Assessment of outcomes with delayed<sup>18</sup>F-FDG PET-CT response assessment in head and neck squamous cell carcinoma

Slevin, Finbar; Subesinghe, Manil; Ramasamy, S.; Şen, Mehmet; Scarsbrook, Andrew; Prestwich, R.

doi:10.1259/bjr.20140592

Cited by 38 publications

(43 citation statements)

References 23 publications

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“…This is consistent with the Kishino report along with several additional small studies correlating SUVmax with oncologic outcomes [35][36][37]. The value of posttreatment, pre-operative FDG-PET in predicting pathologic response to chemoradiotherapy in EC has been a subject of debate, with several studies reporting no clear relationship [38][39][40][41].…”

Section: Discussionsupporting

confidence: 85%

Long-term Results of a Pilot Study Comparing FLT-PET and FDG-PET in the Evaluation of Response to Treatment in Advanced Head and Neck and Esophageal Malignancies

RS¹,

Vj²,

Rl³

et al. 2017

J Nucl Med Radiat Ther

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Objective: We prospectively compared FDG-PET and FLT-PET in assessing patient responses to induction cetuximab and/or chemoradiotherapy (CRT) for advanced head and neck squamous cell carcinoma (HNSCC) and esophageal cancer (EC). Methods:Sixteen patients were enrolled, 9 with HNSCC and 7 with EC. FDG-PET and FLT-PET scans were performed at baseline and two weeks into chemoradiotherapy (CRT) for patients with EC. Patients with HNSCC received two weeks of induction chemotherapy along with post-induction PET scans prior to starting CRT in addition to the baseline and intra-chemoradiotherapy PET scans. Changes in SUVmax and total lesion glycolysis/ proliferation (TLG/TLP) were compared with baseline.Results: Median follow-up for living patients was 6.0 years. Median overall survival (OS) was 3.3 years and progression-free survival (PFS) was 2.5 years. Patients with HNSCC had higher baseline SUVmax, TLG and TLP than those with EC. Changes in SUVmax, TLG and TLP after induction chemotherapy or during CRT did not correlate with PFS or OS. Those with >40% decline in SUVmax on FDG-PET six weeks after completing CRT had better PFS (p<0.0001) and OS (p=0.0003) than those with less of a response. In addition, >70% decrease in posttreatment TLG correlated with better PFS (p=0.03) and OS (p=0.04). Conclusions:Functional imaging performed early during chemoradiotherapy for advanced HNSCC and EC is feasible. Changes on post-induction and intra-CRT FLT and FDG PET did not correlate with PFS or OS. However, better PFS and OS were seen in patients with >40% decline in SUVmax and >70% decrease in TLG on FDG-PET performed six weeks after completing CRT. Further research is needed to determine the prognostic impact of PET performed during chemotherapy and radiotherapy.

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Section: Discussionsupporting

confidence: 85%

Long-term Results of a Pilot Study Comparing FLT-PET and FDG-PET in the Evaluation of Response to Treatment in Advanced Head and Neck and Esophageal Malignancies

RS¹,

Vj²,

Rl³

et al. 2017

J Nucl Med Radiat Ther

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“…Although the optimal time for post-radiotherapy 18 F-FDG PET evaluations remains to be established, most studies recommended that the first follow-up 18 F-FDG PET be performed 3 months after completion of radiotherapy to reduce false-positive findings by post-radiotherapy inflammatory reactions. However, even in studies that evaluated the role of delayed post-radiotherapy 18 F-FDG PET performed 4 months after radiotherapy, the PPVs ranged from 19 to 47% for T-and from 29 to 63% for N-, 30,31,33 ant that still seem to be suboptimal to determine the necessity of salvage treatment. Further less invasive evaluations are needed for the positive post-radiotherapy 18 F-FDG PET response to rule out false-positive findings.…”

Section: Discussionmentioning

confidence: 99%

“…The PPVs ranged from 43 to 63% when equivocal PET findings were classified as positive PET findings and from 71.1 to 77.8% when equivocal PET findings were classified as negative PET findings. [29][30][31][32] Considering previously reported results, the PPVs might be increased if we excluded equivocal PET findings from the definition of positive PET criteria, but the PPVs in that studies seemed also to be suboptimal to determine the necessity of salvage treatment. Further studies appear to be needed to evaluate the appropriate interpretation and management of equivocal PET findings.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of the post-radiotherapy 18F-fludeoxyglucose positron emission tomography response in nasopharyngeal carcinoma

