Skip to main content

Advertisement

SpringerLink
Log in

Prognostic value of maximum standardized uptake value measured by pretreatment 18F-FDG PET/CT in locally advanced head and neck squamous cell carcinoma

  • Research Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Purpose/objectives

To evaluate the prognostic impact of maximum standardized uptake value (SUVmax) in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) undergoing pretreatment [F-18] fluoro-d-glucose-positron emission tomography/computed tomography (FDG PET/CT) imaging.

Materials/methods

Fifty-eight patients undergoing FDG PET/CT before radical treatment with definitive radiotherapy (±concomitant chemotherapy) or surgery + postoperative (chemo)radiation were analyzed. The effects of clinicopathological factors (age, gender, tumor location, stage, Karnofsky Performance Status (KPS), and treatment strategy) including primary tumor SUVmax and nodal SUVmax on overall survival (OS), disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) were evaluated. Kaplan–Meier survival curves were generated and compared with the log-rank test.

Results

Median follow-up for the whole population was 31 months (range 2.3–53.5). Two-year OS, LRC, DFS and DMFS, for the entire cohort were 62.1, 78.3, 55.2 and 67.2%, respectively. Median pretreatment SUVmax for the primary tumor and lymph nodes was 11.85 and 5.4, respectively. According to univariate analysis, patients with KPS < 80% (p < 0.001), AJCC stage IVa or IVb vs III (p = 0.037) and patients undergoing radiotherapy vs surgery (p = 0.042) were significantly associated with worse OS. Patients with KPS < 80% (p = 0.003) or age ≥65 years (p = 0.007) had worse LRC. The KPS < 80% was the only factor associated with decreased DFS (p = 0.001). SUVmax of the primary tumor or the lymph nodes were not associated with OS, DFS or LRC. The KPS < 80% (p = 0.002), tumor location (p = 0.047) and AJCC stage (p = 0.025) were associated with worse cancer-specific survival (CSS). According to Cox regression analysis, on multivariate analysis KPS < 80% was the only independent parameter determining worse OS, DFS, CSS. Regarding LRC only patients with IK < 80% (p = 0.01) and ≥65 years (p = 0.01) remained statistically significant. Nodal SUVmax was the only factor associated with decreased DMFS. Patients with a nodal SUVmax > 5.4 presented an increased risk for distant metastases (HR, 3.3; 95% CI 1.17–9.25; p = 0.023).

Conclusions

The pretreatment nodal SUVmax in patients with locally advanced HNSCC is prognostic for DMFS. However, according to our results primary tumor SUVmax and nodal SUVmax were not significantly related to OS, DFS or LRC. Patients presenting KPS < 80% had worse OS, DFS, CSS and LRC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Chiesa F, Mauri S, Tradati N, Calabrese L, Giugliano G, Ansarin M, et al. Surfing prognostic factors in head and neck cancer at the millennium. Oral Oncol. 1999;35(6):590–6.

    Article  CAS  PubMed  Google Scholar 

  2. Haberkorn U, Strauss LG, Reisser C, Haag D, Dimitrakopoulou A, Ziegler S, et al. Glucose uptake, perfusion, and cell proliferation in head and neck tumors: relation of positron emission tomography to flow cytometry. J Nucl Med Off Publ Soc Nucl Med. 1991;32(8):1548–55.

    CAS  Google Scholar 

  3. Minn H, Clavo AC, Grénman R, Wahl RL. In vitro comparison of cell proliferation kinetics and uptake of tritiated fluorodeoxyglucose and l-methionine in squamous-cell carcinoma of the head and neck. J Nucl Med Off Publ Soc Nucl Med. 1995;36(2):252–8.

    CAS  Google Scholar 

  4. Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349(22):2091–8.

    Article  CAS  PubMed  Google Scholar 

  5. Bonner JA, Harari PM, Giralt J, Cohen RB, Jones CU, Sur RK, et al. Radiotherapy plus cetuximab for locoregionally advanced head and neck cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival. Lancet Oncol. 2010;11(1):21–8.

    Article  CAS  PubMed  Google Scholar 

  6. Pignon J-P, le Maître A, Maillard E, Bourhis J. MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2009;92(1):4–14.

