The prognostic role of 18F-fluorodeoxyglucose PET in head and neck cancer depends on HPV status

• Published in: Radiotherapy and oncology 2019-11, Vol.140, p.54-61
• Main Authors: Moan, Jon Magne, Amdal, Cecilie Delphin, Malinen, Eirik, Svestad, Jørund Graadal, Bogsrud, Trond Velde, Dale, Einar
• Format: Article
• Language: English
• Subjects: 18F-fluorodeoxyglucose; Adult; Aged; Aged, 80 and over; Carcinoma-squamous cell; Chemoradiotherapy; Female; Fluorodeoxyglucose F18 - metabolism; Head and neck neoplasms; Head and Neck Neoplasms - diagnostic imaging; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - therapy; Head and Neck Neoplasms - virology; Humans; Male; Middle Aged; Papillomaviridae; Positron emission tomography; Positron Emission Tomography Computed Tomography - methods; Prognosis; Proportional hazards models; Radiopharmaceuticals; Tumor Burden
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2019.05.019

•Traditional clinical risk factors showed the strongest associations with survival.•Tumor volume was the most important image factor in univariate survival analysis.•FDG PET provided strong predictors only for HPV-unrelated head and neck cancer. Standardized uptake value (SUV) and related parameters derived from 2-deoxy-2-[18F]-fluoro-d-glucose (FDG) PET/CT prior to radiochemotherapy of head and neck cancer (HNC) were significantly associated with survival in a number of studies. The aim of this study was to validate these findings and to evaluate the prognostic role of PET parameters also including clinical factors and HPV status. We reviewed 166 HNC cases with a radiotherapy planning FDG PET/CT scan. All patients received radiotherapy, 68–70 Gy with or without concomitant cisplatin. Primary endpoint was disease-free survival (DFS). Twelve clinical factors, including HPV, performance status, stage and treatment parameters and ten PET/CT image parameters including gross tumor volume (GTV), metastatic lymph node volume, SUVmax, metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were collected. Univariate and multivariate Cox regression analyses were employed. Of the 166 patients included, 48 had locoregional and 23 had metastatic recurrence. None of the FDG PET parameters were significant in the univariate analysis using DFS as endpoint. HPV status, ECOG status and GTV-U (primary tumor and lymph node volume from CT) were statistically significant (p