Frontal and anterior temporal hypometabolism post chemoradiation in head and neck cancer: A real‐world PET study

• Published in: Journal of neuroimaging 2024-03, Vol.34 (2), p.211-216
• Main Authors: Bishay, Steven, Robb, W. Hudson, Schwartz, Trent M., Smith, David S., Lee, Lok Hin, Lynn, Cynthia J., Clark, Tammy L., Jefferson, Angela L., Warner, Jeremy L., Rosenthal, Eben L., Murphy, Barbara A., Hohman, Timothy J., Koran, Mary Ellen I.
• Format: Article
• Language: English
• Subjects: adverse effects; Biomarkers; Brain; Cancer; Cancer therapies; chemobrain; chemoradiation; Chemoradiotherapy; chemotherapy‐related cognitive impairment; Glucose; Glucose metabolism; Head; Head & neck cancer; Hypometabolism; Image acquisition; Metabolism; Neck; Neuroimaging; PET imaging; Positron emission; Positron emission tomography
• ISSN: 1051-2284; 1552-6569
• DOI: 10.1111/jon.13181

Background and Purpose Adverse neurological effects after cancer therapy are common, but biomarkers to diagnose, monitor, or risk stratify patients are still not validated or used clinically. An accessible imaging method, such as fluorodeoxyglucose positron emission tomography (FDG PET) of the brain, could meet this gap and serve as a biomarker for functional brain changes. We utilized FDG PET to evaluate which brain regions are most susceptible to altered glucose metabolism after chemoradiation in patients with head and neck cancer (HNCa). Methods Real‐world FDG PET images were acquired as standard of care before and after chemoradiation for HNCa in 68 patients. Linear mixed‐effects voxelwise models assessed changes after chemoradiation in cerebral glucose metabolism quantified with standardized uptake value ratio (SUVR), covarying for follow‐up time and patient demographics. Results Voxelwise analysis revealed two large clusters of decreased glucose metabolism in the medial frontal and polar temporal cortices following chemoradiation, with decreases of approximately 5% SUVR after therapy. Conclusions These findings provide evidence that standard chemoradiation for HNCa can lead to decreased neuronal glucose metabolism, contributing to literature emphasizing the vulnerability of the frontal and anterior temporal lobes, especially in HNCa, where these areas may be particularly vulnerable to indirect radiation‐induced injury. FDG PET shows promise as a sensitive biomarker for assessing these changes.