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18F-FDG Metabolic Tumor Volume: Association with Short- and Long-Term Feeding Tube Use in Head and Neck IMRT

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Abstract

The purpose of this study was to investigate whether the metabolic tumor volume (MTV) of head and neck primary tumors may be a significant prognostic factor for feeding tube (FT) use and FT dependence. Seventy-nine patients with evaluable primary tumors, pre-therapy FDG-PET scans, treated with definitive intensity-modulated radiotherapy (IMRT) (± concurrent chemotherapy) for head and neck mucosal cancers were included. MTV was quantified and recorded for the primary lesion using a minimum standardized uptake value (SUV) threshold of 2.0. Patients were recommended prophylactic FT and followed up by a dietician for at least eight weeks of post-radiotherapy. Associations between MTV, dose to swallowing organs at risk, FT use, and FT dependence were analyzed. MTV was positively correlated with gross tumor volume (GTV) (r = 0.7357; p < 0.0001). MTVs larger than 17 cc were associated with higher rates of FT use (87.8% vs. 69.5%, p = 0.0067) and FT dependence at six weeks (76.7% vs. 41.7%, p = 0.0024) and six months (25.0% vs. 8.7%, p = 0.0088). Increasing MTV was associated with increasing mean dose to the oral cavity (p = < 0.0001), tongue base (p = 0.0009), and superior (SPCM) (p = 0.0001) and middle pharyngeal constrictor muscles (MPCM) (p = 0.0005). Increasing MTV was associated with increasing maximum dose to oral cavity (p = 0.0028), tongue base (p = 0.0056), SPCM (p = 0.0037), and MPCM (p = 0.0085). Pre-treatment MTV is a reproducible parameter that can be generated at or prior to a pre-treatment Multidisciplinary Tumor Board and may expedite decisions regarding placement of prophylactic FTs. Prospective evaluation in larger series is required to determine whether MTV is a more useful prognostic variable for FT use than clinical T-classification.

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Acknowledgements

Departments of Nutrition and Dietetics & Speech Pathology, Austin Health, Heidelberg, Victoria, Australia.

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Authors and Affiliations

  1. Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, VIC, Australia

    James E. Jackson MBBS, FRANZCR, Nigel J. Anderson BAppSc, Maureen Rolfo DipAppSc, Morikatsu Wada MBBS, FRANZCR, Maziar Fahandej BMBS FRACGP, Daryl Lim Joon MBBS FRANZCR & Vincent Khoo MD

  2. Radiation Oncology Centres, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia

    James E. Jackson MBBS, FRANZCR, Michael Poulsen MBBS, FRANZCR & Anna Huynh BAppSc

  3. School of Medicine, Griffith University, Gold Coast, Australia

    James E. Jackson MBBS, FRANZCR

  4. Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia

    James E. Jackson MBBS, FRANZCR

  5. Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Nigel J. Anderson BAppSc

  6. Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC, Australia

    Michal Schneider PhD & Vincent Khoo MD

  7. Faculty of Medicine, The University of Queensland, Herston, QLD, Australia

    Michael Poulsen MBBS, FRANZCR

  8. Centre for PET, Austin Health, Heidelberg, VIC, Australia

    Sze Ting Lee

  9. Department of Clinical Oncology, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Chelsea, London, UK

    Vincent Khoo MD

  10. Department of Medicine, University of Melbourne, Parkville, VIC, Australia

    Vincent Khoo MD

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  1. James E. Jackson MBBS, FRANZCR
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Correspondence to James E. Jackson MBBS, FRANZCR.

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Jackson, J.E., Anderson, N.J., Rolfo, M. et al. 18F-FDG Metabolic Tumor Volume: Association with Short- and Long-Term Feeding Tube Use in Head and Neck IMRT. Dysphagia 34, 341–349 (2019). https://doi.org/10.1007/s00455-018-9946-z

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