FDG-PET/CT in the surveillance of head and neck cancer following radiotherapy

Risør, Louise Madeleine; Loft, Annika; Berthelsen, Anne Kiil; Loft, Frederik Cornelius; Madsen, Andreas Ruhvald; Vogelius, I.R.; Kjær, Andreas; Friborg, Jeppe

doi:10.1007/s00405-019-05684-2

Cited by 18 publications

(7 citation statements)

References 24 publications

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“…Cancer aggressiveness is probably best related to the maximal local expression of uPAR as the most aggressive phenotype will determine the prognosis and traditional biopsy may over-or underestimate the aggressiveness depending on the sampling site. This strongly supports the idea of using an image-derived and tumor-specific "in-situ" measurement of the heterogoenous uPAR expression for treatment stratification, which is exactly what uPAR-PET is capable of doing as demonstrated in our previous study 17 .…”

Section: Discussionsupporting

confidence: 86%

“…However, in our study pre-treatment total plasma uPAR was not able to predict RFS, in line with the results of previous studies, and a post-treatment sample is irrelevant for selecting therapy 8 . In contrast, we have previously shown that uPAR-PET/CT predicted RFS in a similarly sized study (n = 54) 17 . The advantage of uPAR-PET compared to measurement of total plasma uPAR is that it is not susceptible to non-cancerous origin of uPAR, since the measurement is limited to the tumor volume on PET/CT.…”

Section: Discussionmentioning

confidence: 61%

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Urokinase-type plasminogen activator receptor (uPAR) assessed by liquid biopsies and PET/CT for prognostication in head and neck cancer patients

Risør

Binderup²,

Fosbøl³

et al. 2022

Sci Rep

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Strong prognostic biomarkers are lacking regarding the stratification of treatment and surveillance regimens in head and neck squamous cell carcinoma (HNSCC). The study aimed to assess the prognostic value of soluble urokinase-type plasminogen activator receptor in plasma (suPAR) compared to evaluation by uPAR-positron-emission-tomography (PET) in HNSCC patients. Plasma from 19 controls and 49 HNSCC patients referred to curatively intended radiotherapy (2017–2021) was collected pre-treatment and post-treatment (n = 37). Information on uPAR-PET was available from previous evaluation. Patient median suPAR was significantly higher pre- and post-treatment compared to controls (p = 0.013, p = 0.003) and increased significantly during radiotherapy (p = 0.003). Pre-treatment suPAR did not predict survival outcomes. Post-treatment suPAR significantly predicted RFS (HR = 6.67 (95% CI 1.44–30.9) p = 0.015), but not OS (HR = 3.29 (95% CI 0.882–12.3) p = 0.076) in univariate analysis. RFS prediction was maintained for post-treatment suPAR in multivariate analysis, including TNM-stage (HR = 6.62 (95% CI 1.40–31.4) p = 0.017). Pre-treatment uPAR-PET/CT and post-treatment suPAR was available in 24 patients. High uPAR-estimates on both modalities was significantly associated with poor RFS compared to patients with low uPAR-estimates (log-rank, p = 0.008). Patients with discordant uPAR-estimates (one-low/one-high) were at intermediate risk, although non-significant (p = 0.131). In conclusion, pre-treatment suPAR did not predict RFS or OS. Pre-treatment uPAR-PET and post-treatment suPAR predicted RFS.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 61%

Urokinase-type plasminogen activator receptor (uPAR) assessed by liquid biopsies and PET/CT for prognostication in head and neck cancer patients

Risør

Binderup²,

Fosbøl³

et al. 2022

Sci Rep

Self Cite

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“…The post-radiation inflammatory response has similar imaging manifestations to tumor lesions, which makes it difficult to differentiate them by conventional imaging examination. With the capability of reflecting tumor metabolism, PET/CT is more accurate in distinguishing residual or recurrent disease from postradiation changes (39). Liu et al (40) reported a meta-analysis including 21 articles.…”

Section: Pet/ct In the Surveillance And Assessment Of Npcmentioning

confidence: 99%

The role of PET/CT in radiotherapy for nasopharyngeal carcinoma

Kong

Xiang

et al. 2022

Front. Oncol.

