Is FDG -PET-CT A Valuable Tool in Prediction of Persistent Disease in Head and Neck Cancer

Abstract

Objectives: To evaluate accuracy of FDG-PET CT in prediction of persistent disease in head and neck cancer cases and to determine prognostic value of metabolic tumor response. Materials and Methods: Between 2009 and 2011, 46 patients with squamous cell carcinoma of head and neck receiving PET-CT were treated with definitive radiotherapy, with or without chemotherapy. There were 29 nasopharyngeal, 11 hypopharyngeal, 3 oropharyngeal and 3 laryngeal cancer patients, with a median age of 50.5 years (range 16-84), 32 males and 14 females. All patients were evaluated with PET-CT median 3-5 months (2.4-9.4) after completion of radiotherapy. Results: After a median 20 months of follow up, complete metabolic response was observed in 63% of patients. Suspicious residual uptake was present in 10.9% and residual metabolic uptake in 26.0% of patients. The overall sensitivity, specificity, positive predictive value and negative predictive value of FDG-PET-CT for detection of residual disease was 91% and 81%, 64% and 96% respectively. Two year LRC was 95% in complete responders while it was 34% in non-complete responders. Conclusions: FDG PET CT is a valuable tool for assessment of treatment response, especially in patients at high risk of local recurrence, and also as an indicator of prognosis. Definitely more precise criteria are required for assessment of response, there being no clear cut uptake value indicating residual disease. Futhermore, repair processes of normal tissue may consume glucose which appear as increased uptake in control FDG PET CT.

In vivo evaluation of the effects of simultaneous inhibition of GLUT-1 and HIF-1α by antisense oligodeoxynucleotides on the radiosensitivity of laryngeal carcinoma using micro 18F-FDG PET/CT

“…There is controversy regarding the value of PET/CT in evaluating therapeutic effects on cancers. Some have stated that FDG PET/CT was a valuable tool for assessing treatment responses [21, 51]. 18 F-FDG uptake was increased in hyperglycolyzed regions, but the exact mechanisms were complex and influenced by several microenvironmental parameters, such as the intracellular 18 F-FDG phosphorylation capability, tumor oxygenation status, GLUT activity, blood flow and permeability [52–54].…”

Risk of Cancer Mortality according to the Metabolic Health Status and Degree of Obesity

“…In vivo and animal studies have shown that hyperglycemia promotes tumor growth and proliferation (Nunez et al, 2006;Liu et al, 2011). Indeed, this is the basis for Positron Emission Tomography/Computed Tomography (PET/CT), which enables detection of potentially cancerous cells based on their greater uptake of glucose (Gambhir, 2002;Uzel et al, 2013). A prospective cohort study in Sweden also reported that abnormally elevated fasting glucose and postload glucose levels are associated with an increased risk of cancer incidence in females (Stattin et al, 2007).…”

Standardized Uptake Values Highly Correlate with Tumor Size and Fuhrman Grade in Patients with Clear Cell Renal Cell Carcinoma

“…Also it has become an important tool for the detection of bone metastasis (Liu et al, 2013 18-F-FDG accumulation rate evaluated by PET and patient prognosis. The standardized uptake value (SUV) is a semiquantitative simplified measurement of the tissue FDG accumulation rate, and the recent studies of the head-and-neck, esophagus, lung, and cervical cancer have explored the prognostic significance of the maximum standardized uptake value (SUVmax) (Sasaki et al, 2005;Lee et al, 2009;Ma et al, 2013;Uzel et al, 2013;Zhu et al, 2013). Although several number of studies have investigated the usage of PET/CT in the evaluation of RC, its connection with tumor size and nuclear grade are not researched enough in literature.…”