Clinical Utility of Pretreatment and 3-Month ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Standardized Uptake Value in Predicting and Assessing Recurrence in T3-T4 Laryngeal Carcinoma Treated With Definitive Radiation

Abstract

Objectives: The aim of this study was to investigate the utility of pretreatment and 3-month 18F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) standardized uptake value (SUV) in predicting and assessing recurrence in T3-T4 laryngeal carcinoma treated with definitive radiation therapy (RT). Methods: Patients with newly diagnosed T3-T4 laryngeal squamous cell carcinoma treated with definitive RT from 2004 to 2014 were reviewed. Patients who underwent pretreatment or 3-month PET/CT 2 to 4 months after treatment were included. Those with prior systemic, surgical, or RT treatment were excluded. The primary objective was to assess whether pretreatment or posttreatment maximum SUV of the primary site (pSUV) of disease was associated with local recurrence-free survival. Overall survival was a secondary end point. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to assess the accuracy of 3-month PET/CT at the larynx primary. Results: Twenty-eight patients were eligible for analysis. Median follow-up time was 34.7 months (range, 5.3-138.7 months), and median age was 57 years. Most patients had supraglottic (71.4%), T3 (89.3%), N2 (50.0%) disease, received chemotherapy (96.4%), and had histories of tobacco use (96.4%). On univariate analysis, 3-month posttreatment pSUV was associated with local recurrence-free survival (P < .01), while pretreatment pSUV was not (P = .41). No other associations were found with local recurrence-free survival. Neither pretreatment nor 3-month pSUV was significantly associated with overall survival. The calculated sensitivity, specificity, positive predictive value, and negative predictive value of 3-month PET/CT at the primary site were 33%, 85%, 40%, and 81%, respectively. Conclusions: High initial fluorodeoxyglucose uptake in T3-T4 laryngeal primaries did not show an association with the risk for postradiation local relapse or overall survival, while increased fluorodeoxyglucose uptake at 3 months was associated with increased local recurrence. At 3 months, the relatively low sensitivity and positive predictive value may limit the utility of PET/CT in the assessment of persistent advanced laryngeal cancer after definitive radiation.

Lipidomics Identified Lyso-Phosphatidylcholine and Phosphatidylethanolamine as Potential Biomarkers for Diagnosis of Laryngeal Cancer

“…Early detection of LaC is essential for treating this disease. Although some imaging methods, for example computed tomography (CT) ( 4 ), positron emission tomography (PET) scan ( 5 ), and magnetic resonance imaging (MRI) ( 6 ), are commonly used in the screening and detection of LaC, current imaging methods are challenged by problems related to availability of primary healthcare workers capable of assessing images. Thus, there is still an urgent need to identify novel biomarkers for LaC screening or detection.…”

Routine restaging after primary non-surgical treatment of laryngeal squamous cell carcinoma—a review

“…The PPV in the study by Mayo et al for FDG PET was K [17], which was lower compared to the PPV of 67 and 62% detected in the studies of Been et al and Wedman et al, respectively [16,18]. All three studies showed a comparable NPV, with 86, 81, and 73%, respectively [16][17][18]. All studies investigated imaging 2-12 months after finishing radiotherapy.…”

“…Drawbacks of FDG are the physiological uptake in muscles of the larynx and the uptake by inflammatory or reactive tissues occurring after radiotherapy. The sensitivity of FDG PET to detect residual tumor after RT or CRT was 33% in one study [17], and 67 and 75% in two other studies [16,18]. Been et al and Mayo et al reported a specificity of 86 and 85% for FDG PET, respectively [16,17], whereas Wedman et al showed a lower specificity of 53% [18].…”

“…Been et al and Mayo et al reported a specificity of 86 and 85% for FDG PET, respectively [16,17], whereas Wedman et al showed a lower specificity of 53% [18]. The PPV in the study by Mayo et al for FDG PET was K [17], which was lower compared to the PPV of 67 and 62% detected in the studies of Been et al and Wedman et al, respectively [16,18]. All three studies showed a comparable NPV, with 86, 81, and 73%, respectively [16][17][18].…”

“…The sensitivity of FDG PET to detect residual tumor after RT or CRT was 33% in one study [17], and 67 and 75% in two other studies [16,18]. Been et al and Mayo et al reported a specificity of 86 and 85% for FDG PET, respectively [16,17], whereas Wedman et al showed a lower specificity of 53% [18]. The PPV in the study by Mayo et al for FDG PET was K [17], which was lower compared to the PPV of 67 and 62% detected in the studies of Been et al and Wedman et al, respectively [16,18].…”