Jeong

Jung

Kim

et al. 2019

The British Journal of Radiology

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Objective: The aim of the present study was to evaluate the clinical significance of the post-radiotherapy 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) response for detecting residual disease and predicting survival outcome in patients with nasopharyngeal cancer. Methods: We reviewed 143 patients with nasopharyngeal cancer who underwent 18F-FDG PET within 6 months after completion of radiotherapy between 2001 and 2012. 18F-FDG PET findings at the primary tumor (T–) and regional lymph nodes (N–) were separately assessed and considered negative [PET (–)] or positive [PET (+)] depending on the remaining focal increased uptake of 18F-FDG that was greater than that of the surrounding muscle or blood vessels. The standard of reference was histopathological confirmation or clinical/imaging follow-up. Overall survival (OS), distant metastasis-free survival (DMFS), and locoregional recurrence-free survival (LRRFS) rates were estimated from the date of the start of radiotherapy. Results: The median follow-up period was 73 months (range, 9–182 months). Overall, 83 and 66% of patients achieved T–PET (-) and N–PET (-) responses, and the negative-predictive values (NPVs) for T– and N– were 100 and 99%, respectively. The sensitivity, specificity, and positive-predictive value were 100, 84, and 8% for T–, and 67, 80, and 7% for N–, respectively. The 5-year OS, DMFS, and LRRFS rates were 83, 83, and 87%, respectively, and patients with N–PET (+) with SUVmax >2.5 showed significantly inferior 5-year OS and DMFS rates than patients with N–PET (-) or N–PET (+) with SUVmax ≤2.5 (44 vs 86%, p = 0.004; 36 vs 85%, p < 0.001). Conclusion: In patients that have received definitive (chemo)radiotherapy for nasopharyngeal cancer, 18F-FDG PET within 6 months of completion of treatment has a high NPV for predicting residual disease and is prognostic for long-term treatment outcomes. Patients with remaining focal increased uptake of 18F-FDG at lymph nodes may benefit from more aggressive treatments, and further studies are needed to validate the clinical significance of post-radiotherapy 18F-FDG PET. Advances in knowledge: We found that post-radiotherapy 18F-FDG PET findings have a high NPV for detecting residual disease and are a significant prognostic factor for treatment outcomes.

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“…Post-treatment FDG PET-CT has an NPV up to 99% for nodal disease (when performed at 4 months), 17 benefit over conventional assessment (anatomical imaging and clinical examination) 18 and a high probability of long-term regional control (2.3% regional failure rate at 36 months). 19 A recent randomized controlled trial, the UK PET-NECK study, demonstrated that PET-CT surveillance had equivalent survival outcome at lower overall cost, when compared with routine neck dissection for N2/3 nodal disease post-CRT for advanced nodal disease.…”

Section: Current Uses Of Fdg Positron Emission Tomography-ct In Treatmentioning

confidence: 99%

“…20 Some groups have adopted a policy of response assessment at least 4 months post-treatment. 17,21 The clinical management of equivocal results remains problematic. 12,14,17 The majority of published data relate to the use of response assessment PET-CT following CRT for oropharyngeal carcinoma; the test characteristics of PET-CT for other head and neck tumour sites and following the use of radiotherapy alone remain less clear.…”

Section: Current Uses Of Fdg Positron Emission Tomography-ct In Treatmentioning

confidence: 99%

Radiotherapy response evaluation using FDG PET-CT—established and emerging applications

Cliffe

Patel

Prestwich

et al. 2017

The British Journal of Radiology

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Radiation therapy is a common component of curative cancer treatment. However, there is a significant incidence of treatment failure. In these cases, salvage surgical options are sometimes appropriate. Accurate assessment of response and early recognition of treatment success or failure is therefore critical to guide treatment decisions and impacts on survival and the morbidity of treatment. Traditionally, treatment response has depended upon the anatomical measurement of disease. However, this may not correlate well with the presence of disease, especially after radiotherapy. Combined positron emission tomography (PET) and CT imaging employs radioactive tracers to identify molecular characteristics of tissues. PET imaging exploits the fact that malignancies have characteristic molecular profiles which differ compared with surrounding tissues. The complementary anatomical and functional information facilitates accurate non-invasive assessment of surrogate biomarkers of disease activity.This article reviews the rationale for positron emission tomography (PET)-CT response assessment in radiation oncology, describing current uses of 2-[18 F]-fluoro-2-deoxy-D-glucose (FDG) PET-CT in treatment response following radiotherapy in head and neck, oesophageal, rectal and brain tumours. Emerging applications of FDG PET-CT in cervical and lung carcinomas and hepato-pancreatico-biliary tumours, particularly pancreatic carcinoma and liver metastases (post-selective internal radiotherapy treatment), are reviewed. Finally, the limitations of FDG PET-CT are considered, highlighting areas for future development.

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Assessment of outcomes with delayed¹⁸F-FDG PET-CT response assessment in head and neck squamous cell carcinoma

Cited by 38 publications

References 23 publications

Long-term Results of a Pilot Study Comparing FLT-PET and FDG-PET in the Evaluation of Response to Treatment in Advanced Head and Neck and Esophageal Malignancies

Long-term Results of a Pilot Study Comparing FLT-PET and FDG-PET in the Evaluation of Response to Treatment in Advanced Head and Neck and Esophageal Malignancies

Clinical significance of the post-radiotherapy 18F-fludeoxyglucose positron emission tomography response in nasopharyngeal carcinoma

Radiotherapy response evaluation using FDG PET-CT—established and emerging applications

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Assessment of outcomes with delayed18F-FDG PET-CT response assessment in head and neck squamous cell carcinoma

Cited by 38 publications

References 23 publications

Long-term Results of a Pilot Study Comparing FLT-PET and FDG-PET in the Evaluation of Response to Treatment in Advanced Head and Neck and Esophageal Malignancies

Long-term Results of a Pilot Study Comparing FLT-PET and FDG-PET in the Evaluation of Response to Treatment in Advanced Head and Neck and Esophageal Malignancies

Clinical significance of the post-radiotherapy 18F-fludeoxyglucose positron emission tomography response in nasopharyngeal carcinoma

Radiotherapy response evaluation using FDG PET-CT—established and emerging applications

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Assessment of outcomes with delayed¹⁸F-FDG PET-CT response assessment in head and neck squamous cell carcinoma