    Article  Google Scholar 

  7. Bourhis J, Lapeyre M, Tortochaux J, Rives M, Aghili M, Bourdin S, et al. Phase III randomized trial of very accelerated radiation therapy compared with conventional radiation therapy in squamous cell head and neck cancer: a GORTEC trial. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24(18):2873–8.

    Article  Google Scholar 

  8. Higgins KA, Hoang JK, Roach MC, Chino J, Yoo DS, Turkington TG, et al. Analysis of pretreatment FDG PET SUV parameters in head-and-neck cancer: tumor SUV mean has superior prognostic value. Int J Radiat Oncol Biol Phys. 2012;82(2):548–53.

    Article  PubMed  Google Scholar 

  9. Romesser PB, Lim R, Spratt DE, Setton J, Riaz N, Lok B, et al. The relative prognostic utility of standardized uptake value, gross tumor volume, and metabolic tumor volume in oropharyngeal cancer patients treated with platinum based concurrent chemoradiation with a pre-treatment [(18)F] fluorodeoxyglucose positron emission tomography scan. Oral Oncol. 2014;50(9):802–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Kitajima K, Suenaga Y, Kanda T, Miyawaki D, Yoshida K, Ejima Y, et al. Prognostic value of FDG PET imaging in patients with laryngeal cancer. PLoS One. 2014;9(5):e96999.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cacicedo J, Navarro A, Del Hoyo O, Gomez-Iturriaga A, Alongi F, Medina JA, et al. Role of fluorine-18 fluorodeoxyglucose PET/CT in head and neck oncology: the point of view of the radiation oncologist. Br J Radiol. 2016;89(1067):20160217.

    Article  PubMed  Google Scholar 

  12. Cacicedo J, Fernandez I, Del Hoyo O, Dolado A, Gómez-Suarez J, Hortelano E, et al. Should PET/CT be implemented in the routine imaging work-up of locally advanced head and neck squamous cell carcinoma? A prospective analysis. Eur J Nucl Med Mol Imaging. 2015;42(9):1378–89.

    Article  PubMed  Google Scholar 

  13. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4.

    Article  PubMed  Google Scholar 

  14. NCCN Clinical Practice Guidelines in Oncology. [Internet]. 2016 [cited 2016 Apr 04]. Available from: http://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf.

  15. Peters LJ, Goepfert H, Ang KK, Byers RM, Maor MH, Guillamondegui O, et al. Evaluation of the dose for postoperative radiation therapy of head and neck cancer: first report of a prospective randomized trial. Int J Radiat Oncol Biol Phys. 1993;26(1):3–11.

    Article  CAS  PubMed  Google Scholar 

  16. Ang KK, Trotti A, Brown BW, Garden AS, Foote RL, Morrison WH, et al. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001;51(3):571–8.

    Article  CAS  PubMed  Google Scholar 

  17. Lee N, Mechalakos J, Puri DR, Hunt M. Choosing an intensity-modulated radiation therapy technique in the treatment of head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2007;68(5):1299–309.

    Article  PubMed  Google Scholar 

  18. Grégoire V, Ang K, Budach W, Grau C, Hamoir M, Langendijk JA, et al. Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2014;110(1):172–81.

    Article  Google Scholar 

  19. Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre J-L, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004;350(19):1945–52.

    Article  CAS  PubMed  Google Scholar 

  20. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004;350(19):1937–44.

    Article  PubMed  Google Scholar 

  21. Bernier J, Vermorken JB, Koch WM. Adjuvant therapy in patients with resected poor-risk head and neck cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24(17):2629–35.

    Article  Google Scholar 

  22. Allal AS, Slosman DO, Kebdani T, Allaoua M, Lehmann W, Dulguerov P. Prediction of outcome in head-and-neck cancer patients using the standardized uptake value of 2-[18F]fluoro-2-deoxy-d-glucose. Int J Radiat Oncol Biol Phys. 2004;59(5):1295–300.

    Article  CAS  PubMed  Google Scholar 

  23. Romesser PB, Qureshi MM, Shah BA, Chatburn LT, Jalisi S, Devaiah AK, et al. Superior prognostic utility of gross and metabolic tumor volume compared to standardized uptake value using PET/CT in head and neck squamous cell carcinoma patients treated with intensity-modulated radiotherapy. Ann Nucl Med. 2012;26(7):527–34.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Castelli J, De Bari B, Depeursinge A, Simon A, Devillers A, Roman Jimenez G, et al. Overview of the predictive value of quantitative 18 FDG PET in head and neck cancer treated with chemoradiotherapy. Crit Rev Oncol Hematol. 2016;108:40–51.

