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Definitive chemo-radiotherapy for squamous cell carcinoma of the pharynx: impact of baseline low hemoglobin level (<12 g/dL) and post-radiation therapy F-18 FDG-PET/CT

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Abstract

Objective

To identify reliable predictors of overall survival (OS), locoregional control (LC), and metastasis-free survival (MFS) after definitive concurrent chemo-radiotherapy (CCRT) for squamous cell carcinoma (SCC) of the pharynx (nasopharynx, oropharynx and hypopharynx), we examined 16 potential prognostic factors, including pre-treatment hemoglobin level and pre- and post-treatment [18F]fluorodeoxyglucose positron emission tomography CT (F-18 FDG-PET/CT) maximum standardized up-take values (SUVmax) of primary sites and lymph node (LN) regions.

Methods

We retrospectively reviewed records of 70 patients treated with definitive CCRT for pharyngeal cancer in our institution during July 2006–April 2012, with particular regard to 16 prognostic factors: age, sex, T stage, N stage, retropharyngeal LN (RPLN) involvement, existence of multiple primary cancer, treatment interruptions, overall treatment time, chemotherapy type, pre-treatment hemoglobin level, pre-treatment body mass index, enteral feeding period, and pre- and post-treatment F-18 FDG-PET/CT SUVmax of primary site and LN region. All patients in our cohort underwent pre- and post-treatment F-18 FDG-PET/CT.

Results

Multivariate analysis associated improved OS with pre-treatment hemoglobin level (≥12 g/dL; hazard ratio [HR] 3.902; 95 % confidence interval [CI] 1.244–12.236; P = 0.020) and post-treatment SUVmax (primary site) (SUVmax <5.00; HR 4.237; 95 % CI 1.072–16.747; P = 0.039). Improved LC was associated with pre-treatment hemoglobin level (≥12 g/dL; HR 2.983; 95 % CI 1.123–7.920; P = 0.028), and post treatment SUVmax (primary site) (SUVmax <5.00; HR 5.233; 95 % CI 1.582–17.309; P = 0.007). No variable was found to be significant for improved MFS.

Conclusions

Significant predictors for outcome in pharyngeal SCC treated with definitive CCRT were pre-treatment baseline hemoglobin level and post-treatment F-18 FDG-PET/CT SUVmax for primary site. Patients who have hemoglobin level lower than 12 g/dL may tend to have dismal prognosis. Additional treatment should be considered in those who have higher SUVmax at primary site in post-treatment F-18 FDG-PET/CT finding.

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Authors and Affiliations

  1. Department of Radiology, Yokohana City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan

    Ryoko Katahira-Suzuki, Masaharu Hata, Ukihide Tateishi, Shoko Takano & Tomio Inoue

  2. Department of Otorhinolaryngology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan

    Takahide Taguchi

  3. Department of Radiation Oncology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, 247-8533, Japan

    Ryoko Katahira-Suzuki, Shoko Takano & Motoko Omura-Minamisawa

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  1. Ryoko Katahira-Suzuki
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  2. Masaharu Hata
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  3. Ukihide Tateishi
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Correspondence to Ryoko Katahira-Suzuki.

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Katahira-Suzuki, R., Hata, M., Tateishi, U. et al. Definitive chemo-radiotherapy for squamous cell carcinoma of the pharynx: impact of baseline low hemoglobin level (<12 g/dL) and post-radiation therapy F-18 FDG-PET/CT. Ann Nucl Med 29, 37–45 (2015). https://doi.org/10.1007/s12149-014-0907-9

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  • DOI: https://doi.org/10.1007/s12149-014-0907-9

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