Prognostic value of 18F-FDG PET metabolic parameters in oropharyngeal squamous cell carcinoma

J Radiat Oncol (2013) 2:27–34 DOI 10.1007/s13566-012-0065-4

ORIGINAL RESEARCH

Prognostic value of 18F-FDG PET metabolic parameters in oropharyngeal squamous cell carcinoma Adam A. Garsa & Albert J. Chang & Todd DeWees & Christopher R. Spencer & Douglas R. Adkins & Farrokh Dehdashti & Hiram A. Gay & Wade L. Thorstad

Received: 3 August 2012 / Accepted: 30 August 2012 / Published online: 12 September 2012 # Springer-Verlag 2012

Abstract Objective To evaluate whether pretreatment metabolic parameters obtained from positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) can improve risk prediction for patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with definitive intensitymodulated radiation therapy (IMRT). Methods Between 2003 and 2009, 86 patients with OPSCC had FDG-PET/CT prior to treatment with definitive IMRT. Chemotherapy was administered to 90 % of the patients. Metabolic tumor volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake value (SUVmax), mean SUV (SUVmean), and inverse coefficient of variation (1/CoV) were analyzed for the primary tumor alone and the total of the primary tumor and involved lymph nodes. Results Median follow-up time for surviving patients was 41 months. On univariate analysis, total MTV and total TLG were significant predictors of disease-free survival (DFS) and overall survival (OS). SUVmax, SUVmean, and 1/CoV

failed to predict DFS or OS. On multivariate analysis controlling for T- and N-classification, total MTV remained a significant predictor of DFS and OS. The optimal cutpoint for total MTV was 20.5 ml. A total MTV >20.5 ml was associated with a 4.13-fold increased risk of death (95 % confidence interval [CI], 2.12–8.05; p20.5 ml was significantly associated with a 13.0-fold increased risk of death in p16-positive patients

and 4.27-fold increased risk of death in p16-negative patients. Given the limited number of patients with p16 status available, further investigation to define the relative prognostic value of total MTV for p16-positive and p16-negative disease is recommended. In the present study, we limited our analysis to patients with oropharyngeal cancer. Most of the studies listed in Table 4 included multiple head and neck cancer subsites. The pathophysiology, clinical behavior, and prognosis of malignancies in these subsites can differ significantly. By limiting our analysis to OPSCC, we eliminated this potentially confounding effect. Potential limitations of this study include its singleinstitution retrospective design, non-uniform treatment, and the limited number of patients with p16 status available. Despite these limitations, total MTV was highly predictive of recurrence and survival for the entire cohort and both the p16-positive and p16negative subgroups. Ideally, the prognostic value of total MTV and other FDG-PET parameters should be validated in a prospective study.

Conclusion Total MTV is an independent predictor of DFS and OS for patients with OPSCC treated with definitive radiotherapy. Total MTV >20.5 ml was associated with a 4.13-fold increased risk of death. Total MTV remained predictive of DFS and OS for both p16-positive and p16-negative cancer.

Conflict of interest The authors declare that no actual or potential conflicts of interest exist.

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