    Article  CAS  PubMed  Google Scholar 

  25. La TH, Filion EJ, Turnbull BB, Chu JN, Lee P, Nguyen K, et al. Metabolic tumor volume predicts for recurrence and death in head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2009;74(5):1335–41.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Chung MK, Jeong H-S, Park SG, Jang JY, Son Y-I, Choi JY, et al. Metabolic tumor volume of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography predicts short-term outcome to radiotherapy with or without chemotherapy in pharyngeal cancer. Clin Cancer Res Off J Am Assoc Cancer Res. 2009;15(18):5861–8.

    Article  CAS  Google Scholar 

  27. Kubicek GJ, Champ C, Fogh S, Wang F, Reddy E, Intenzo C, et al. FDG PET staging and importance of lymph node SUV in head and neck cancer. Head Neck Oncol. 2010;16(2):19.

    Article  Google Scholar 

  28. Inokuchi H, Kodaira T, Tachibana H, Nakamura T, Tomita N, Nakahara R, et al. Clinical usefulness of [18F] fluoro-2-deoxy-d-glucose uptake in 178 head-and-neck cancer patients with nodal metastasis treated with definitive chemoradiotherapy: consideration of its prognostic value and ability to provide guidance for optimal selection of patients for planned neck dissection. Int J Radiat Oncol Biol Phys. 2011;79(3):747–55.

    Article  PubMed  Google Scholar 

  29. Lim R, Eaton A, Lee NY, Setton J, Ohri N, Rao S, et al. 18F-FDG PET/CT metabolic tumor volume and total lesion glycolysis predict outcome in oropharyngeal squamous cell carcinoma. J Nucl Med Off Publ Soc Nucl Med. 2012;53(10):1506–13.

    CAS  Google Scholar 

  30. Lee SJ, Choi JY, Lee HJ, Baek C-H, Son Y-I, Hyun SH, et al. Prognostic value of volume-based 18 F-fluorodeoxyglucose PET/CT parameters in patients with clinically node-negative oral tongue squamous cell carcinoma. Korean J Radiol. 2012;13(6):752.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Tang C, Murphy JD, Khong B, La TH, Kong C, Fischbein NJ, et al. Validation that metabolic tumor volume predicts outcome in head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2012;83(5):1514–20.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Moon SH, Choi JY, Lee HJ, Son Y-I, Baek C-H, Ahn YC, et al. Prognostic value of 18F-FDG PET/CT in patients with squamous cell carcinoma of the tonsil: comparisons of volume-based metabolic parameters. Head Neck. 2013;35(1):15–22.

    Article  PubMed  Google Scholar 

  33. Abd El-Hafez YG, Moustafa HM, Khalil HF, Liao C-T, Yen T-C. Total lesion glycolysis: a possible new prognostic parameter in oral cavity squamous cell carcinoma. Oral Oncol. 2013;49(3):261–8.

    Article  CAS  PubMed  Google Scholar 

  34. Garsa AA, Chang AJ, Dewees T, Spencer CR, Adkins DR, Dehdashti F, et al. Prognostic value of (18)F-FDG PET metabolic parameters in oropharyngeal squamous cell carcinoma. J Radiat Oncol. 2013;2(1):27–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Schwartz DL, Harris J, Yao M, Rosenthal DI, Opanowski A, Levering A, et al. Metabolic tumor volume as a prognostic imaging-based biomarker for head-and-neck cancer: pilot results from Radiation Therapy Oncology Group protocol 0522. Int J Radiat Oncol Biol Phys. 2015;91(4):721–9.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ju J, Wang J, Ma C, Li Y, Zhao Z, Gao T, et al. Nomograms predicting long-term overall survival and cancer-specific survival in head and neck squamous cell carcinoma patients. Oncotarget. 2016;7(32):51059–68.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Käsmann L, Janssen S, Schild SE, Rades D. karnosky performance score and radiation dose predict survival of patients re-irradiated for a locoregional recurrence of small cell lung cancer. Anticancer Res. 2016;36(2):803–5.

