PET-based prognostic survival model after radiotherapy for head and neck cancer

  • Joël CastelliEmail author
  • A. Depeursinge
  • A. Devillers
  • B. Campillo-Gimenez
  • Y. Dicente
  • J. O. Prior
  • E. Chajon
  • F. Jegoux
  • C. Sire
  • O. Acosta
  • E. Gherga
  • X. Sun
  • B. De Bari
  • J. Bourhis
  • R. de Crevoisier
Original Article



The aims of this multicentre retrospective study of locally advanced head and neck cancer (LAHNC) treated with definitive radiotherapy were to (1) identify positron emission tomography (PET)-18F-fluorodeoxyglucose (18F-FDG) parameters correlated with overall survival (OS) in a training cohort, (2) compute a prognostic model, and (3) externally validate this model in an independent cohort.

Materials and methods

A total of 237 consecutive LAHNC patients divided into training (n = 127) and validation cohorts (n = 110) were retrospectively analysed. The following PET parameters were analysed: SUVMax, metabolic tumour volume (MTV), total lesion glycolysis (TLG), and SUVMean for the primary tumour and lymph nodes using a relative SUVMax threshold or an absolute SUV threshold. Cox analyses were performed on OS in the training cohort. The c-index was used to identify the highly prognostic parameters. A prognostic model was subsequently identified, and a nomogram was generated. The model was externally tested in the validation cohort.


In univariate analysis, the significant PET parameters for the primary tumour included MTV (relative thresholds from 6 to 83% and absolute thresholds from 1.5 to 6.5) and TLG (relative thresholds from 1 to 82% and absolute thresholds from 0.5 to 4.5). For the lymph nodes, the significant parameters included MTV and TLG regardless of the threshold value. In multivariate analysis, tumour site, p16 status, MTV35% of the primary tumour, and MTV44% of the lymph nodes were independent predictors of OS. Based on these four parameters, a prognostic model was identified with a c-index of 0.72. The corresponding nomogram was generated. This prognostic model was externally validated, achieving a c-index of 0.66.


A prognostic model of OS based on primary tumour and lymph node MTV, tumour site, and p16 status was proposed and validated. The corresponding nomogram may be used to tailor individualized treatment.


Head and neck cancer Nomogram Prognostic score PET Radiotherapy 



This work was partly supported by the Swiss National Science Foundation with grant agreement PZ00P2_154891 and 205320_179069 (A. Depeursinge).

Compliance with ethical standards

Conflict of interest

All authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

259_2018_4134_MOESM1_ESM.docx (217 kb)
ESM 1 (DOCX 217 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Joël Castelli
    • 1
    • 2
    • 3
    Email author
  • A. Depeursinge
    • 4
    • 5
  • A. Devillers
    • 6
  • B. Campillo-Gimenez
    • 2
    • 3
    • 7
  • Y. Dicente
    • 4
    • 8
  • J. O. Prior
    • 9
  • E. Chajon
    • 1
  • F. Jegoux
    • 10
  • C. Sire
    • 11
  • O. Acosta
    • 2
    • 3
  • E. Gherga
    • 12
  • X. Sun
    • 12
    • 13
  • B. De Bari
    • 13
  • J. Bourhis
    • 14
  • R. de Crevoisier
    • 1
    • 2
    • 3
  1. 1.Radiotherapy DepartmentCancer Institute Eugène MarquisRennesFrance
  2. 2.INSERM, U1099RennesFrance
  3. 3.University of Rennes 1, LTSIRennesFrance
  4. 4.Ecole Polytechnique Fédérale de LausanneLausanneSwitzerland
  5. 5.University of Applied Sciences Western SwitzerlandSierreSwitzerland
  6. 6.Nuclear Medicine DepartmentCancer Institute Eugène MarquisRennesFrance
  7. 7.Clinical Research DirectionCancer Institute Eugène MarquisRennesFrance
  8. 8.University of GenevaGenevaSwitzerland
  9. 9.Nuclear Medicine and Molecular Imaging DepartmentLausanne University HospitalLausanneSwitzerland
  10. 10.Head and Neck DepartmentCHU RennesRennesFrance
  11. 11.Radiotherapy DepartmentLorient HospitalLorientFrance
  12. 12.Radiotherapy DepartmentCHU BesançonBesançonFrance
  13. 13.Radiotherapy DepartmentHôpital Nord Franche Comté MontbéliardMontbéliardFrance
  14. 14.Radiotherapy DepartmentLausanne University HospitalLausanneSwitzerland

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