Annals of Surgical Oncology

, Volume 22, Issue 8, pp 2746–2754 | Cite as

Intratumor Textural Heterogeneity on Pretreatment 18F-FDG PET Images Predicts Response and Survival After Chemoradiotherapy for Hypopharyngeal Cancer

  • Jungsu S. Oh
  • Bung Chul Kang
  • Jong-Lyel RohEmail author
  • Jae Seung Kim
  • Kyung-Ja Cho
  • Sang-wook Lee
  • Sung-Bae Kim
  • Seung-Ho Choi
  • Soon Yuhl Nam
  • Sang Yoon Kim
Head and Neck Oncology



Increasing evidence suggests that intratumor heterogeneity of solid tumors characterized by textural features on 18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) images is associated with response to chemoradiotherapy (CRT) and survival. The current study aimed to determine whether a similar relationship exists in hypopharyngeal squamous cell carcinoma (HPSCC).


This study investigated 27 patients with HPSCC who underwent cisplatin-based induction chemotherapy followed by definitive CRT underwent pretreatment 18F-FDG PET/CT. Standardized uptake value (SUV), metabolic tumor volume (MTV), and textural features (coarseness, busyness, complexity, and contrast) of primary tumors were measured. Patients were classified as nonresponders or responders according to the response evaluation criteria in solid tumors. The capacity of each parameter to classify response was assessed using the Mann–Whitney U test. Cox-proportional hazard models were used to identify variables associated with disease-free survival (DFS) and overall survival (OS).


Of 70 patients, 58 (83 %) had complete or partial response after CRT. Responders showed lower maximum SUV (P = 0.037), lower MTV (P = 0.039), lower coarseness (P < 0.001), and busyness (P = 0.015) compared with nonresponders. Multivariate analysis showed that high coarseness (P = 0.001, hazard ratio [HR] 5.65; 95 % confidence interval [CI] 2.12–15.07) and busyness (P = 0.045; HR 2.56; 95 % CI 1.02–6.42) were independently associated with poor DFS, and that high coarseness (P = 0.013; HR 2.48; 95 % CI 1.21–5.09) was independently associated with poor OS.


Abnormal coarseness in baseline 18F-FDG PET scans may be useful for predicting response and survival after CRT in HPSCC patients.


Positron Emission Tomography Overall Survival Standardize Uptake Value Textural Feature Textural Parameter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was supported by Grant No. 2014-0306 from the Asan Institute for Life Science and by Grant No. NRF-2012R1A1A2002039 from the Basic Science Research Program through the National Research Foundation of Korea and the Ministry of Education, Science and Technology, Seoul, Korea (J.-L.R.).

Conflict of interest

There are no conflicts of interest.

Supplementary material

10434_2014_4284_MOESM1_ESM.tif (967 kb)
Receiver operating characteristic curves of complete or partial response after chemoradiotherapy according to maximum and peak standardized uptake value (SUVmax and SUVpeak), metabolic tumor volume (MTV), and tumor coarseness on 18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) images. (TIFF 967 kb)


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Jungsu S. Oh
    • 1
  • Bung Chul Kang
    • 2
  • Jong-Lyel Roh
    • 2
    Email author
  • Jae Seung Kim
    • 1
  • Kyung-Ja Cho
    • 3
  • Sang-wook Lee
    • 4
  • Sung-Bae Kim
    • 5
  • Seung-Ho Choi
    • 2
  • Soon Yuhl Nam
    • 2
  • Sang Yoon Kim
    • 2
    • 6
  1. 1.Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Otolaryngology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  3. 3.Department of Pathology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  4. 4.Department of Radiation Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  5. 5.Department of Internal Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  6. 6.Biomedical Research InstituteKorea Institute of Science and TechnologySeoulRepublic of Korea

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