    PubMed  Google Scholar 

  38. Roh J-L, Pae KH, Choi S-H, Kim JS, Lee S, Kim S-B, et al. 2-[18F]-Fluoro-2-deoxy-D-glucose positron emission tomography as guidance for primary treatment in patients with advanced-stage resectable squamous cell carcinoma of the larynx and hypopharynx. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2007;33(6):790–5.

    Google Scholar 

  39. Mehanna H, Wong W-L, McConkey CC, Rahman JK, Robinson M, Hartley AGJ, et al. PET-CT surveillance versus neck dissection in advanced head and neck cancer. N Engl J Med. 2016;374(15):1444–54.

    Article  CAS  PubMed  Google Scholar 

  40. Wong KH, Panek R, Welsh LC, Mcquaid D, Dunlop A, Riddell A, et al. The predictive value of early assessment after one cycle of induction chemotherapy with 18F-FDG PET/CT and DW-MRI for response to radical chemoradiotherapy in head and neck squamous cell carcinoma. J Nucl Med Off Publ Soc Nucl Med. 2016;57(12):1843–50.

    Google Scholar 

  41. Pak K, Cheon GJ, Nam H-Y, Kim S-J, Kang KW, Chung J-K, et al. Prognostic value of metabolic tumor volume and total lesion glycolysis in head and neck cancer: a systematic review and meta-analysis. J Nucl Med Off Publ Soc Nucl Med. 2014;55(6):884–90.

    CAS  Google Scholar 

  42. Castelli J, Depeursinge A, de Bari B, Devillers A, de Crevoisier R, Bourhis J, et al. Metabolic tumor volume and total lesion glycolysis in oropharyngeal cancer treated with definitive radiotherapy: which threshold is the best predictor of local control? Clin Nucl Med. 2017;42(6):e281–e285

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiation Oncology Department, Cruces University Hospital (University of the Basque Country)/Biocruces Health Research Institute, c/Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia (Basque Country), Spain

    J. Cacicedo, O. del Hoyo, A. Gomez-Iturriaga & P. Bilbao

  2. Nuclear Medicine Department, Cruces University Hospital, Barakaldo, Spain

    I. Fernandez

  3. Radiation Oncology Department, Hospital Duran i Reynals (ICO) Avda, Gran Via de L´Hospitalet, 199-203, Hospitalet de Llobregat, 08908, Barcelona, Spain

    A. Navarro

  4. Clinical Epidemiology Unit, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain

    J. Ignacio Pijoan, L. Martinez-Indart & J. Escudero

  5. CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

    J. Ignacio Pijoan

  6. Otolaryngology Department, Cruces University Hospital, c/Plaza de Cruces s/n, 48903, Barakaldo, Vizcaya (Basque Country), Spain

    J. Gomez-Suarez

  7. Medical Physics and Radioprotection Department, Cruces University Hospital/Biocruces Health Research Institute, Vizcaya, Spain

    R. Ortiz de Zarate & J. Fernando Perez

  8. Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany

    D. Rades

Authors
  1. J. Cacicedo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. del Hoyo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Navarro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Gomez-Iturriaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Ignacio Pijoan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. Martinez-Indart
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Escudero
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J. Gomez-Suarez
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. R. Ortiz de Zarate
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. J. Fernando Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. P. Bilbao
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. D. Rades
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JC developed and oversaw the study design, and drafted the manuscript. IF collected data and OdH provided and collected data. AN helped in the study design and coordination. AGI provided and collected data. LMI statistical analysis and interpretation of the data. JIP and JE performed the statistical analysis, interpretation of the results. JGS collected data JFO and ROZ collected data and carried out the treatment data and designed treatment plans. PB provided and collected data. DR performed the interpretation of the data and drafted the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to J. Cacicedo.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts of interest.

Human rights ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cacicedo, J., Fernandez, I., del Hoyo, O. et al. Prognostic value of maximum standardized uptake value measured by pretreatment 18F-FDG PET/CT in locally advanced head and neck squamous cell carcinoma. Clin Transl Oncol 19, 1337–1349 (2017). https://doi.org/10.1007/s12094-017-1674-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-017-1674-6

Keywords

Search

Navigation