Subscribe to RSS
DOI: 10.1055/s-0042-1744197
Impact of Primary Tumor Size, SUVmax of Primary Tumor and the Most Avid Neck Node on Baseline 18FDG PET/CT upon Disease Recurrence in Head and Neck Oropharyngeal SCC Using Standardized Imaging Protocol
Abstract
Objective The purpose fo this prospective study was to find the impact of primary tumor size (Ts), standardized uptake values (SUVmax) of primary tumor, and the most avid neck node on disease recurrence in patients with head and neck oropharyngeal squamous cell carcinoma (HNOP-SCC).
Material and methods We included patients with HNOP-SCC (without distant metastasis—M0 disease) who had pre- and post-treatment F-18 fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET/CT) using strict standardized imaging protocol from 2017 to 2019. Based on follow-up (18FDG PET/CT) findings, patients were categorized as disease free (no or minimal 18FDG uptake ≤ background over surgical bed and no distant metastasis) and disease recurrence (18FDG uptake > background over surgical bed with or without nodal and/or distant metastasis). Ts and SUVmax of primary tumor and the most avid neck node were compared and impact of these was studied upon disease recurrence.
Results Total 112 patients were included. No significant difference was seen in mean age (overall: 60 ± 14 years), gender distribution (overall M:F: 69:31%), body mass index (overall: 25.20 ± 5.82), and history of diabetes (overall: 19%) between disease-free and disease recurrence groups. Similarly, no significant difference was observed for fasting blood sugar (overall: 110 ± 28 mg%), 18FDG dose (overall: 169 ± 37 MBq), and uptake period (overall: 70 ± 12 minutes) between two groups ensuring strict adherence to standardized imaging protocol. Significant difference (p < 0.05) was observed between disease-free and disease recurrence for Ts (25 ± 10 vs. 33 ± 14 mm), SUVmax of primary tumor (6.2 ± 6.8 vs. 9.3 ± 7.2) and the most avid neck node (2.1 ± 3.3 vs. 4.7 ± 5.9) and median follow-up (13 ± 12 vs. 08 ± 13 months), respectively. Using receiver operating characteristic analysis, Ts greater than 29 mm, baseline tumor SUVmax greater than 4.6, and nodal SUVmax greater than 6.2 were found independent predictors for disease recurrence. Nodal SUVmax greater than 6.2 was found an independent predictor of shortest disease-free survival (DFS) than Ts and tumor SUVmax.
Conclusion We conclude that in HNOP-SCC, primary Ts (> 29 mm), SUVmax of primary tumor (> 4.6), and the most avid neck node (> 6.2) in baseline 18FDG PET/CT using standardized imaging protocol are the independent predictors of disease recurrence. Furthermore, SUVmax greater than 6.2 of the most avid node predicts the shortest DFS than primary Ts and SUVmax of primary tumor.
Keywords
head and neck cancer - squamous cell cancer - 18FDG PET/CT - primary tumor size - SUVmax - disease recurrence - disease-free survivalPublication History
Article published online:
24 February 2022
© 2022. World Association of Radiopharmaceutical and Molecular Therapy (WARMTH). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Ragin CC, Modugno F, Gollin SM. The epidemiology and risk factors of head and neck cancer: a focus on human papillomavirus. J Dent Res 2007; 86 (02) 104-114
- 2 Abgral R, Querellou S, Potard G. et al. Does 18F-FDG PET/CT improve the detection of posttreatment recurrence of head and neck squamous cell carcinoma in patients negative for disease on clinical follow-up?. J Nucl Med 2009; 50 (01) 24-29 [PubMed: 19091901]
- 3 Brizel DM. Different strokes for different folks: new paradigms for staging oropharynx cancer. J Clin Oncol 2015; 33 (08) 817-818 [PubMed: 25667276]
- 4 Imsande HM, Davison JM, Truong MT. et al. Use of 18F-FDG PET/CT as a predictive biomarker of outcome in patients with head-and-neck non-squamous cell carcinoma. AJR Am J Roentgenol 2011; 197 (04) 976-980 [PubMed: 21940588]
- 5 Machtay M, Natwa M, Andrel J. et al. Pretreatment FDG-PET standardized uptake value as a prognostic factor for outcome in head and neck cancer. Head Neck 2009; 31 (02) 195-201 [PubMed: 19107945]
- 6 Jensen JS, Christensen JT, Håkansson K. et al. High nodal FDG uptake increases risk of distant metastasis in patients with oropharyngeal squamous cell carcinoma. Eur J Nucl Med Mol Imaging 2020; 47 (05) 1039-1045 [PubMed: 31720757]
- 7 Boellaard R, Delgado-Bolton R, Oyen WJ. et al; European Association of Nuclear Medicine (EANM). FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging 2015; 42 (02) 328-354 [PubMed: 25452219]
- 8 Boellaard R. Need for standardization of 18F-FDG PET/CT for treatment response assessments. J Nucl Med 2011; 52 (Suppl. 02) 93S-100S [PubMed: 22144561]
- 9 Kazmi FN, Adil A, Ghaffar S, Ahmed F. Association between tumour volume and recurrence of squamous cell carcinoma of the head and neck. J Pak Med Assoc 2012; 62 (11) 1129-1133 [PubMed: 23866396]
- 10 Sanderson RJ, Ironside JA. Squamous cell carcinomas of the head and neck. BMJ 2002; 325 (7368): [PubMed: 12376446] 822-827
- 11 Mohiyuddin SMA, Padiyar BV, Suresh TN. et al. Clinicopathological study of surgical margins in squamous cell carcinoma of buccal mucosa. World J Otorhinolaryngol Head Neck Surg 2016; 2 (01) 17-21 [PubMed: 29204544]
- 12 Eldeeb H, Macmillan C, Elwell C, Hammod A. The effect of the surgical margins on the outcome of patients with head and neck squamous cell carcinoma: single institution experience. Cancer Biol Med 2012; 9 (01) 29-33 [PubMed: 23691451]
- 13 Behcet S, Suphi B, Ilker A, Ibrahim C. Prognostic factors of recurrence and neck metastasis in oral carcinomas. Pak. J Med Sci 2016; 32 (06) 153-156 [PubMed: 28083063]
- 14 Rasmussen JH, Håkansson K, Rasmussen GB. et al. A clinical prognostic model compared to the newly adopted UICC staging in an independent validation cohort of P16 negative/positive head and neck cancer patients. Oral Oncol 2018; 81: 52-60 [PubMed: 29884414]
- 15 Bonomo P, Merlotti A, Olmetto E. et al. What is the prognostic impact of FDG PET in locally advanced head and neck squamous cell carcinoma treated with concomitant chemo-radiotherapy? A systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2018; 45 (12) 2122-2138 [PubMed: 29948105]
- 16 Minn H, Lapela M, Klemi PJ. et al. Prediction of survival with fluorine-18-fluoro-deoxyglucose and PET in head and neck cancer. J Nucl Med 1997; 38 (12) 1907-1911 [PubMed: 9430467]
- 17 Oruc Z, Emin BM, Kaplan MA, Urakcı Z, Küçükoner M, Isıkdogan A. Association between standardized uptake value and survival in patients with locally advanced or metastatic squamous cell head and neck cancer. J Oncol Sci 2016; 1: 1-4
- 18 Ghosh-Laskar S, Mummudi N, Rangarajan V. et al. Prognostic value of response assessment fluorodeoxyglucose positron emission tomography-computed tomography scan in radically treated squamous cell carcinoma of head and neck: long-term results of a prospective study. J Cancer Res Ther 2019; 15 (03) 596-603 [PubMed: 31169226]