Dataset Information

18F-FDG-PET/CT for the detection of disease in patients with head and neck cancer treated with radiotherapy.

ABSTRACT:

Objective

The aim of this study is to evaluate the diagnostic performance of FDG-PET/CT for the detection of residual disease after (chemo)radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC) and to evaluate the prognostic value of the FDG-PET/CT findings.

Methods

Patients with HNSCC who underwent FDG-PET/CT after (chemo)radiotherapy were studied retrospectively.

Results

104 FDG-PET/CT-scans were performed at a median of 13.2 weeks post-treatment (5.4-19.0 weeks). The diagnostic performance was time dependent with decreasing sensitivity and slightly increasing specificity over time. Sensitivity, specificity, PPV and NPV at 9 months after imaging were 91%, 87%, 77% and 95%, respectively. In a logistic regression model, the odds of a correct FDG-PET/CT increased with 33% every additional week after end of therapy (p = 0.01) and accuracy plateaued after 11 weeks (97%; p<0.001). A complete response on FDG-PET/CT was associated with an overall survival benefit (50.7 versus 10.3 months; p<0.001). Residual disease on FDG-PET/CT increased the risk of death 8-fold (p<0.001).

Conclusion

FDG-PET/CT is able to detect residual disease after (chemo)radiotherapy, with an optimal time point for scanning between 11-12 weeks after therapy. However, a reevaluation is probably necessary 10-12 months after the FDG-PET/CT to detect late recurrences. In addition, FDG-PET/CT can guide decisions about neck dissection and identifies patients with poor prognosis.

SUBMITTER: Helsen N

PROVIDER: S-EPMC5542639 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

18F-FDG-PET/CT for the detection of disease in patients with head and neck cancer treated with radiotherapy.

Helsen Nils N Roothans Dessie D Van Den Heuvel Bert B Van den Wyngaert Tim T Van den Weyngaert Danielle D Carp Laurens L Stroobants Sigrid S

PloS one 20170803 8

<h4>Objective</h4>The aim of this study is to evaluate the diagnostic performance of FDG-PET/CT for the detection of residual disease after (chemo)radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC) and to evaluate the prognostic value of the FDG-PET/CT findings.<h4>Methods</h4>Patients with HNSCC who underwent FDG-PET/CT after (chemo)radiotherapy were studied retrospectively.<h4>Results</h4>104 FDG-PET/CT-scans were performed at a median of 13.2 weeks post-treatment (5.4 ...[more]

PMID: 28771540

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Project description:Background and objectives: Induction chemotherapy (ICT) before definitive chemoradiation (CRT) gives high response rates in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, pre-ICT gross tumor volume (GTV) for radiotherapy (RT) planning is still recommended. As 18F-FDG PET/CT has an advantage of biological tumor information comparing to standard imaging methods, we aimed to evaluate the feasibility of 18F-FDG PET/CT-based post-ICT GTV delineation for RT planning in LA-SCCHN and to assess the prognostic value of PET parameters: maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Methods: 47 LA-SCCHN patients were treated with 3 cycles of ICT (docetaxel, cisplatin, and 5-fluorouracil) followed by CRT (70 Gy in 35 fractions with weekly cisplatin). Pre- and post-ICT PET/CT examinations were acquired. Planning CT was co-registered with post-ICT PET/CT and RT target volumes were contoured according to post-ICT PET. Post-ICT percentage decrease of SUVmax, MTV and TLG in primary tumor and metastatic regional lymphnodes (LN) was counted. Loco-regional failure patterns, 3-year progression free (PFS) and overall survival (OS) were evaluated. Results: 3-year PFS and OS rates for study population were 67% and 61% respectively. 31.9% of patients progressed loco-regionally. All progress was localized in high-to-intermediate dose (60?70 Gy) RT volumes and none in low dose (50 Gy) volumes. Decrease of SUVmax ? 74% (p = 0.04), MTV ? 68% (p = 0.03), TLG ? 76% (p = 0.03) in primary tumor, and LN TLG decrease ? 74% (p = 0.03) were associated with PFS. Decrease of primary tumor SUVmax ? 74% (p = 0.04), MTV ? 69% (p = 0.03), TLG ? 74% (p = 0.02) and LN TLG ? 73% (p = 0.02) were prognostic factors for OS. Conclusions: According to our results, 18F-FDG PET/CT-based post-ICT GTV delineation is feasible strategy without negative impacts on loco-regional control and survival. Percentage decrease of metabolic PET parameters SUVmax, MTV and TLG has a prognostic value in LA-SCCHN.

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Dataset Information

18F-FDG-PET/CT for the detection of disease in patients with head and neck cancer treated with radiotherapy.

Objective

Methods

Results

Conclusion

Publications

18F-FDG-PET/CT for the detection of disease in patients with head and neck cancer treated with radiotherapy.

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