney Clinical SchoolUniversity of New South WalesSydneyAustralia
  3. 3.Western Sydney UniversitySydneyAustralia
  4. 4.Cancer Therapy CentreLiverpool HospitalLiverpoolAustralia
  5. 5.Ingham Institute of Applied Medical ResearchLiverpoolAustralia

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