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Radiotherapy has already been developed as the standard of care for patients with nasopharyngeal carcinoma (NPC), and precision staging, target volume delineation, prognosis prediction, and post-treatment surveillance are essential in the management of NPC. Positron emission tomography/computed tomography (PET/CT) is increasingly recognized as an imaging modality to guide precision radiotherapy in these areas. The feasibility and efficacy of 18F-FDG PET/CT have been confirmed in tumor diagnosis, treatment planning, prognosis, surveillance, and assessment. Coupled with the capability of revealing tumor metabolic information, 18F-FDG PET/CT is more accurate in identifying primary lesions and metastases of NPC than other conventional imaging methods including CT and MRI and shows the independently diagnostic and prognostic value for radiotherapy. However, 18F-FDG has limitations due to its physiological distribution in brain tissue and increasing uptake in post-radiation inflammation. Novel PET radiotracers including FAPI, NaF, CHO, and FLT are explored as alternatives with potential superiority for radiotherapy in NPC. In this review, we summarized the evolving role of PET/CT in the management of radiotherapy in NPC patients, aiming to facilitate precision radiotherapy from a molecular imaging aspect.

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“…The working group also has experience in the use of CEUS in cervical LN metastases [ 1 ], showing a strong tendency towards a shortened time-to-peak and an increased contrast enhancement (AUC = area under the curve) in malignant LNs. The state of the art assessment of the therapy response after induction chemotherapy or chemoradiation is performed by PET/CT [ 32 , 33 ], but the metabolic response may be inconclusive [ 34 ] and a routine PET-based follow-up may not be achievable for all head and neck cancer patients as PET resources may be limited. In this regard, the advantages of US diagnostics are the quick implementation, low costs, lack of radiation exposure and the possibility of direct interventional biopsy.…”

Section: Introductionmentioning

confidence: 99%

Multiparametric Ultrasound of Cervical Lymph Node Metastases in Head and Neck Cancer for Planning Non-Surgical Therapy

et al. 2022

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Background: We aimed to evaluate multiparametric ultrasound, to achieve a better understanding of the baseline characteristics of suspected cervical lymph node metastases in head and neck cancer before induction chemotherapy or chemoradiation. Methods: From February 2020 to April 2021, our complete ultrasound examination protocol was carried out on clinically evident malignant lymph nodes of histologically proven HNSCC in the pre-therapeutic setting. Results: A total of 13 patients were eligible for analysis. Using elastography, irregular clear hardening in areas in the center of the lymph node could be detected in all cases. Elastographic Q-analysis showed a significantly softer cortex compared to the center and surrounding tissue. The time–intensity curve analysis showed high values for the area under the curve and a short time-to-peak (fast wash-in) in all cases compared to the surrounding tissue. A parametric evaluation of contrast enhanced the ultrasound in the early arterial phase and showed an irregular enhancement from the margin in almost all investigated lymph nodes. These results show that the implementation of comprehensive, multiparametric ultrasound is suitable for classifying suspected lymph node metastasis more precisely than conventional ultrasound alone in the pre-therapeutic setting of HNSCC. Thus, these parameters may be used for improvements in the re-staging after chemoradiation or neoadjuvant therapy monitoring, respectively.

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FDG-PET/CT in the surveillance of head and neck cancer following radiotherapy

Cited by 18 publications

References 24 publications

Urokinase-type plasminogen activator receptor (uPAR) assessed by liquid biopsies and PET/CT for prognostication in head and neck cancer patients

Urokinase-type plasminogen activator receptor (uPAR) assessed by liquid biopsies and PET/CT for prognostication in head and neck cancer patients

The role of PET/CT in radiotherapy for nasopharyngeal carcinoma

Multiparametric Ultrasound of Cervical Lymph Node Metastases in Head and Neck Cancer for Planning Non-Surgical Therapy

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